The final stage of gastritis is mucosal atrophy, characterized by a decrease in proper gastric glands and intestinal metaplasia.
Understanding the Final Stage: Mucosal Atrophy
Chronic gastritis, if left untreated, progresses to mucosal atrophy. This is a significant development because it alters the stomach lining and its ability to function correctly. Here's a breakdown:
Mucosal Atrophy Explained
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Decrease in Proper Gastric Glands: The stomach lining contains glands responsible for producing stomach acid and enzymes necessary for digestion. In mucosal atrophy, these glands are gradually destroyed and reduced in number. This reduction impacts the stomach's ability to produce acid (hypochlorhydria or achlorhydria) and digest food effectively.
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Intestinal Metaplasia: This is a process where the normal gastric epithelial cells are replaced by cells that resemble those found in the intestine, such as columnar absorptive cells and goblet cells. While the stomach normally has a certain cell structure and function, intestinal metaplasia shifts that structure and function toward that of the intestines. This can impact the stomach's ability to absorb nutrients and its overall digestive capabilities. Intestinal metaplasia is considered a premalignant condition, increasing the risk of gastric cancer.
Consequences of Mucosal Atrophy
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Reduced Acid Production: Decreased gastric glands lead to reduced stomach acid production. This can impair the digestion of food, especially proteins, and increase the risk of bacterial overgrowth in the stomach.
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Nutrient Malabsorption: The altered stomach lining can interfere with the absorption of essential nutrients, such as vitamin B12 and iron. This can lead to deficiencies and associated health problems like anemia.
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Increased Cancer Risk: Intestinal metaplasia, a key feature of mucosal atrophy, is associated with an increased risk of developing gastric cancer. Regular monitoring and surveillance are often recommended in patients with confirmed intestinal metaplasia.
Diagnosis and Management
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Endoscopy and Biopsy: Mucosal atrophy is typically diagnosed through an upper endoscopy, where a small camera is used to visualize the stomach lining. Biopsies are taken to examine the tissue under a microscope and confirm the presence of atrophy and intestinal metaplasia.
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Treatment: The treatment for mucosal atrophy focuses on managing the symptoms and addressing the underlying causes. This may involve medications to reduce acid production (although this needs careful consideration due to existing low acid production), treating Helicobacter pylori infection if present, and supplementing any nutrient deficiencies. Regular endoscopic surveillance is crucial to monitor for the development of dysplasia or cancer.
