Antrum of the stomach: what it is, functions, where it is located, diseases

According to the anatomical structure and functional purpose, the stomach is divided into 3 parts:

• upper - connects to the esophagus, is called “cardial”, contains a dome or bottom, a raised formation;
• middle - body;
• the lower - pyloric, located on the border with the duodenum, in turn, is divided into the antrum and the pyloric canal, which ends with the muscular sphincter.

The antrum accounts for up to 30% of the volume of the stomach. It is impossible to visually determine exactly where the antrum is located, since the border is very arbitrary. Based on the histological picture of the epithelial layer, there is a better chance of establishing that the tissue belongs to a specific part of the organ.

The antrum of the stomach is involved in the general functions of the organ, but also has its own characteristics. Their violation causes various diseases. Therefore, it is worth dwelling on the specifics of the antrum’s work.

Physiological “duties” of the antrum

All functions of the antrum of the stomach are associated with the digestion process. Here's what happens:

• crushing food particles to 2 mm or less with simultaneous mixing, the result should be a homogeneous mass without separation of pieces;
• pushing the formed lump towards the pylorus and duodenum;
• preparation for further digestion in the intestine means a decrease in acidity, which was provided by the body of the stomach, because there must be an alkaline reaction in the small intestine, the maximum concentration of alkaline mucus is produced in the pyloric area;
• to eliminate hydrochloric acid in the cells of the mucous membrane there is a hormonal substance - gastrin, it is also called the “informant hormone”, since the action is associated with the transmission of an impulse to higher centers about the appearance of food;
• the production of serotonin allows for reliable evacuation of the food bolus by stimulating the muscular apparatus of the stomach;
• synthesis of somatostatin, which, if necessary, can suppress the secretion of enzymes.

Its main functions

Active digestion of food does not occur in this department, as some people may mistakenly assume. The main task of the antrum is to form a food bolus from food processed under the influence of gastric juice . To create a bolus, the contents of the stomach are thoroughly mixed and ground, which allows the stomach enzymes to finish their work. During food processing, small particles with a diameter of less than 2 mm appear. Mucus is secreted by epithelial cells, which reduces the activity of hydrochloric acid. This mucus is necessary for the normal functioning of stomach enzymes, but it can also harm the small intestine, which has a slightly different environment than the stomach (it is slightly alkaline).

What is antrum

Later, the resulting pulp passes through the cavity of the pyloric sphincter into the human small intestine. This pushing is ensured by slight antispasmodic contractions of the gastric walls. Thanks to secretory functions, some antrum cells can synthesize certain substances onto the surface of the stomach.

Anatomical sections of the stomach and duodenum

Substances produced include:

• gastrin. It is released as a result of excessive pressure on the surface of the walls of the antrum. As a rule, this occurs when a large amount of insufficiently digested food accumulates in the stomach;

  Gastrin-17

• serotonin. It has a stimulating effect on the stomach, in which the muscles of the organ intensively contract to quickly move the resulting bolus of food;

  The role of serotonin in the body

• somatostatin . It has a depressing effect on cells that secrete enzymes.

Somatostatin

The antrum plays an important role in the digestive process, so it is necessary to take various preventive measures that can prevent diseases of the antrum.

What causes antrum diseases?

All variants of pathology of the antrum are united by a single most common cause - the presence of a special pathogen Helicobacter pylori or Helicobacter. The fact is that the antrum is the favorite location of this microorganism.

Human infection occurs through the mouth. And, once in the stomach, in the pyloric part the pathogen finds the most convenient conditions for life. It tolerates the acidity of gastric juice well. It independently neutralizes it with the help of enzymes that release ammonia. Actively reproducing.

Due to the presence of antennae, the bacterium is able to move in the gel-like environment of mucus. Excessive alkalization is considered a mechanism that triggers pathological changes in the antrum, which subsequently leads to stomach diseases.

In addition to Helicobacter, the following risk factors are involved in the pathology of the antrum:

• alcohol abuse;
• smoking;
• long-term use of irritating drugs (from the Aspirin group, non-steroidal anti-inflammatory drugs, against headaches, for the treatment of tuberculosis);
• commitment to violating the rules of nutrition (passion for spicy seasonings, fried and smoked foods, very hot or cold foods, fast food, disproportionately long breaks in eating);
• stressful conditions in the family, at work, contributing to the emergence of neuroses;
• general vascular changes with severe atherosclerosis, arteritis, diathesis, disrupting the nutrition of the stomach wall;
• infection with parasites (helminthiasis, amoebiasis, giardiasis);
• allergic reactions to food;
• exposure to viruses (HIV, cytomegalovirus);
• decreased immunity caused by various reasons;
• hereditary genetic predisposition.

There was a connection between the frequency of gastric damage and diseases of the endocrine organs, bronchi, lungs and heart, iron deficiency, diseases of the urinary system, as well as the presence of chronic foci of infection (tonsillitis, sinusitis, caries, adnexitis in women and others).

Chronic pathology is accompanied by suppression of the body's defenses. In combination with Helicobacter, these factors cause gastric damage of varying extent and depth. Let's consider the most common diseases with features of symptoms and treatment.

Diagnosis is based on identified morphological changes in tissues and endoscopic examination

Features of treatment of antrum gastritis

The antrum is part of the final section of the stomach. It contains glands and also produces bicarbonates and mucus. Bicarbonates alkalize food, and mucus prevents the stomach from digesting itself. Another function of this organ is motor. Muscular peristalsis pushes food into the duodenum and then into the small intestine.

During the inflammatory process taking place in this part, there is a disruption in the functioning of glandular cells, as well as an increase in the secretory acid-forming function. Antral gastritis belongs to group B and has a bacterial cause. Most often, the inflammatory process occurs against the background of the bacterium Helicobacter pylori, which actively develops on the surface of the gastric mucosa.

The main reasons that contribute to the development of the disease include overeating before bed, drinking strong drinks (tea, coffee, alcohol), and junk food (spicy, salty, fried).

Diet therapy is also very important in the treatment of gastritis, which includes rational, proper nutrition; food should be gentle and not too dry.

In advanced cases of the disease, bleeding may occur. It is worth noting that chronic antral gastritis, which does not manifest itself so clearly, but gradually, can lead to such consequences.

Gastritis, characterized by damage to the antrum, requires a special approach. Treatment should be selected exclusively by a specialist and only after a thorough diagnosis of the patient. Due to the fact that a disease such as antrum gastritis has a bacterial cause, the first step is to eliminate the factors that caused this problem.

Treatment consists of taking special antibiotics that suppress the development of bacteria. In combination with antibacterial therapy, special drugs are used that reduce the level of acidity in the stomach, as well as agents that envelop the entire mucous membrane, for example, almagel.

For severe pain, the doctor may include antispasmodics, for example, no-spa, in the treatment. No less important are enzyme agents such as mezim, festal, pancreatin. The next stage is the restoration of the mucous membrane and the normalization of all functions of the organ. For this purpose, vitamin therapy and the use of drugs such as Actovegin and solcoseryl are used.

Drug treatment can be combined with traditional methods of combating gastritis. So, for this you can take decoctions of medicinal herbs that help restore the functions of the stomach. You can drink decoctions of peppermint, St. John's wort, cumin seeds, plantain, linden blossom, chamomile or fennel fruit. They help calm the stomach itself, as well as the nervous system, which often becomes one of the causes of stomach diseases.

Diet therapy, which includes rational, healthy nutrition, is also very important. Food should be gentle and not dry. In this case, you should exclude fried, fatty, salty, spicy and smoked foods. All dishes are best boiled or steamed. Jelly, dried fruit compotes and herbal teas are very useful.

Sources:

• https://gastritinform.ru/www.gastroscan.ru/patient/disease/01/07/
• https://gastrit.guru/lechenie/antrum-gastrit.html
• https://kprf-msk.ru/3807-antralniy-gastrit-s-atrofiey-slizistoy.html
• https://www.krasotaimedicina.ru/diseases/zabolevanija_gastroenterologia/antral-gastritis
• https://gastritinform.ru/www.yod.ru/articles/id_4387/
• https://otgastrita.ru/zheludok/antrum-gastrit.html
• https://gigiena-center.ru/antralnyj-atroficheskij-gastrit-zhel.html
• https://www.blogoduma.ru/antrum-gastrit

Antral gastritis

The morphology of the inflammatory response includes step-by-step processes:

• infiltration of the antrum mucosa with lymphocytes, neutrophils, macrophages, plasma cells;
• formation of follicles from lymphoid tissue (lymphoid hyperplasia);
• destruction of the epithelium in the form of individual foci (focal gastritis) or massive areas of damage.

Antral gastritis is mainly a chronic disease. Unlike gastritis, the body of the stomach is rarely acute. It begins against a background of high acidity. The production of hydrochloric acid by parietal cells is stimulated by Helicobacter.

Gradually, the functions of the epithelium are depleted, and atrophy processes begin. This means replacing epithelial cells with non-functioning fibrous cells. Another option is the transformation of the gastric epithelium into the intestinal epithelium, which is atypical in location. The process is dangerous due to degeneration into a cancerous tumor.

Depending on the violation of secretion, there are:

• atrophic gastritis - accompanied by a gradual loss of the gastric mucosa's ability to synthesize acid, hormonal substances, mucus, death of the epithelium, thinning of the stomach wall, is considered a precancerous disease;
• hyperplastic - characterized by the formation of large folds, cysts, small polyps, and activation of the process of cell proliferation.

The type of antral gastritis depends on the depth of the lesion. Superficial is considered the most favorable form of the course; changes affect only the superficial layer of the mucosa and are not accompanied by the formation of scars or pronounced disorders of secretory function.

Fibrogastroscopy reveals hyperemic and edematous mucosa, and pinpoint hemorrhages are possible.

Superficial inflammation reaches the muscles, but does not touch them

Erosive gastritis - the inflammatory reaction goes deep into the stomach wall. As a result, surface erosions and cracks are formed first. Chronic erosion without treatment leads to the formation of ulcers. If the outcome is favorable, a scar appears at the site of inflammation.

Symptoms of antral gastritis with superficial damage may not bother a person or may occur after overeating or drinking alcohol. Other forms are more persistent. Most often patients are concerned about:

• pain of varying intensity immediately after eating or on an empty stomach;
• heartburn and belching;
• taste in mouth;
• smell when breathing;
• bloating;
• bowel dysfunction (diarrhea or constipation).

With massive damage, manifestations of general intoxication are possible: nausea and vomiting, weakness, loss of appetite, weight loss.

The appearance of blood in stool and vomit indicates an erosive form of gastritis. The addition of anemia is accompanied by increased weakness, headaches, and pallor. Persistent symptoms that respond poorly to treatment should cause alarm due to the transformation of gastritis into a peptic ulcer, tumor, inflammation of the pancreas, and bulbitis of the head of the duodenum.

Treatment options

The antrum of the stomach (located above the rectum) is treated with an individual course of therapy, which is aimed at stopping and eliminating symptomatic manifestations. Treatment is carried out in two directions: conservative (medicines, physiotherapy) and the appointment of surgical intervention.

Medications and surgery

Drug therapy for diseases of the antrum is a long process that is always complex. During the treatment period, certain measures are prescribed in the form of changes in diet and giving up bad habits. Based on the result of therapy, the doctor decides whether to make such recommendations.

Treatment with medications involves the use of several groups of drugs at once. The main ones are described in the table below, including detailed descriptions and names.

Depending on other signs of the disease, the doctor prescribes symptomatic remedies that quickly relieve negative complications.

These include antispasmodics, sedatives and antiemetics.

Probiotics and enzymes may also be used. Vitamin complexes and immunomodulators are often used.

The average duration of drug treatment is from 1 to 2 months.

If the pathological processes are chronic, therapy is prescribed for life or during exacerbations. In some cases, doctors may resort to surgery.

These include: low effectiveness of drug therapy, increased bleeding, the presence of cancer and polyps. The easiest surgical method is endovasal laser coagulation, which can reduce inflammatory reactions, eliminate bleeding or remove formed polyps without the risk of complications.

Due to the lack of evidence, folk remedies for treatment are practically not used and can be prescribed as an additional measure under the direct advice of the treating specialist.

Beneficial changes in diet and lifestyle

Since almost all stomach diseases are caused by an unhealthy lifestyle, drug therapy is not enough. In addition to treatment, the doctor prescribes a number of preventive measures to improve the patient’s condition.

Step-by-step recommendations for preventing and maintaining stomach health:

1. Introduce a balanced diet: eliminate absolutely all unhealthy foods, including fried, fatty or spicy foods; give up carbonated drinks and strong coffee; avoid simple carbohydrates. Add as many vegetables and fruits as possible to your daily diet and eat only lean meats and fish.

2. Give up bad habits: smoking, drinking alcohol or taking hard drugs or psychopathic drugs. This also includes thoughtless taking of medications.
3. Avoid stressful and psycho-emotional situations, achieve maximum physical peace through meditative practices and frequent walks in the fresh air. Eliminate excess weight.
4. If you have any symptoms, visit your doctor promptly and undergo an annual medical examination. Periodic testing for the presence of Helicobacter Pylori is mandatory.

Detailed adherence to the recommendations described above will significantly reduce the risk of severe gastric diseases, and simple adherence to dietary standards will relieve unwanted weight.

The antrum is an important part of the stomach, responsible for the process of grinding and pushing consumed food through the outlet sphincter. A correct understanding of where the antrum is located, as well as timely diagnosis of diseases, will allow you to avoid dangerous consequences in the form of cancer or inflammation.

With a correctly selected and timely treatment method, you can quickly get rid of pathological processes.

Article design: Oleg Lozinsky

Ulcers

Ulcerative lesions of the antrum are possible after the stage of inflammation, when focal atrophy of the mucosa passes through the stage of erosion to deep damage to the submucosal and muscular layers.

Ulcers located in the antrum account for up to 10% of all gastric ulcers

In addition to inflammation, the mechanisms of the disease include:

• low contractile function of the antrum;
• stagnation and fermentation of the food bolus;
• increased enzyme production.

The presence of risk factors provokes the transition of inflammation into an ulcer. Typical symptoms:

• pain in the epigastric region, becoming more intense at night;
• constant heartburn;
• nausea and vomiting;
• belching after eating;
• blood impurities in stool and vomit.

Benign neoplasms of the antrum

Non-cancerous formations of the antrum include polyps and lymphofollicular hyperplasia. Polyps arise from the proliferation of glandular epithelial cells. The antrum accounts for 60% of all gastric polyps.

They are characterized by single growth or the formation of an entire colony. They differ in shape and size (up to 30 mm). Identified against the background of other stomach diseases. They pose a threat of cancerous degeneration. They practically do not give any symptoms. Pain is caused by eating disorders. They can become twisted or pinched, causing blood to appear in the stool.

Based on their origin, antral polyps are divided into three types:

• inflammatory - begin with lymphoid follicles (from 70 to 90%);
• adenomas - grow from the glandular epithelium;
• specific - neoplasms in Pattes-Jeghers-Touraine syndrome, which is a hereditary pathology including hyperpigmentation of the skin and polyposis of the intestines, stomach, differ in glandular structure, pigment content (melanin), and rarely - muscle fibers.

The first two types of polyps develop in old and senile age; specific ones are usually detected before the age of 30.

Pattes-Jeghers-Touraine syndrome is also characterized by the appearance of spots on the face (xanthomas), in which the melanin pigment is located at the level of the basal layer of the epidermis and in the mucous membrane. Pigmentation appears in childhood and may decrease or disappear with age.

Polyps can “sit on a stalk” or be attached with a wide base to the wall

Lymphofollicular hyperplasia is accompanied by the growth or formation of follicular tissue in the submucosal layer of the stomach. The disease has no age-related advantages. Among the reasons, in addition to those described above, a special place is given to:

• herpes infection;
• autoimmune diseases;
• endocrine disorders;
• contact with carcinogens.

It is important that, according to observations, this type of hyperplasia most often precedes the formation of polyps.

Cancer tumor

Cancer (cancer in Latin or abbreviated cr) of the antrum accounts for up to 70% of malignant tumors of the stomach. There are:

• adenocarcinoma - formed from glandular cells, the most common tumor (90%);
• solid cancer is a rare neoplasm, the structure is not related to glandular elements;
• scirrhus cancer is an even rarer form, formed from connective tissue.

Specifics of antral cancer localization:

• infiltrative growth without the formation of clear boundaries;
• aggressive course with rapid metastasis;
• frequent relapses after gastric resection.

This disease gives a disappointing prognosis. The stage of cancer development is determined by the depth of the lesion and the presence of metastasis

The most common cause of cancer is chronic atrophic gastritis. It causes three types of morphological changes:

• glandular atrophy - disappearance of mucosal cells;
• dysplasia - the appearance in the stomach of epithelium characteristic of the intestine (intestinal metaplasia) with correspondingly impaired properties;
• neoplasia - transformation into malignant cells.

Symptoms of antrum cancer, compared to those described above, are different:

• constant feeling of fullness or distension in the stomach area;
• nausea and vomiting, which patients induce themselves to alleviate the condition;
• aversion to food;
• significant exhaustion;
• patient irritability;
• temperature rise.

Tumor infiltration of stomach tissue is accompanied by destruction of blood vessels. Therefore, one of the signs is gastric bleeding (vomiting blood, black loose stools).

Symptoms of gastropathy

After clinical studies are carried out and tests are submitted to the laboratory, the doctor diagnoses the form of the disease. The epithelial layer of cells located on the inner surface of the stomach serves as a protective barrier - mucus forms on it, which prevents hydrochloric acid from corroding the tissue.

By determining how damaged the walls of the stomach are, it is possible to make an accurate diagnosis of what kind of disease the patient has.

In an infant, this disease may manifest itself during the transition to artificial formula. If the baby's diet is not suitable, it can cause allergies. Various infections, taking medications, improperly selected diet, products with expired expiration dates - all this can cause gastrointestinal diseases. Children cannot complain of pain, so parents need to closely monitor the child's condition.

The role of diagnostics

In identifying diseases of the gastric antrum, diagnosis is crucial, since symptoms do not reflect the extent and severity of the lesion.

Fibrogastroduodenoscopy is an endoscopic method that allows you to visually examine all parts of the esophagus, stomach and the beginning of the duodenum; in addition, it is used when choosing a section of the mucosa for taking a cytological examination, microscopy to identify Helicobacter.

To detect the root cause of the lesion and prescribe treatment, it is necessary to confirm the presence of Helicobacter in the stomach. To do this, use the methods of enzyme immunoassay of blood, polymerase chain reaction for typical antibodies and immunoglobulins, urease breath test and stool analysis.

The presence of a bleeding ulcer or a disintegrating tumor can be indicated by a timely fecal reaction to occult blood.

Undeservedly, some doctors have forgotten the x-ray diagnostic method. It allows one to judge the ulcer niche or the presence of polyps or cancer by folding, deficiency or excess of tissue, and altered contours.

An x-ray can diagnose a benign tumor.

Using a daily urine test, you can determine the amount of uropepsin secreted and calculate the acidity of gastric juice. There are no characteristic signs in a general blood test. Anemia, eosinophilia, and leukocytosis may indicate a severe course of the disease. Analyzes are carried out both during the diagnostic period and to monitor the effectiveness of treatment.

Causes of the disease

The aggressive impact of Helicobacter pylori increases in the presence of negative external factors:

• poor nutrition;
• systematic use of alcohol;
• smoking;
• long-term use of medications that irritate the mucous membrane - steroid hormones, anti-inflammatory drugs, acetylsalicylic acid;
• very cold or hot food;
• stress;
• living in an area contaminated with radiation and harmful chemical impurities;
• parasitic infections;
• extensive burns;
• candidiasis;
• cytomegalovirus.

Gastritis of the antrum of the stomach can be caused by endocrine disorders. Hormone imbalance and genetic predisposition cause autoimmune disorders that cause stomach diseases.

The main cause of gastritis is the harmful effects of Helicobacter pylori. If the body is weakened by an infection, the metabolism is disrupted, favorable conditions are created for its reproduction and vital activity. Typically, a combination of several negative factors leads to the development of the disease.

Under the influence of Helicobacter pylori, urea is broken down in the stomach, forming ammonia. The acidic environment becomes alkalized, and the viscosity of the mucus decreases. This leads to disruption of the glands.

Features of the fibrogastroscopic picture: erosion and gastropathy

Consideration of erosive lesions of the antrum became possible only with the development of the fibrogastroscopic type of diagnosis. This pathology complicates gastritis and serves as the beginning of ulcers and tumor degeneration.

Erosion is a violation of the integrity of the mucous membrane without penetration into the deep parts of the stomach wall. The following varieties are distinguished:

• acute erosions - limited to compactions, cured in 10 days;
• chronic - look like spots with a diameter of up to 10 mm, require long-term treatment;
• hemorrhagic erosions - give a picture of the consequences of needle injections, the size of the lesion remains within 10 mm in diameter, the color takes on shades from scarlet to cherry-red (depending on the affected vessel, the vein gives dark spots), the mucous membrane surrounding the lesions is swollen, in it contains blood.

In the antrum, you can find a single erosion with all the described signs, as well as a complete type of erosion - characterized by spreading along the ridges of the folds of the stomach, the formation of a black coating. Antrum gastropathy is described by a doctor if there are no signs of inflammation, the entire mucous membrane is hyperemic, but the specific form of the disease is unclear.

If H. pylori has settled in the antrum

The bacterium is mobile, with the help of its enzymes and receptors, it penetrates through the protective layer of mucus to the epithelial cells, attaches to them, multiplies and produces substances that help reduce the production of bicarbonates by mucosal cells.

This leads to a decrease in alkalization of the stomach contents, and when the pylorus opens and food is evacuated, the acid entering the intestine injures its lining, a reverse reflex reflux may occur - reflux, and the digestion process suffers.

Helicobacter pylori infection creates and maintains a long-term inflammatory process, which can lead to atrophy of the glands, thinning of the mucosa, and the triggering of autoimmune reactions.

In place of atrophically changed areas in the area of ​​the pyloric sphincter, scars can form over time, and then a terrible complication of chronic inflammation of the antrum occurs - pyloric stenosis.

Due to the fact that the acidity in the antrum is lower than in other parts of the stomach, Helicobacter, which loves an alkaline environment, colonizes it.

Self-healing does not occur when infected with Helicobacter. When it is identified, specific therapy is required to help expel the “tenant” who behaves like a master in the antrum.

Classification

The acute stage of the disease almost always remains undiagnosed, so gastritis of the antrum is a chronic process.

Based on the degree of damage to the mucous membrane and the severity of the process, the following forms of the disease are distinguished:

• Superficial. This form is characterized by the involvement of only superficial areas of the mucosa in the inflammation process. The glands are not affected, and no ulceration of the membrane is observed.
• Erosive. With a deeper spread of the inflammation process, the lower parts and layers of the stomach are affected, ulcerations and erosions are formed.
• Follicular. A rare form, histologically there is an accumulation of a large number of lymphocytes in areas of inflammation.
• Hyperplastic. In response to inflammatory changes, mucosal cells begin to grow and hypertrophy.