1.What are the common symptoms of chronic gastritis clinical symptoms?
Chronic gastritis is one of the common and frequent diseases of the digestive system and belongs to the category of “stomach pain”, “fullness”, “acid swallowing”, “noisy” and “dullness” in Chinese medicine. “and “dullness” and other diseases. According to Chinese medicine, chronic gastritis is mostly caused by long-term emotional and mental disorders, poor diet, and abnormal labor, resulting in liver qi stagnation, spleen loss of health, gastric and epigastric disharmony, and deficiency of middle energy over time, which leads to various symptoms. The main clinical manifestations are long-term recurrent or intermittent epigastric vague pain, abdominal distension, aggravated after eating, accompanied by belching, nausea and loss of appetite. The clinical symptoms mainly include liver-stomach disharmony, spleen-stomach weakness, spleen-stomach damp-heat, blood stasis in the stomach, stomach-yin deficiency, spleen-stomach cold deficiency, dampness and turbidity obstruction, diet injury to the stomach, and cold evil in the stomach. The common symptoms are as follows.
(1) Liver and stomach disharmony: common stomach distension and pain, pain in both hypochondria, frequent belching, anger and pain, stuffiness in the chest and epigastrium, noisy and acid swallowing, sighing, red tongue, white fur, sunken and string pulse.
(2) Weakness of the spleen and stomach: common vague pain in the stomach and epigastrium, stomach pain like pressing and warmth, stuffiness and distension after eating, fullness, dullness and little food, loose stools, weakness, shortness of breath and lazy speech, vomiting water, pale tongue with teeth marks on the side, slow and weak pulse.
(3) Damp-heat in the spleen and stomach: common with bloating or pain in the stomach, fullness in the chest and epigastrium, bitter and dry mouth, bad breath or greasy mouth, nausea and vomiting, heavy head and body, dull and noisy, yellow and greasy tongue coating, slippery pulse.
(4) Stasis of blood in the stomach: common with distension and fullness, stabbing pain in the stomach and epigastrium, refusing to press for a long time, pain that does not move, or vomiting blood, or black stool, red tongue with purple dullness or dull red tongue, or petechiae; pulse stringent and astringent.
(5) Gastric Yin deficiency: common with bloating and burning pain in the stomach and epigastrium, noisy in the stomach, hunger without knowing how to eat, dryness and vomiting, dry mouth, heat in the hands and feet, or dry stools, red tongue with little fluid, little moss, or crackles, and fine pulse.
(6) Spleen and Stomach Deficiency Cold Evidence: common with cold and vague pain in the stomach, preferring to press and heat, little food and loose stools, cold in the extremities, reduced pain with food, heavy pain with cold, pale salivation in the mouth, pale tongue with teeth marks, thin white tongue coating, sunken and thin pulse.
(7) Dampness and turbidity obstruction: Commonly fullness or hidden pain in the stomach and epigastrium, nausea and vomiting of clear water or sour water, not thinking about eating and drinking, bloating after eating, sticky mouth, heavy limbs, light mouth and no hunger, light red tongue, white greasy moss, smooth pulse.
(8) Cold evil guest stomach evidence: common cold stomach pain, heavy pain when cold, dull and like heat, light and tasteless mouth, or cold and heat surface evidence, pan vomiting clear water, loose stools, clear and long urine, light tongue with white coating, tight pulse.
(9) diet injury to the stomach: common injury to the stomach and stomach pain, the epigastric and abdominal fullness, anorexia and refusal to press, belching and sour odor, nausea and vomiting, vomiting after the symptoms are light, the stool is not crisp, sour odor, thick and greasy tongue coating, smooth pulse.
2.What are the common treatments for chronic atrophic gastritis?
The clinical manifestations of chronic atrophic gastritis are diverse, and the pathogenesis is a combination of deficiency and deficiency, with spleen deficiency as the basis and damp-heat, phlegm-dampness, gas stagnation, blood stasis as the standard. The clinical treatment is based on the identification of different treatments, which are commonly used as follows.
(1) Dredging the liver and stomach method, applicable to stomach pain and liver-stomach disharmony. Main symptoms: distension and pain in the stomach and epigastrium. Secondary symptoms: pain in the dorsum, anger and pain, congestion in the chest and epigastrium, frequent belching, sighing, unpleasant bowel movement, thin white tongue coating and string-like pulse. Commonly used formula is Chai Hu Dredging Liver San.
(2) Dispersing cold and warming the stomach method is used in treating stomach pain with cold condensation. Main symptom: cold pain in the stomach. Secondary symptoms: pain in cold, light salivation in the mouth, preference for heat and pressure, or cold and heat, loose stools, clear and long urine, pale tongue with white fur, tight pulse. Commonly used formula is Liang Fu Wan.
(3) Tonifying the middle and benefiting the qi method, applicable to the evidence of lowering of middle qi in stomach diseases. Primary symptom: stomach cramps and distention. Secondary symptoms: Absence of food and drink, heaviness after eating, fullness in the stomach and abdomen, vomiting of clear water, squeaking water, yellow face and thin body, pale tongue with white fur and sunken pulse. Commonly used formula is Tonifying Zhong Yi Qi Tang.
(4) Nourishing Yin and moistening the stomach method, applicable to stomach pain and deficiency of stomach Yin. Main symptoms: heartburn and vague pain. Secondary symptoms: irritable heat in the five hearts, dry mouth and tongue, noisy and dry vomiting, thirst without drinking, irritability, dryness of the bowels, red tongue without coating, and fine pulse. Commonly used formula is Yixing Stomach Tang.
(5) Promoting blood circulation and resolving blood stasis, which is applicable to the evidence of blood stasis in gastric pain. Main symptom: Stomach stabbing and cutting pain. Secondary symptoms: fixed pain, refusal to press when in pain, severe pain at night, persistent pain, vomiting of blood and black stool, severe pain after eating, dark red tongue and stringent pulse. The commonly used formula is Lost Smile San.
(6) Warming the middle of the stomach is applicable to the evidence of deficiency cold in stomach pain. Main symptom: cold stomach with vague pain. Secondary symptoms: pain in case of cold, preferring to press and warm, preferring hot food, fearing cold extremities, weakness, loose stools, pale tongue with white fur, thin and stringent pulse. Commonly used formula is Huangqi Jianzhong Tang.
(7) Dampness-transformation method, applicable to damp-heat evidence of stomach pain. Main symptom: Stomach fullness and burning pain. Secondary symptoms: stuffiness in the chest and epigastrium, bitterness and stickiness in the mouth, heavy head and body, loss of appetite, sticky stools, burning in the anus, yellowish coating on the tongue and moistened pulse. The common formula is Stomach Ling Tang.
(8) Clearing heat and diarrhea of the stomach method, applicable to the evidence of actual heat in stomach pain. Main symptom: burning stomach pain. Secondary symptoms: acute pain, dry mouth, bitterness, irritability, thirst for cold drinks, dry stool, yellow urine, red tongue with yellow coating, slightly counted pulse. The commonly used formula is Clear Stomach San.
3.What are atypical hyperplasia and intestinalization? What is the significance?
Some patients with chronic atrophic gastritis often see atypical hyperplasia and intestinalization in the pathology report obtained after gastroscopy, and their specific meanings are as follows.
Atypical hyperplasia is also called heterotypic hyperplasia of the gastric mucosal epithelium. Its main manifestations are cellular heterotypes, structural disorders and abnormal differentiation. At present, a 3-grade grading scheme of mild, moderate and severe is mostly used: mild heterogeneous hyperplasia refers to very mild heterogeneous hyperplasia of gastric mucosal structure and epithelial cell heterogeneity; moderate heterogeneous hyperplasia is more obvious structural heterogeneity and cell heterogeneity; severe heterogeneous hyperplasia refers to those with very obvious structural heterogeneity and cell heterogeneity or difficulty in determining benign and malignant, which are often difficult to distinguish from highly differentiated microscopic carcinoma on gastric mucosal biopsy specimens, so this category is Heterogeneous proliferative lesions are classified as junctional lesions. Under endoscopy, the general morphology of atypical hyperplasia is divided into three types: depressed, flat and augmented, but the most characteristic type is augmented. The augmented type can be flattened and elevated or flattened and disc-shaped, often described as a flowerbed-like or broad-based elevation with a relatively rough surface, and some lesions are slightly depressed in the central part with disc-shaped or hemispherical sides, shaped like a polyp, much like early cancer.
Intestinal epithelial metaplasia refers to the replacement of gastric mucosal epithelial cells by intestinal epithelial cells, i.e., epithelial cells similar to small intestine or large intestine mucosa appear in gastric mucosa, which is a common lesion of gastric mucosa in chronic gastric disease. The intestinal epithelial chemotaxis cells are derived from undifferentiated cells in the neck of the intrinsic gastric glands, which are proliferation centers with the potential to differentiate into gastric and intestinal epithelial cells. Normally, it continuously differentiates into gastric-type epithelial cells to replenish the surface epithelium shed by senescence; in pathological conditions, it can differentiate into intestinal-type epithelial cells to form intestinal metaplasia. Recently, it has been further studied that the histological initiation site of enteric foci is mainly in the gastric sulcus, and the tiny enteric foci are centered in the gastric sulcus and can develop into small foci and large lamellar enteric foci to different degrees in the surrounding gastric cell. Through pathological studies, a series of classifications of intestinal epithelial metaplasia have been made, and intestinal epithelial metaplasia can be divided into complete or incomplete intestinal epithelial metaplasia according to the function of the metaplastic epithelium. The former is similar to small intestinal mucosal absorptive cells, has brush border, does not secrete mucus, has Pan cells, cup cells and absorptive cells, contains sucrase, alglucosidase and leucine-based peptidase and alkaline phosphatase; while incomplete intestinal epithelial metaplasia has inconspicuous brush border, incompletely developed microvilli, mucus secreting granules in cytoplasm, contains sucrase, but low aminopeptidase and alkaline phosphatase activity, and no alglucosidase. Intestinal epithelial metaplasia was classified by mucohistochemical staining into small intestinal metaplasia (i.e., complete intestinal epithelial metaplasia) and colonic metaplasia (i.e., incomplete intestinal epithelial metaplasia). Small intestinal metaplasia, with good epithelial differentiation, is a common mucosal lesion and is widely seen in various benign gastric diseases (57.8%), especially in chronic gastritis, and the metaplasia increases with the development of inflammation, so it is thought that small intestinal metaplasia may belong to the nature of inflammatory reaction; while colonic metaplasia, with poor epithelial differentiation, has a low detection rate in benign gastric diseases (11.3%) but a high detection rate in the parietal mucosa of intestinal gastric cancer (88.5%). The detection rate was high (88.2%) in the mucosa adjacent to intestinal gastric cancer, indicating a close relationship between colonic chemosis and the occurrence of gastric cancer. Generally, colon type chemosis occurs at a later age than small intestine type chemosis, and both are located in the more severe small intestine chemosis foci. The two types of chemosis can be mixed, so colonic chemosis may occur on the basis of the progressive aggravation of small intestinal chemosis.
Chronic atrophic gastritis is often associated with intestinal chemosis, which is an indicator of gastric mucosal damage and an important epithelial change in chronic atrophic gastritis. Statistics show that 65.5% of people with atrophic gastritis have intestinalization, which increases with age, and the ratio of intestinalization increases with the expansion of the atrophic zone. The distribution of enterosis and atrophic gastritis is basically the same, with the highest rate of occurrence in the gastric sinus, followed by the displaced part of the body sinus. Because atrophic gastritis and intestinal epithelial metaplasia are closely related to the occurrence of gastric cancer, such patients should be given great attention clinically, followed up for a long time and reviewed regularly to prevent cancer. In the study of precancerous lesions of gastric mucosa, intestinal hyperplasia and atypical hyperplasia are the focus of research, and atypical hyperplasia has more precancerous significance than intestinal hyperplasia, so it should be paid more attention to regular follow-up, gastroscopy once every 3 to 6 months, and cellular deoxyribonucleic acid (DNA) content and tumor-related antigens can be checked if available.
4.How to prevent cancer in chronic atrophic gastritis?
At present, there is no direct drug for chronic atrophic gastritis to prevent its carcinogenesis, but removing the cause of chronic atrophic gastritis and correcting its pathological state can prevent gastric cancer. For example, Helicobacter pylori is the main culprit of gastritis and gastric cancer. H. pylori causes cytotoxic factors that then lead to proliferative or atrophic gastritis of the gastric mucosa. The incidence of gastric cancer is 3-6 times higher in patients with H. pylori infection than in non-infected patients, and killing H. pylori can prevent cancer.
In addition, selenium can remove the free radicals in the tissue of chronic atrophic gastritis that cause cell aging and interfere with the metabolism of carcinogens, enhance the immune function of human cells, which can play a role in preventing and fighting cancer by eating animal liver, kidney, fish, shrimp and crustacean seafood, garlic, celery, mushrooms, sesame, etc.
Furthermore, folic acid is a water-soluble vitamin, which is closely related to the synthesis, repair and stability of DNA. The cause of tumors caused by folic acid deficiency may be related to the ability of folic acid to stabilize DNA and prevent cellular carcinogenesis. Folic acid maintains DNA methylation, and if the methylation level is low, oncogenes are prone to activation, which promotes cancer development. Folic acid can prevent cancer by inhibiting oncogene activation.
In addition, vitamin C and gastric juice can work together to prevent the synthesis of carcinogenic precursor nitrosamine compounds, which can be eaten with oranges, oranges, tomatoes, spinach, fresh dates and kiwis.
Finally, Chinese medicine plays an important role in the prevention and treatment of chronic atrophic gastric cancer. It has been found that Chinese medicine can play a role in cancer prevention in the treatment of chronic atrophic gastritis with intestinal metaplasia and cellular heterogeneous hyperplasia by appropriately applying herbs to activate blood circulation and resolve blood stasis, detoxify and disperse nodules, benefit qi and support the righteousness, strengthen the spleen and dispel dampness, and nourish yin and generate fluid on the basis of evidence-based treatment. Chinese herbal medicines for promoting blood circulation and resolving blood stasis include Trigonella, Curcuma longa, August zha, Panax ginseng, Peach kernel, Phellodendron, and Wu Ling Ling, etc.; Chinese herbal medicines for detoxifying and dispersing knots include Shi Jian Dian Dian, Han Zhi Lian, Shu Yang Quan, Bai Hua Shi Tong Tong Cao, Long Qi, Huang Yao Zi, Seaweed, Kun Bu, Wei Ling Xian, Half side lotus, Shi Da Dian, Tiger stick, Flea Hu, etc.; Chinese herbal medicines for benefiting qi and supporting righteousness include Astragalus, Radix Codonopsis, Prince’s ginseng, Atractylodes, Fried yam, etc.; Chinese herbal medicines for strengthening spleen and dispelling dampness include Coix seed, Poria, Semen, and Chinese herbs for strengthening the spleen and dispelling dampness include Coix Seed, Poria, Radix Panax notoginseng, Ze Xie, etc.; Chinese herbs for nourishing Yin and promoting fluid include Wu Mei, Cornu Cervi Pantotrichum, Tian Dong, Tian Tian Tian Fan, Zhen Zhen Zi, etc. This will play a positive therapeutic role in suppressing precancerous lesions of the stomach and preventing chronic atrophic gastritis with intestinal metaplasia and cellular heterogeneous hyperplasia from occurring as gastric cancer.
5, chronic gastritis diet considerations
It is often said that “people eat grains and cereals, who can be free of disease”. The first thing that will be affected by the entrance of the diet is the stomach. The stomach mucosa is rich in blood vessels and has the function of storage, digestion and transportation of food. So diet is an important factor in causing gastric disease. As the dietary factors play an important role in the development of chronic gastritis, a good diet is the key to preventing and treating gastritis, which is different from other diseases. In general, when eating the following points, chronic gastritis to be said to have been half cured.
The actual fact is that you will be able to get a lot more than just a few of the most popular and popular items.
Cleanliness: pay attention to dietary hygiene to prevent external microorganisms from attacking the gastric mucosa.
Fine: Try to eat fine, easily digestible and nutritious food.
Light: Eat less fatty, sweet, thick, greasy and spicy foods, and drink less alcohol and strong tea.