pancreatitis



OVERVIEW

Definition

Carditis is a type of chronic gastritis, which refers to the inflammatory lesion formed in the mucous membrane located in the cardia area, and is related to reflux esophagitis and Barrett’s esophagus.

Generally there is no specific manifestation, patients may have no discomfort, and some of them may show symptoms such as epigastric pain, acid reflux and heartburn.

Incidence

Morbidity is not only related to regional differences in Helicobacter pylori (Hp) infection rates, but also to genetic differences in the virulence of infected Hp and environmental factors.

The prevalence generally increases with age, but the relationship with gender is not obvious.

Etiology

Causes

Carditis may be associated with a variety of factors, including Helicobacter pylori infection, acid reflux, bile reflux, drug damage to the cardia mucosa, mental emotions, and dietary stimuli.

Helicobacter pylori infection

Carditis is a type of chronic gastritis, and Helicobacter pylori infection is the most important cause.

Gastric acid reflux

Carditis has some correlation with gastroesophageal reflux disease and Barrett’s esophagus, due to chemical inflammation formed in the mucosa at the cardia irritated by long-term gastric acid reflux.

Bile Reflux

Long-term bile reflux causes inflammatory reaction, erosion, bleeding and other lesions in the mucosa of cardia.

Drug damage to gastric mucosa

Long-term and large amount of oral intake of certain drugs, such as non-steroidal anti-inflammatory drugs indomethacin, aspirin and other drugs damage the gastric mucosa, resulting in cardia inflammation.

Others

Mental stress, long-term in a state of tension, anxiety, through the vagus nerve excitation affects the gastroduodenal secretion, movement and mucosal blood flow regulation, easy to trigger carditis.

Irregular life, work and rest, easy to stay up late, etc.

Stimulating food such as alcohol, coffee, strong tea, spicy food, etc., will have a certain degree of irritation to the cardia mucosa, long-term consumption of such food is easy to destroy the mucosal protective barrier.

Smoking leads to increased gastric acid secretion, pyloric sphincter dysfunction and bile reflux, destroying the gastric mucosal barrier.

Symptoms

Main Symptoms

Carditis generally has no specific manifestations, patients may have no obvious clinical symptoms, some patients may manifest epigastric pain, acid reflux, heartburn, choking sensation and so on.

Epigastric pain

Patients have intermittent epigastric pain, which is mainly manifested as pain and discomfort under the raphe and behind the sternum, and it is mostly unrelated to eating.

Acid reflux and heartburn

Acid reflux, retrosternal and subxiphoid burning sensations are present in some patients.

Choking sensation

With the progression of the disease, patients may experience intermittent self-awareness of food stagnation and blockage after eating.

Dyspepsia

Symptoms of dyspepsia such as loss of appetite, belching, nausea and vomiting may be present.

Complications

Bleeding

When inflammation of the cardia is recurrent or persistent and fails to improve, causing erosion of the mucous membrane, bleeding may occur, but it is usually mild and does not cause obvious symptoms.

Consultation

Department of Medicine

Gastroenterology

If symptoms such as upper abdominal pain, acid reflux, or heartburn persist or recur over a long period of time, please consult a doctor promptly.

Preparation for medical treatment

Preparing for your visit: registering, preparing your documents, and common problems.

Tips for medical treatment

Do not consume excessively oily food or alcohol for 3 days prior to your visit.

Preparation List

Symptom list

Pay particular attention to the time of onset of symptoms, special manifestations, etc.

Are there any symptoms such as acid reflux, heartburn, difficulty in swallowing, pain in the upper abdomen?

Is there nausea and vomiting?

How long have these symptoms lasted?

Under what circumstances can these symptoms be aggravated or relieved?

Medical History Checklist

Any previous infection with Helicobacter pylori?

Any previous digestive diseases such as GERD, peptic ulcer, etc.?

Has there been any recent emotional excitement, increased work-life stress, etc.?

Any history of long-term smoking and alcohol consumption?

Checklist

Test results in the past six months, which can be brought to the doctor’s office

Laboratory tests: Helicobacter pylori test.

Gastroscopy.

Medication list

Medication used in the last 3 months, if available in boxes or packages, you may bring them to the doctor’s appointment

Acid suppressants: omeprazole, rabeprazole, cimetidine, etc.

Antispasmodics and analgesics: pivacurium bromide, scopolamine, etc.

Gastric mucosal protectants: aluminum thioglycollate, teprenone, magnesium aluminum carbonate, etc.

Gastrointestinal power drugs: domperidone, itopride, mosapride, etc.

Non-steroidal anti-inflammatory drugs: aspirin, ibuprofen, indomethacin, etc.

Glucocorticoids: prednisone, dexamethasone, etc.

Digestive enzyme preparations: cotrimoxazole, mitomycin pancreatic enzyme tablets, etc.

Diagnosis

Diagnosis is based on

Medical history

Possible Helicobacter pylori infection.

Possible history of GERD, Barrett’s esophagus, bile reflux gastritis.

History of medication use with NSAIDs such as aspirin and indomethacin.

Dietary habits of stimulating foods such as coffee, strong tea, and spicy foods.

Factors such as prolonged late nights, stress, anxiety or mood swings.

History of long-term smoking and alcohol consumption.

Clinical manifestations

Symptoms

Some patients with pancreatitis may have no obvious clinical manifestations, while some patients may have epigastric pain, acid reflux, heartburn, choking sensation and other symptoms.

Physical signs

A few patients may have epigastric tenderness.

Helicobacter pylori (Hp) test

Hp testing can identify the cause of the disease, guide clinical use of medication, and evaluate the effect of Hp eradication treatment.

Hp testing methods are divided into two categories: invasive and non-invasive. Invasive tests include rapid urease test, histologic examination, and culture of Helicobacter pylori. Non-invasive tests include serum antibody test, 13C or 14C urea breath test, and fecal H. pylori antigen test.

Gastroscopy

Gastroscopy reveals inflammatory changes in the mucosa with the naked eye or by special imaging methods, and needs to be combined with pathologic findings to make a definitive diagnosis.

The basic manifestations of gastroscopy include erythema of the mucosa at the cardia, mucosal hemorrhages or plaques, roughness of the mucosa with or without edema, and congestion and exudation.

Pathologic examination

Biopsy histology is essential for the diagnosis of carditis, and when available, biopsy can be performed under the guidance of pigmented or electron-stained magnifying endoscopy and confocal laser microendoscopy.

Pathologic results may present different pathological manifestations such as inflammation, atrophy, chemosis and heterogeneous hyperplasia.

Differential diagnosis

Cardia cancer

Similarity: both may present with symptoms such as epigastric pain, acid reflux and heartburn.

Differences: patients with cardia cancer may have alarm symptoms such as wasting, anemia, etc. Under endoscopy, the lesion area has irregular edge, uneven bottom, easy to bleed when touching, and cancer cells can be seen in pathological examination; whereas carditis is an inflammatory manifestation, and most of them have no obvious symptoms.

Peptic ulcer

Similarity: Both of them can manifest as pain in the upper abdomen.

Difference: peptic ulcer typically manifests as regular and periodic pain in the upper abdomen, and ulcer foci can be seen in gastroscopy; while carditis pain has no obvious pattern.

Chronic cholecystitis

Similarity: both can manifest as irregular pain in the upper abdomen.

Differences: chronic cholecystitis is mostly right upper abdominal pain, and there is no obvious abnormality in gastroscopy; carditis can be seen in gastroscopy, such as cardia mucosal congestion, edema, erosion and other changes.

Treatment

Aim of treatment: to remove the cause of the disease, relieve the symptoms and improve the quality of life.

Treatment principle: target the cause of the disease as much as possible, and implement the principle of individualized treatment.

Lifestyle intervention

Improving patients’ living habits and dietary habits is part of the treatment of carditis.

Avoid taking large amounts of drugs that damage the gastric mucosa for a long time, such as aspirin and indomethacin.

Eat regularly, eat less spicy and stimulating food, avoid drinking too much coffee, drinking a lot of alcohol and smoking a lot for a long time.

Medications

Acid suppressants

This group of drugs can inhibit the basic gastric acid secretion, food and other factors caused by the night gastric acid secretion.

Commonly used drugs include omeprazole, rabeprazole, cimetidine and famotidine.

Eradication of Helicobacter pylori

Patients with carditis who have confirmed H. pylori infection should undergo H. pylori eradication.

Currently, quadruple therapy is recommended for H. pylori eradication.

Quadruple therapy consists of a combination of a proton pump inhibitor (e.g., rabeprazole), a bismuth agent (e.g., bismuth pectin), and two antibiotics (e.g., amoxicillin and clarithromycin). The course of therapy is 10 or 14 days.

Prokinetic drugs

Prokinetic drugs increase the tone of the gastrointestinal tract and promote gastric emptying through different mechanisms and routes of action, thereby reducing the reflux of gastric contents and decreasing their exposure time at the cardia.

Commonly used drugs include itopride hydrochloride, mosapride and domperidone.

Gastric Mucosal Protectants

Gastric mucosal protectants can neutralize gastric acid and reduce the acidity of gastric contents after oral administration, thus relieving the erosion of gastric mucosa by gastric acid and reducing the activity of pepsin, as well as combining bile acid and enhancing the effect of gastric mucosal barrier.

Commonly used drugs such as gefalate, teprenone, magnesium aluminum carbonate preparations, Rebapatide, aluminum thioglycollate gel and so on.

Digestive enzyme preparations

Digestive enzyme preparations can relieve the symptoms of indigestion such as fullness in the middle and upper abdomen and poor appetite.

Commonly used drugs such as mitomycin pancreatic enzyme tablets, compound azinomide enteric-coated tablets, pancreatic enzyme enteric-coated capsules, compound digestive enzyme capsules and so on.

Psychotherapy

Patients with dyspeptic symptoms and accompanying obvious mental psychological factors of carditis can use antidepressants or anxiolytics.

Commonly used drugs include tricyclic antidepressants or selective 5-hydroxytryptamine reuptake inhibitors, such as haloperidol melittin, sertraline and other adjuvant therapy.

Traditional Chinese Medicine (TCM)

Chinese medicine has certain effect in treating carditis, but it needs to recognize the symptoms and treatments.

Hovenia Kuanzhong Capsule, Qi Stagnation Gastroparesis Pellet, Wicker Bell Gastroparesis Pellet, Jinghua Gastric Kang Gum Pill, etc. can improve the symptoms of belching, nausea, vomiting and epigastric pain.

Prognosis

Cure

Carditis is mostly relieved after regular medication and dietary regimen.

Daily

Daily management

Dietary management

Daily attention should be paid to a light and varied diet to ensure balanced nutrition, more food containing high quality protein, and more fresh vegetables and fruits.

Try to avoid expired, spoiled, over-sweet, over-acidic, pickled food and spicy and irritating food, such as chili peppers, spicy hot pot, ham sausage, pickles and drinks.

When eating, you should pay attention to chewing and swallowing slowly, and your diet should avoid being too hot or too full.

Avoid drinking large amounts of alcohol and smoking for a long time, and avoid drinking strong tea and coffee.

Life management

Exercise should be strengthened to improve one’s resistance and immunity. According to one’s own situation, one should choose the appropriate way of exercise to the extent that one does not feel fatigue.

Psychological support

Maintain optimism in daily life and try to avoid depressive and anxious psychological state.

If depression or anxiety occurs, psychological guidance and medication can be provided.

Follow-up and review

Consult the doctor in time if there is any change in the condition.

For Hp eradication treatment, 13C or 14C urea breath test should be performed 4 weeks after stopping the medication to determine whether the eradication is successful or not.

Examinations needed for review: gastroscopy, Hp test.

Prevention

Promote communal chopsticks and sharing of meals, and regular sterilization of tableware to reduce the chance of infection with Helicobacter pylori (Hp).

Eat a light diet and reduce the intake of greasy, spicy and irritating foods.

Discontinue unnecessary NSAIDs.

Prompt eradication treatment if Helicobacter pylori (HP) infection occurs.