Chronic gastritis is a common and frequent disease with an incidence of about 50-80% and increases with age, with a large degree of histological variability and inconsistent severity of symptoms with endoscopic and pathological changes.
Common etiologies.
H. pylori infection, autoimmune mechanisms and genetic factors, duodenal fluid reflux and associated with irritating foods, alcohol abuse, and use of NASID medications.
Common classification.
Based on endoscopic manifestations and pathological histological changes, most hospitals in China still clinically classify it into chronic superficial gastritis (non-atrophic gastritis) and chronic atrophic gastritis.
How to prevent chronic gastritis?
1, keep a happy spirit: depression or excessive tension and fatigue, easily caused by the pyloric sphincter dysfunction, bile reflux and chronic gastritis.
2, quit smoking and avoid alcohol: the harmful ingredients in tobacco can cause an increase in gastric acid secretion, which has a harmful stimulating effect on the gastric mucosa, and excessive smoking can cause bile reflux. The actual fact is that you can find a lot of people who have been in the business for a long time. You should quit smoking and avoid alcohol.
3, caution, avoid using drugs that damage the gastric mucosa: long-term abuse of such drugs can cause damage to the gastric mucosa, resulting in chronic gastritis and ulcers.
4, active treatment of oropharyngeal infection foci: do not swallow sputum, nasal discharge and other bacterial secretions into the stomach leading to chronic gastritis.
5, pay attention to diet: too acidic, too spicy and other irritating food and cold indigestible food should be avoided as far as possible, chew slowly when eating, so that the food fully mixed with saliva, which is conducive to digestion and reduce the stimulation of the stomach. Diet should be regular and nutritious, and eat more food containing vitamin A, B and C. Avoid taking strong tea, strong coffee and other stimulating drinks.
What is the prognosis?
The prognosis is generally good. The majority of cases are Hp-associated gastritis, and there is little spontaneous clearance of Hp; therefore, chronic gastritis can persist, but most are asymptomatic. A small proportion of chronic superficial gastritis may develop into chronic multifocal atrophic gastritis, which is often combined with intestinal hyperplasia and, in a few cases, heterogeneous hyperplasia. A very small number of moderate and severe atrophic gastritis can develop into gastric cancer over a long period of time.
The relationship between chronic gastritis and hp infection.
About 15-20% of Hp-associated gastritis will develop into peptic ulcers. Those with predominant inflammation of the gastric sinus are prone to duodenal ulcers, while multifocal atrophic gastritis is prone to gastric ulcers and has an increased risk of developing gastric cancer. The risk of gastric cancer is increased in chronic gastritis with heterogeneous hyperplasia, and the cancer rates are 2.53% for mild heterogeneous hyperplasia, 4-8% for moderate, and 10-83% for severe. the risk of gastric cancer increases 6-fold in Hp-infected patients, and the risk of gastric cancer is 5.8-fold higher in those with severe atrophy of the gastric body mucosa than in those without or with mild atrophy. lymphoma of the gastric mucosa-associated lymphoid tissue can also occur in Hp-associated gastritis.
Treatment.
I. Diet and removal of unfavorable factors.
Eat a light diet and avoid irritating foods, rough foods, overheated beverages, alcohol abuse, and salty foods. Identify and get rid of all causes of chronic gastritis as much as possible, stopping medication, alcohol, smoking, etc.
Second, spiritual and comfort treatment.
People’s fear of chronic gastritis is more biased towards the fear that gastritis will become cancerous. Some clinical observations have found that neuroendocrine dysfunction and imbalance in the release of gastrointestinal hormones play a role in the pathogenesis of chronic gastritis. The lifestyle of patients with autonomic dysfunction manifested by stress, anxiety, agitation, irritability, and sadness should be given adequate attention in the treatment. At present, only atrophic gastritis is related to gastric cancer, so patients should be given proper health education to maintain an optimistic attitude towards life and avoid aggravating their mental burden.
III. Drug treatment.
1.Gastric mucous membrane protective drugs: The main function of gastric mucous membrane protective drugs is to enhance the function of gastric mucous membrane barrier and strengthen the ability of gastric mucous membrane to resist damaging factors. For those with acid reflux, heartburn, stomach pain symptoms and gastroscopy suggesting mucosal erosion and bleeding, mucosal protective agents can be given.
(1) Aluminum thioglycollate.
(2) Bismuth.
(3) Teprenone.
2.Gastric motivational drugs: Gastrointestinal motivational drugs can be given to those who are full and uncomfortable and belching.
(1) morindaine.
(2) mosapride.
3, acid suppressants: chronic gastritis patients can have high or low gastric acid, the application of acid suppressants can improve the pH value of the stomach, reduce the damage of H+ on the gastric mucosa, that is, the degree of H+ anti-dispersion, to create a strong local environment for the repair of inflammation of the gastric mucosa.
(1) H2 receptor antagonists.
(2) Proton pump inhibitors.
Commonly used representative drugs: omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole. Generally use the standard dose, once a day more can achieve better therapeutic effect.
4, Hp eradication therapy: Hp positive active gastritis, Hp should be eradicated.
5.Other treatments.
(1) age-related atrophy and intestinalization; nutritive drugs for gastric mucosa, such as: carotene, folic acid, zinc, VitE, etc.
(2) for gastric mucosal intestinal and atypical hyperplasia, give vitamin C, E and folic acid, regular endoscopic follow-up, chronic atrophic gastritis with severe heterogeneous hyperplasia in the current mostly considered precancerous lesions, advocate that surgical treatment should be considered, feasible endoscopic ESD complete excision of the lesion, without surgery but can achieve a curative effect.
(3) Treatment of autoimmune gastritis: no special, pernicious anemia can be injected VitB12. dilute hydrochloric acid, digestive enzymes can be given to patients with poor digestive function.