Many patients come to the hospital with symptoms such as abdominal pain, bloating, early satiety, belching, etc. The gastroscopy report is chronic gastritis, but the symptoms do not improve and recur for a long time under the treatment of chronic gastritis, and some patients are very stressed and even have anxiety and depression. Because the symptoms of functional dyspepsia are very similar to chronic gastritis, it is easy to be confused clinically, especially after the widespread development of digestive gastroscopy in recent years, most of the patients consulted have inflammatory changes in the gastric mucosa after gastroscopy and pathological histological examination, which makes the diagnosis and treatment very difficult. So what is the relationship between chronic gastritis and functional dyspepsia? What is the difference between the two? The relationship between chronic gastritis and functional dyspepsia Chronic gastritis and functional dyspepsia are both common and prevalent diseases of the digestive system, and most patients with chronic gastritis are asymptomatic. Due to the different diagnostic criteria for endoscopy of chronic gastritis in different countries, a group of 90 patients with functional dyspepsia in China had 100% chronic gastritis on endoscopy, which is really called gastroscopy everywhere is not inflammation, and the pathological results of endoscopic biopsy is “there must be inflammation”. In contrast, a group of 3667 patients with functional dyspepsia in Europe, only 20.9% were diagnosed with inflammation by endoscopy, and Japanese scholars considered the gastric mucosa to be normal with mild congestion and edema. Chronic gastritis is an endoscopic or pathological diagnosis that does not reflect clinical symptoms, and the severity of functional dyspepsia symptoms does not parallel the inflammation of chronic gastritis. Functional dyspepsia is a functional gastrointestinal disease, and the gastric mucosa can also have chronic inflammatory changes, because under normal conditions, the stomach is prone to damage due to grinding food, so it is normal to have varying degrees of lymphocyte and plasma cell infiltration in the gastric mucosa. However, the inflammation of chronic gastritis is due to infection and the gastric mucosa is dominated by neutrophil infiltration, which is the main hallmark of chronic active inflammation. The two are mainly the difference between functional and organic diseases Organic diseases are diseases of an organ or a tissue system of the body caused by multiple causes, resulting in permanent damage to that organ or tissue system. It is characterized by pathological changes in the structure of organs and tissues seen with the naked eye or under the microscope, and by diminished or lost function of the affected organ. Chronic gastritis is an organic disease because gastroscopy reveals lesions in the structures of the stomach. Functional diseases, on the other hand, are generally caused by dysfunction of the innervated organs, and the tissue structure is not altered, so the condition is mild and usually does not lead to serious consequences. For example, functional dyspepsia is a typical functional disease although the patient may have abdominal pain, bloating, nausea, vomiting and other symptoms but there are no obvious abnormal changes through gastroscopy or only mild mucosal congestion and edema. These diseases are mostly related to mental and psychological factors, and although the symptoms are obvious and the history is long, they generally do not affect the patient’s general condition and have a good prognosis. Of course, the distinction between organic and functional diseases is not absolutely constant, and the conditions of both can be transformed into each other. The most common causes of chronic gastritis are physical and chemical factors, such as too cold or too hot food, rough food, strong tea, strong coffee, strong alcohol, long-term stimulation of the gastric mucosa by spicy stimulating foods, long-term use of non-steroidal anti-inflammatory drugs such as aspirin and indomethacin can destroy the gastric mucosal barrier and can lead to repeated damage to the gastric mucosa, as well as biological and immune factors, such as Helicobacter pylori infection and The chronic gastritis can be caused by biological and immune factors, such as H. pylori infection and autoimmune reaction. The main causes of functional dyspepsia are: gastrointestinal motility disorders, visceral sensitivity, and psychosomatic factors. Gastrointestinal motility disorders are mainly manifested by delayed gastric emptying, and visceral sensitivity refers to the increased sensitivity of the stomach to mechanical or chemical stimuli, i.e., dulled sensation of the stomach and increased gaps to pain or fullness. The role of psychological factors in functional dyspepsia is mainly related to the impaired regulation of the brain-gut axis. For example, a person’s emotions are more sensitive, usually in life is easy to anger, the gastrointestinal also easily affected by emotions, some people’s internal organs are more sensitive, eat some spicy stimulating food body will feel uncomfortable, there are some patients appear some functional dyspepsia phenomenon, fear that they have a major disease, but also in the mental anxiety, life and work lazy, headache and even depression The phenomenon of the patient’s mood and diet change, this symptom, if not improved, will affect the patient’s normal life and mental state. Most patients with chronic gastritis often have no symptoms, or only some symptoms of indigestion, such as vague pain in the upper abdomen, postprandial fullness, acid reflux, loss of appetite, etc., but the severity of these symptoms does not reflect the degree of gastric mucosal lesions. In patients with chronic atrophic gastritis, there may be anemia, emaciation, diarrhea, inflammation of the tongue, and in patients with gastric mucosal erosion, the pain in the upper abdomen is more pronounced, and there is also blood in vomiting and defecation. These symptoms often recur, such as abdominal pain, with no apparent regularity. In contrast, patients with functional dyspepsia have a variety of clinical manifestations, mainly epigastric pain, epigastric distention, early satiety, belching, loss of appetite, nausea, and vomiting. It can appear alone or as a group of symptoms. The characteristics are: 1. Early satiety refers to a feeling of fullness soon after eating, resulting in a significant reduction in food intake; 2. Epigastric distention mostly occurs after meals or is persistent and worsens after eating; 3. Early saturation of epigastric distention is often accompanied by belching. Nausea and vomiting are uncommon and often occur in patients with significantly delayed gastric emptying, and vomiting is mostly of the stomach contents of the current meal. 4. Many patients are accompanied by insomnia, anxiety, depression, headache, inattention and other mental symptoms. These symptoms are related to the psychology of “fear of cancer” in some patients; 5. The symptoms may change during the course of the disease, and the onset of the disease is slow, persistent or recurrent over the years. The difference in diagnosis Gastroscopy is a common method to diagnose chronic gastritis and functional dyspepsia, but gastroscopy, often due to the presence of gastric mucosa congestion, edema, most of the diagnosis of “chronic gastritis” without taking a pathological biopsy, even if the pathological biopsy is mostly diagnosed as “chronic inflammation of the mucosa “This makes it more difficult to diagnose functional dyspepsia in clinical practice. Functional dyspepsia is a diagnosis based on symptoms, provided that organic lesions of the gastric mucosa are excluded. Whereas we speak of chronic gastritis, characterized by active inflammation and glandular epithelial lesions, with endoscopic manifestations of erosion or atrophy of the gastric mucosa and pathological biopsy showing neutrophil infiltration of the gastric mucosa or atrophy or destruction of the glands, in functional dyspepsia the mucosa is predominantly infiltrated by lymphocytes and plasma cells. Therefore, pathological biopsy is the main reliable criterion for differentiating chronic gastritis from functional dyspepsia. As a result of the way of thinking of dividing diseases into functional and organic diseases, people place biological and physical examinations in a very important position in clinical diagnosis in order to exclude organic diseases or to search for objective evidence for the initial diagnosis of organic diseases. Therefore, modern medicine attaches great importance to the positive findings of instrumental and laboratory tests, and pays less attention to or even ignores cases where the tests are not positive. This is especially common in functional dyspepsia, which often leads to the patient’s prolonged condition, repeated visits and repeated examinations, resulting in unbearable pain and a huge waste of medical resources. Differences in treatment The principles of treatment for chronic gastritis are symptom relief and improvement of pathological changes in the gastric mucosa. Since most patients with chronic gastritis have H. pylori infection, in principle, anti-H. pylori treatment should be administered. Eradication of H. pylori can improve the digestive symptoms in some patients and can stop gastric mucosal atrophy and intestinal metaplasia caused by long-term H. pylori infection. According to the patient’s symptoms, appropriate acid-suppressing, pro-dynamic, digestive enzyme and gastric mucosa-protecting drugs are selected. For epigastric fullness, nausea and vomiting, prokinetic drugs can be chosen; with bile reflux, gastric mucosal protection drugs combined with bile acid can be added; if there is erosion and bleeding of gastric mucosa, acid suppressants can be used to promote the repair of mucosa. Functional dyspepsia is mainly symptomatic treatment to improve symptoms, and our guidelines for the diagnosis and treatment of functional dyspepsia propose 2 steps: examination before treatment, or empirical treatment first according to the relationship between symptoms and eating. Gastrointestinal motility disorder is the main pathological basis of functional dyspepsia, so gastrointestinal motility drugs are the most commonly used drugs for functional dyspepsia. If pre-meal epigastric pain is considered to be caused by the stimulation of gastric acid or bile on the gastric mucosa in fasting, then the diet needs to develop good habits and avoid gastric fasting as much as possible, or assist acid suppressants to reduce the secretion of gastric acid in order to reduce the stimulation of gastric acid on the gastric mucosa. The most important difference between functional dyspepsia and chronic gastritis is that patients with functional dyspepsia have varying degrees of mental and psychological regulation disorders, manifested as depression and/or anxiety, and pathophysiological manifestations of hypersensitivity of the central nervous system, abnormalities in the regulatory function of the brain-gut axis and abnormalities in the secretion of certain neuromediators and neuropeptides. For such patients, cognitive and behavioral therapy is often required to adjust the patient’s mental and psychological disorders, if necessary with anti-anxiety-depressant treatment. Summary: Chronic gastritis and functional dyspepsia are both common and frequent diseases of the digestive system, the main difference between the two is that chronic gastritis is an organic disease and functional dyspepsia is a functional disease. Modern medicine attaches great importance to the positive findings of instruments and laboratory tests, and pays less attention to or even ignores cases where the tests are not positive. This situation is especially common in functional dyspepsia, which is often confused with chronic gastritis, resulting in patients’ prolonged illness, repeated visits and repeated examinations, causing patients to suffer and a huge waste of medical resources. Therefore, the awareness of functional dyspepsia must be enhanced in order to improve the treatment effect.