1.General treatment: Patients with chronic atrophic gastritis, regardless of its etiology, should quit smoking and avoid alcohol, avoid using drugs that damage gastric mucosa such as aspirin, anti-inflammatory pain, erythromycin, etc. Diet should be regular, avoid overheating, salty and spicy food, and actively treat chronic mouth, nose and throat infection lesions.
2.Weak acid treatment: Patients with low acid or no acid as confirmed by peptide gastrin test can take rice vinegar in appropriate amount, 1-2 spoons each time, 3 times a day; or 10% dilute hydrochloric acid 0.5-10ml, before or during meals, and pepsin combination, 10ml each time, 3 times a day; also choose multi-enzyme tablets or pancreatic enzyme tablets to improve the symptoms of indigestion.
3, anti-Helicobacter pylori treatment: chronic atrophic gastritis, gastric acid is reduced or lack of, the stomach bacteria, especially the detection rate of H. pylori is very high. The application of antibiotic drugs is effective in promoting the improvement of symptoms of chronic atrophic gastritis. Commonly used to clear H. pylori treatment are: tri-potassium dicron complex bismuth, 120mg each time, 4 times a day for 4-6 weeks; hydroxybenzyl penicillin capsules, 0.5g each time, 4 times a day; furazolidone (dysentery) 100mg, 3-4 times a day. These drugs can not only remove H. pylori, but also help to reduce and eliminate the accompanying active gastritis. Other drugs with therapeutic effects on H. pylori include gentamicin, flavopiridol, metronidazole, tetracycline, haloperidol, etc.
4, inhibit bile reflux and improve gastric power: bile amines can complex the reflux to the stomach bile salts, to prevent bile acids destroy the gastric mucosal barrier, the method is 3-4g each time, 3-4 times a day. Aluminum thioglycollate can bind to bile acids and lysolecithin, and can also be used to treat bile reflux by 0.5-1g, 3 times a day. Ursodeoxycholic acid can also be given at 100mg 3 times a day. Gastrofacial, morpholine and cisapride can enhance gastric motility, promote gastric emptying, assist gastric and duodenal motility, prevent bile reflux, regulate and restore gastrointestinal motility. Specific application method: Gastrodia 5-10mg, 3 times a day; morpholine 10mg, 3 times a day; cisapride 5mg, 3 times a day.
5, plus mucosal nutrition: Acacia gastrodia leaf ester can increase the renewal of gastric mucosa, improve cell regeneration capacity, enhance the resistance of gastric mucosa to gastric acid, to protect the gastric mucosa, the dose of 50-60mg, divided into 3 times a day. Also can use live blood, the dose is 80-90mg per day; or use thioglycollate, allantoin capsule, raw gastrone, prostaglandin E, etc.
6, pentagastrin and hormone: pentagastrin, in addition to promoting mural cell secretion of hydrochloric acid and increasing pepsinogen secretion, also has a significant proliferative effect on gastric mucosa and other upper gastrointestinal tract mucosa, can be used to treat chronic atrophic gastritis patients with low acidity and no acidity or gastric body atrophy, the dose of 50μg, half an hour before breakfast intramuscular injection, once a day, changed to once every other day in the third week, changed to twice a week in the fourth week. After that, the dose should be changed to once a week for 3 months. The development of chronic atrophic gastritis is related to autoimmunity, so a short course of prednisone can be tried as immunosuppressive therapy. This method should be particularly suitable for patients with chronic atrophic gastritis who are PCA positive and pernicious anemia, but the clinical effect is not too precise.
7, other symptomatic treatment: including antispasmodic and analgesic, antiemetic, digestive aid, anti-anxiety, improve anemia, etc.. For anemia, if it is iron deficiency, iron supplements should be given. For macrocytic anemia, supplementation should be given according to vitamin B12 or folic acid deficiency, respectively. The method is vitamin B50-100μg/day for 20-30 days, and folic acid 5-10mg 3 times a day until the symptoms and anemia completely disappear.
8.Surgical treatment: Patients with chronic atrophic gastritis above middle age, if ulcers, polyps, bleeding appear during treatment or follow-up, or even if no obvious lesions are seen, but moderate or severe atypical hyperplasia appears in gastroscopic biopsy pathology, partial gastrectomy can be considered in combination with the patient’s clinical condition, and early gastric cancer may be detected from the gastrectomy specimens of such patients.
Chinese medicine treatment for chronic atrophic gastritis.
There are many ways to treat chronic atrophic gastritis in Chinese medicine, but in summary it can be treated according to five types of evidence: liver and stomach disharmony, spleen and stomach dampness and heat, spleen and stomach weakness, stomach yin deficiency, and stomach complex blood stasis.
They are described as follows.
1. Liver and stomach disharmony
The main symptoms: distension and pain in the stomach and epigastrium, attacking the chest, belching and swallowing acid, dry mouth and bitterness, loss of appetite, poor stool, and the onset is mostly related to emotional factors, with a red tongue, thin white or yellow fur, and a string or string pulse.
Treatment: Drain the liver, harmonize the stomach, move Qi and subdue distension.
Formula: Sichiban combined with Chai Hu Dredging Liver San plus and minus: Chai Hu, Citrus aurantium, Radix Aromaticus, Radix Angelicae Sinensis, Radix Paeoniae Alba, Radix Mucuna Pruriens, Radix Yuan Hu, Radix Fo Guang.
Add and subtract.
(1) If the liver and stomach are depressed with qi and fire or if liver heat offends the stomach, the symptoms include burning pain in the stomach and epigastrium, acidity, heartburn, bitterness in the mouth, noisy, and irritability, Zuojin Wan combined with Jinlingzi San or Danjian Yiyao San can be added and reduced.
(2) If the appetite is not clear, add Liu Shen Qu, fried grain and wheat sprouts, jiao hawthorn, etc.
(3) If nausea and vomiting are also seen, then add bamboo rhizome, half-xia, Chen Pi, etc.
2.Spleen and stomach damp-heat type
Symptoms: Stuffiness and discomfort or burning pain in the stomach and epigastric region, noisy belching, bitter mouth, sticky mouth, thirsty, or loose abdomen and stool, red tongue, thick yellow or greasy moss, and string or slippery pulse.
Treatment: Clearing heat, resolving dampness, strengthening the spleen and harmonizing the stomach.
Radix: San Ren Tang with addition and subtraction: cardamom kernel, almond, coix seed, thick park, half summer, tongcao, slippery stone, bamboo leaf, yellow lily of the valley, Yin Chen, Dan Shen.
Add and subtract.
(1) For those who also have superficial dampness, add Elsholtzia and Patchouli to dissolve dampness.
(2) In cases of nausea and vomiting, add bamboo rhizome and ginger to harmonize the stomach and lower the rebellion.
(3) In case of loss of appetite, add hen’s nest, Shen Qu and malt to eliminate food and induce stagnation.
3.Weak spleen and stomach type
Main symptoms: vague pain in the stomach and epigastrium, preferring to get warm pressure or fullness in the epigastrium, aggravated after eating, poor appetite and little food, loose bowel movements, or accompanied by tiredness and fatigue, little breath and lazy speech, soreness and weakness of the limbs, light red tongue, thin white or white fur or teeth marks, sunken and thin pulse.
Treatment: Benefit Qi, harmonize the middle, strengthen the spleen and nourish the stomach.
Radix et Rhizoma aromaticum, Rhizoma Atractylodis Macrocephalae, Semen Coicis, Poria, Mucuna Pruriens, Radix et Rhizoma Sandy, Pericarpium Citri Reticulatae, Semen Parviflorum, Rhizoma Malt.
Addition and reduction.
(1) If abdominal pain and loose stools, unheated extremities, white fur, tight pulse, deficiency cold, the treatment is to warm the spleen and stomach, the formula uses Huangqi Jianzhong Tang with Liangfen Wan plus or minus.
(2) If the stomach and abdomen are distended after eating, add chicken naijin, lycopodium and foxglove.
(3) If vomiting of large amount of clear water is seen, Chen Pi, Radix et Rhizoma Polygonati and Poria; for those with obvious acidity, Zuo Jin Wan can be used.
(4) For those with spleen deficiency and loose stools, add yam, lotus seeds, raw lentils, etc. to strengthen the spleen and resolve dampness.
(5) For those with black stools, add dried ginger charcoal, Fulong liver, Baihe, and Diyu charcoal.
4.Deficiency of stomach yin
Symptoms: hidden pain or burning pain in the stomach and epigastrium, noisy like hunger, dry mouth and tongue, dry stool, red tongue with little fluid and cracks, little or no moss or flaking moss, thin pulse.
Treatment: Clearing heat and generating fluid, nourishing Yin and benefiting the stomach.
Radix: Sha Shen Mai Dong Tang with addition and subtraction: Sha Shen, Mai Dong, Dendrobium, Pollen, Wu Mei, Bai Shao, Hawthorn, Licorice.
Add and subtract.
(1) If the symptoms of thirst, dry vomiting and epistaxis are also seen, the formula is based on deficiency of stomach yin and internal burning of deficiency fire.
(2) If one also sees pain in the chest and abdomen, dry mouth and bitterness, and stringiness of the pulse, the evidence belongs to liver and stomach yin deficiency and blood dryness and qi stagnation, the formula should be selected from Consistent Decoction plus or minus.
(3) If the patient also sees gas stagnation in the stomach and abdomen, it is appropriate to use moistening agents such as Buddha’s hand, green calyx plum, thick park flower and Citrus aurantium.
(4) If the stool is very dry, Zengliang Tang can be used in combination.
(5) In case of Yin deficiency and heat, add gypsum and Zhi Mu as appropriate to enhance the function of clearing heat and generating fluid.
(6) In case of Dampness, use Coix Seed, Cardamom Seed and Yin Chen to clear heat and resolve Dampness.
(7) For those with stagnation, add Salvia miltiorrhiza, Radix Angelicae Sinensis, and Peach kernel to invigorate blood and resolve stasis.
5.Stasis of blood in the stomach
Symptoms: Pain in the stomach and epigastrium that does not heal for a long time, or pain with a fixed location, refusing to press, pain like a cone, or with vomiting of blood, black stool, purple or dark red tongue or petechiae, and sunken pulse.
Treatment: Promote blood circulation, resolve blood stasis, promote blood circulation and relieve pain.
Radix: Peach-Hong Siwu Tang combined with Loss of Smile San plus or minus: peach kernel, safflower, angelica, Chuanxiong, red peony, five lingzhi, raw pu huang, Yuan Hu, Dan Shen, Ze Lan, Jiang Xiang, Jiuxiang worm.
Add and subtract.
(1) If Qi is deficient, add Astragalus, Radix Codonopsis, Rhizoma Atractylodis Macrocephalae, Rhizoma Atractylodis Macrocephalae to benefit Qi; if Qi stagnation is obvious, add Citrus Aurantium, Green Peel, Mucuna Pruriens, and Radix et Rhizoma Polygonati to move Qi.
(2) In cases of vomiting blood and black stool, if the bleeding is bright red, with a red tongue and yellow fur and a taut pulse, use Diarrhea Heart Soup to clear heat and cool the blood to stop bleeding; if the bleeding is dull red, with a shriveled face, unheated extremities and a weak tongue and pulse, the spleen does not control the blood, use Huang Tu Tang to warm the spleen and benefit Qi to regulate the blood.