I. What is chronic gastritis
Chronic gastritis refers to a variety of chronic inflammatory lesions of the gastric mucosa caused by different etiologies, is a common disease, multi-morbidity, because of its high incidence, the folk have “ten people nine stomach” said.
The common classification of chronic gastritis
2. Erosive gastritis: also known as warty gastritis or pockmarked gastritis. It has the highest clinical chance of developing cancer.
3, atrophic gastritis: is a chronic digestive system disease characterized by atrophy of the epithelium and glands of the gastric mucosa, reduction in number, thinning of the gastric mucosa, thickening of the mucosal base, or with pyloric glandular hyperplasia and intestinal glandular hyperplasia, or atypical hyperplasia. The disease has a long course and progresses slowly. Complications such as gastric bleeding, gastric ulcer, anemia and gastric cancer often occur in the course of its pathology, and the chance of cancer is high.
4, hypertrophic gastritis: characterized by significant hypertrophy of the gastric mucosal folds such as the brain gyrus, which occurs in the fundus and body of the stomach, focal or diffuse. It is often accompanied by unexplained hypoproteinemia.
5, bile reflux gastritis: is due to the bile from the gallbladder into the duodenum and other intestinal fluid mixed, through the pylorus, reflux to the stomach, stimulating the gastric mucosa, resulting in inflammatory lesions.
6, gastric sinusitis: is a chronic inflammatory disease confined to the gastric sinus.
Three, chronic gastritis common causes of morbidity
1, H. pylori infection, virus or its toxins: mostly seen after acute gastritis, gastric mucosal lesions over time and develop into chronic superficial gastritis. Mainly refers to Helicobacter pylori infection. Currently, some scholars believe that the rate of H. pylori infection in patients with chronic gastritis is more than 95%.
2, dietary irregularities: overeating, hunger and satiety disorders, over-eating spicy, pickled, barbecued, fried, moldy food, destruction of the gastric mucosa.
3, irritating substances: such as long-term drinking strong wine, strong tea, strong coffee and other irritating substances, can destroy the gastric mucosa protective barrier and gastritis.
4, drugs: certain drugs can cause chronic gastric mucosal damage.
5, chronic infection of the oral cavity, pharynx: oral cavity, pharynx with germs secretions into the stomach, damage to the gastric mucosa.
6, bile reflux: bile contains bile salts can destroy the gastric mucosal barrier, so that the hydrogen ions in the gastric juice counter-diffusion into the gastric mucosa and cause inflammation.
7, long-term mental tension, irregular life: modern medicine, mental depression or excessive tension and fatigue, easily caused by the pyloric sphincter dysfunction, bile reflux and chronic gastritis.
The common clinical manifestations of chronic gastritis
The chronic gastritis lacks specific symptoms, and the severity of symptoms is not consistent with the degree of lesion of the gastric mucosa. The majority of patients are often asymptomatic or have varying degrees of indigestion symptoms such as epigastric pain, loss of appetite, postprandial fullness, acid reflux, etc.
1, superficial gastritis: common symptoms include chronic upper abdominal burning pain, hidden pain, distension, bloating, belching, loss of appetite, acid reflux, nausea and vomiting, weakness, constipation or diarrhea, and the course of the disease is lingering and prone to recurrent attacks.
2, erosive gastritis: most patients are often asymptomatic or have varying degrees of indigestion symptoms such as epigastric pain, loss of appetite, postprandial fullness, acid reflux, etc.
3, atrophic gastritis: patients may have epigastric pain, loss of appetite, postprandial fullness, anemia, emaciation, tongue inflammation, diarrhea and other symptoms, individual patients with mucosal erosion epigastric pain is more obvious, and there may be bleeding, such as vomiting blood, black stool. Symptoms are often recurrent, irregular abdominal pain, pain often occurs during or after meals, mostly located in the upper abdomen, around the umbilicus, some patients are not fixed, intermittent hidden pain or dull pain in mild cases, severe colic in severe cases.
4, gastric sinusitis: manifested as a sense of upper abdominal support and distension, hidden pain or severe pain, often in periodic episodes, may be accompanied by belching, acid reflux, epigastric burning sensation, vomiting, poor appetite, wasting, etc., a few may have bleeding, there are also asymptomatic people. The disease is closely related to psychological factors. Mood swings, anger, mental stress or fear of cancer can aggravate the symptoms. It mostly occurs in men over 30 years old. This is one of its characteristics.
V. Clinical diagnosis of chronic gastritis
1. Gastrointestinal X-ray barium meal examination: when the gas-barium double imaging shows the fine structure of gastric mucosa, atrophic gastritis can appear with relatively flat and reduced gastric mucosal folds.
2, gastroscopy and biopsy: gastroscopy and pathological biopsy are the main methods to diagnose chronic gastritis.
(1) superficial gastritis: often the most obvious in the gastric sinus, mostly diffuse gastric mucosal surface mucus increased, with gray or yellowish-white exudate, lesions of mucosa red and white or florid, like measles-like changes, sometimes with erosion.
(2) Erosive gastritis: often manifested as multiple warts, inflated crepitations or papule-like elevations of the gastric mucosa, varying in size, with the gastric sinus being the most common, and can be divided into the persistent and vanishing types. Because of its characteristics, it is divided into augmented erosive gastritis and flat erosive gastritis.
(3) chronic atrophic gastritis: the lesion mucosa is mostly pale or grayish white, but also red and white, the white area depressed; folds become thin or flat, due to the thinning of the mucosa can be permeable to the submucosal blood vessels in a purple-blue color; lesions can be diffuse or mainly in the gastric sinus, if accompanied by proliferative changes, the mucosal surface granular or nodular.
(4) Hypertrophic gastritis: microscopically, the gastric pits are highly hyperplastic and extend down to the mucosal muscle layer.
(5) Gastric sinusitis: the main lesion is mostly confined to the mucosal layer, but it also extends to the muscular or plasma layer. There is edema, inflammatory cell infiltration and fibrous tissue proliferation in the lesioned portion, resulting in local thickening and even stenosis; some cases may have mucosal surface erosion and changes in intestinal glandular epithelialization.
(6) Bile reflux gastritis: bile reflux can be directly observed under endoscopy, and the gastric mucosa shows diffuse congestion with varying degrees of mucosal fold edema or erosion.
The symptoms of chronic gastritis are non-specific, signs are rare, and x-ray examination is generally only useful to exclude other gastric diseases, so the diagnosis depends on gastroscopy and gastric mucosal tissue examination. Taking biopsy specimens for pathological examination can determine chronic superficial gastritis, chronic atrophic gastritis, intestinal epithelial metaplasia, and heterotypic hyperplasia.
Especially, early detection of stomach tumors directly affects the prognosis (please see my article – Understanding gastric cancer and preventing gastric cancer).
In addition, H. pylori can be found in the gastric mucosa in 50% to 80% of patients in China.
VI. Treatment of chronic gastritis
Most of the chronic superficial gastritis can be reversed, and a few can be turned into chronic atrophic gastritis. Chronic atrophic gastritis gets progressively worse with age, but mild cases can also be reversed. The actual fact is that you can get a lot more than just a few of these.
The actual fact is that you will not be able to get a good deal on your own. Actively treat chronic diseases of the mouth, nose and throat. Strengthen exercise to improve physical fitness.
2.Medication: Prudence, belladonna combination, etc. are available for painful episodes. Gastric acid increase can be used PPI proton pump inhibitors such as rabeprazole, lansoprazole, omeprazole, etc. For milder symptoms, H2 receptor blockers such as metformin, ranitidine, aluminum hydroxide amine, etc. Those with lack of gastric acid or no acid can be given 1% dilute hydrochloric acid or pepsin combination, and those with dyspepsia can add pancreatic enzyme tablets, multi-enzyme tablets and other digestive aids. If H. pylori is found in gastric mucosa biopsy, antibiotics can be added. If bile reflux is obvious, use gastric reassurance and morpholine to enhance peristalsis of the gastric sinus and reduce bile reflux. Magnesium aluminum carbonate tablets, biliary amine, aluminum thioglycollate can be combined with bile acid, reduce symptoms.
3, Chinese medicine treatment: chronic gastritis is characterized by pain in the stomach and epigastric region, which belongs to the category of gastroparesis in Chinese medicine. The common causes of this disease in Chinese medicine are cold evil guest stomach, diet injury to the stomach, liver gas offending the stomach and spleen and stomach weakness. The pathogenic mechanism is divided into the deficiency and the real end, the real evidence is qi blockage, not pass is pain; deficiency evidence is the stomach and internal organs lost in warmth or moisten, not glory also pain. The actual evidence should be used to examine the four diagnoses and eight outlines in detail, according to the different conditions of the patient, to establish the appropriate treatment (for more details, see “Chronic gastritis treatment of Chinese medicine”).
The chronic gastritis prevention and care
1, keep the mood relaxed: emotions and gastritis close relationship, clinical research found that anger, tension and other adverse emotional reactions, can directly lead to gastric muscle contraction, microvascular spasm, gastric own protective repair function is reduced, gastric acid secretion hyperactivity and other changes that induce gastrointestinal disorders, which is consistent with the views of Chinese medicine liver gas offending the stomach. In clinical practice, it is not uncommon for chronic gastritis to be aggravated or triggered by mental factors, so it is important to keep the mood relaxed in daily life for the treatment and recovery of chronic gastritis.
The first should avoid eating cold and spicy products, fried, greasy, sticky and other difficult to digest food should not eat. The diet should be soft and easy to digest, avoid too rough, too strong spices and overheated diet. Try not to eat soaked rice, leftovers, eat to develop the habit of chewing slowly, so that the food fully mixed with saliva, in order to achieve easy digestion, reduce the purpose of gastric mucosa irritation. Eat less pickled, smoked, not fresh food. Each meal to seven minutes full is appropriate, should not eat too much. Eat three meals a day on time, less in the morning, full at noon, less at night, and do not eat too late for dinner. Drink more water, avoid taking strong tea, strong coffee and other stimulating drinks. Lie still for half an hour after a meal. Eat fruit 1 to 2 hours after meals. Eat more fresh vegetables and fruits to keep the bowels flowing smoothly.
3, get up and live normally: Chinese medicine believes that this disease mostly occurs in those who are deficient in the spleen and stomach, the spleen and stomach are both deficient and weak, so patients should pay attention to keeping warm, especially the abdomen and back to avoid wind and cold, and to ensure proper rest and avoid overwork.
4, active treatment of oropharyngeal infection foci: do not swallow phlegm, nasal discharge and other bacterial secretions into the stomach leading to chronic gastritis.
5, 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 get a lot more than just a few of these. Therefore, you should quit smoking and avoid alcohol.
6, 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.
Eight, H. pylori and its hazards and treatment methods
Helicobacter pylori belongs to the human body parasitic bacteria, when the human body resistance is weakened, it becomes an opportunistic pathogenic bacteria, also known as conditional pathogenic bacteria, some people describe H. pylori “like a spring, you are strong it is weak, you are weak it is strong”. At present, the medical community has been clear that H. pylori is the causative factor of many common gastrointestinal diseases, the general population of H. pylori infection rate can be as high as 40% to 60%. In the case of a healthy stomach body and normal gastric function, there is no need to deliberately kill (i.e., take medication), because excessive use of antibiotics, not only will cause dysbiosis, but also can produce drug resistance, can improve their own quality, enhance immunity, to achieve a balance of flora in the body to get along.
However, if you suffer from chronic gastric disease, especially peptic ulcer patients, you need to take medication to treat it.
At present, the commonly used anti-H. pylori drugs at home and abroad are: organic colloidal bismuth (such as colloidal bismuth, bismuth potassium raffinate, etc.), proton pump inhibitors (such as omeprazole, rabeprazole, pantoprazole, etc.), antibacterial drugs (commonly used amoxicillin, metronidazole, doxycycline, clindamycin, etc.).
Commonly used regimen: omeprazole (pantoprazole or rabeprazole) + amoxicillin (clindamycin) + metronidazole. The course of treatment is usually two weeks.
For those who are not particularly well off, this regimen is easier and the effect can reach 80% eradication. For those with ulcerative disease, h2 receptor antagonists (such as ranitidine or famotidine) can be added to the above drugs.