Overview of Gastritis (Gastric Residual Inflammation)
Residual gastritis is the mucosal inflammation that occurs in the residual stomach after gastric resection for benign lesions such as gastric and duodenal ulcers or malignant tumors such as gastric cancer, and it is a relatively common residual gastric lesion. Clinical manifestations include epigastric pain, discomfort, fullness and other symptoms of chronic gastritis. Therefore, regular review is needed after partial gastrectomy. The high incidence of post-surgical gastritis is related to a variety of factors such as bile and intestinal fluid reflux, reduction of serum gastrin, lack of nutritional factors in the mucosa of the remnant stomach, surgical injury, and the internal environment of the remnant stomach being suitable for the growth of bacteria. Its treatment is based on mucosal protective agents and prokinetic drugs.
Etiology
The etiology of gastric mucosa is damaged by reflux of intestinal fluid (bile + pancreatic fluid); reduction of G-cell count after gastric antrum resection, resulting in reduction of mucosal trophic factor gastrin; residual HP infection and physical damage caused by anastomotic mucosal prolapse.Residual gastritis is easier to occur in Billroth II type of surgery than in I type.
Symptoms
Most patients are asymptomatic, but some have epigastric symptoms, mainly characterized by a burning sensation in the “heart socket”, which is usually aggravated after eating, and may be accompanied by nausea, vomiting, and bile in the vomit, which does not completely disappear after vomiting.
Examination
1. X-ray examination has no special significance for diagnosis.
2. Endoscopic examination reveals congestion and edema of the gastric mucosa of the remnants of the stomach, which is prominent near the anastomosis; bile reflux and/or retention of a large amount of yellow bile in the mucus lake of the fundus of the stomach are common; in severe cases, the mucosa of the anastomosis is eroded or ulcerated. Often, due to edema, epithelial hyperplasia in the gastric recesses or mucosal aggregation during suturing, the anastomotic mucosa appears as a “polypoid” elevation, which is sometimes difficult to distinguish from a tumor.
Diagnosis
1. Clinical manifestations
Persistent burning pain and vague pain in the middle and upper abdomen, usually aggravated after meals; a few patients have retrosternal pain, abdominal distension, lethargy, malnutrition and diarrhea, and sometimes bile can be vomited. Vomiting mostly occurs in the evening or in the middle of the night, and the symptoms do not disappear completely after vomiting.
2.Auxiliary examination
Gastroscopy shows bile reflux, gastric mucosal anastomosis mucosal congestion, edema or erosion.
Treatment
1. General treatment
Adjust the diet, preferably into the softer, easy to digest food, avoid eating too hard, too acid, too hot food and strong tea, coffee, etc., quit smoking and alcohol, avoid taking certain drugs, such as salicylate, pau d’arco, anti-inflammatory pain and so on. Gastric mucous membrane protectant, bile acid neutralizing drugs (such as magnesium aluminum carbonate); prokinetic drugs (such as mosapride, itopride) can also be applied.
2. Surgical treatment
If the general treatment is ineffective and the symptoms are more serious, surgical treatment is feasible, such as the original gastrectomy Bi Ⅰ’s or Bi Ⅱ’s anastomosis, as long as it is changed to Roux-en-y diversion can be used; such as the original vagus nerve severance and pyloromyoplasty, then it is necessary to make gastric sinus resection and Roux-en-y diversion.
Questions you may be concerned about
What is the most effective treatment for residual gastritis?
There is no absolute most effective way to treat residual gastritis, and it is mostly treated by general treatment, medication and surgery.
1. General treatment: It is recommended that patients adopt a small amount of food, many times, many times easy to digest food, chewing and swallowing slowly.
2. Drug treatment: under the guidance of doctors, bismuth pectin, rabeprazole, magnesium aluminum carbonate, mosapride and other drugs can be used for treatment.
3. Surgical treatment: common surgical methods include Roux-en-Y surgery and changing Bi-II surgery to Bi-I. Roux-en-Y surgery can effectively alleviate the danger of reflux and protect the stomach. By changing the procedure from Bi-II to Bi-I, the symptoms of some patients can be relieved.
Patients diagnosed with residual gastritis are advised to visit a hospital promptly.
Symptoms and treatment of residual gastritis
Some patients with residual gastritis may be asymptomatic, while some may have symptoms such as a burning sensation in the heart socket; treatment mainly includes general treatment, medication, and surgery.
Gastritis is caused by inflammation of the mucous membrane of the stomach after gastrectomy for benign lesions in the stomach and duodenum or diagnosis of malignant tumors such as gastric cancer. Some patients with gastritis may be asymptomatic, while some may have a burning sensation in the pit of the heart, especially after eating, as well as nausea, vomiting and other symptoms.
Treatment mainly includes general treatment, drug treatment and surgery. General treatment is mainly to avoid eating too hot, too hard, too acidic food in daily life and taking medicines such as salicylate and povidone; medication includes the use of gastric stimulants such as mosapride as prescribed by the doctor; surgery is suitable for those who have failed to take medication and have more severe symptoms.
Patients with symptoms of residual gastritis are advised to go to the hospital and actively cooperate with the doctor for treatment.