Gastritis is an inflammation of the gastric mucosa caused by various causes and is one of the most common digestive diseases. According to the urgency of clinical onset, it can be generally divided into two types: acute and chronic gastritis; according to the different etiologies, it can be divided into Helicobacter pylori-associated gastritis, stress gastritis, autoimmune gastritis and so on. The pathological changes of gastritis caused by different etiologies are different and usually include three processes, namely epithelial injury, mucosal inflammatory response and epithelial regeneration. Acute gastritis can be divided into simple, erosive-hemorrhagic, corrosive, and septic gastritis according to its pathological changes, while chronic gastritis can be divided into non-atrophic, atrophic, and special types of gastritis according to its pathological changes. The diagnosis and differential diagnosis of each type of gastritis are mainly based on gastroscopy.
Etiology
1. Causes of acute gastritis
The causes of acute gastritis can be divided into two categories: exogenous and endogenous. Any entry into the stomach through the mouth, such as bacteria, drugs, toxins, corrosives, etc., are exogenous. Where the causative agent is disseminated to the stomach wall through the blood circulation or lymph, it is called endogenous.
(1) Physical and chemical factors Strong tea, strong coffee, spicy food, strong alcohol, too cold or too hot food, rough food, etc. can damage the gastric mucosa and destroy the mucosal barrier leading to inflammation of the gastric mucosa. Non-steroidal anti-inflammatory drugs such as aspirin, indomethacin, certain antibiotics, adrenal corticosteroids and other drugs can not only stimulate the gastric mucosa damage, but also affect the repair of the gastric mucosa and aggravate inflammation. If swallowed some strong corrosive agents such as nitric acid, hydrochloric acid, sulfuric acid, potassium hydroxide, sodium hydroxide, etc., can lead to acute corrosive gastritis.
(2) Biological factors Mainly a variety of pathogenic bacteria and toxins, such as Salmonella, Escherichia coli, halophilic bacteria, as well as Staphylococcus aureus toxin and botulinum toxin. Gastritis can occur after a few hours of eating food contaminated with bacteria or toxins. Septic bacteria such as alpha-hemolytic streptococci and Staphylococcus aureus can cause acute septic gastritis when they are disseminated to the stomach wall through blood or lymph.
(3) Other stressful conditions such as systemic infection, severe trauma, major surgery, shock, and severe mood swings. Foreign bodies in the stomach, gastric calculi, radiation therapy in the stomach area can lead to this disease.
2. Chronic gastritis etiology
(1) Biological factors The main causative agent of chronic gastritis is Helicobacter pylori, and more than 90% of patients with chronic gastritis have H. pylori infection.
(2) Immune factors Some of the chronic gastritis is related to immune factors, and mural cell antibodies can be detected in the serum of patients.
(3) Physical factors such as too cold or too hot food, rough food, strong tea, strong coffee, strong alcohol, spicy stimulating food on the long-term stimulation of the gastric mucosa, can lead to repeated damage to the gastric mucosa, causing chronic gastritis.
(4) Chemical factors Smoking is one of the causes of chronic gastritis, tobacco nicotine can affect the gastric mucosa blood circulation, while the pyloric sphincter dysfunction, causing bile reflux. Long-term use of non-steroidal anti-inflammatory drugs such as aspirin and indomethacin can destroy the gastric mucosal barrier.
(5) Other Ageing, malnutrition, heart failure, cirrhosis, diabetes, thyroid disease, etc. are all associated with the development of chronic gastritis.
Clinical manifestations
1. Acute gastritis
The onset of the disease is acute and the clinical symptoms vary in severity. The most common is acute simple gastritis, which mainly manifests as epigastric pain, bloating, belching, loss of appetite, nausea, vomiting, etc. In cases caused by Salmonella or Staphylococcus aureus toxins, it is often accompanied by diarrhea, fever, and even dehydration and shock. Acute vesicular hemorrhagic gastritis may have vomiting of blood and black stools. Acute septic gastritis has systemic sepsis and acute peritonitis as the main clinical manifestations. Acute corrosive gastritis is the most obvious symptom, manifested by severe pain in the mouth, throat, posterior sternum, and epigastrium after swallowing corrosive agents, accompanied by nausea and vomiting, and even vomiting blood. Lip, oral cavity, throat mucosa can produce different colors of burning crust, which helps to identify various corrosives.
2. Chronic gastritis
The clinical manifestations of different types of gastritis can vary, but the symptoms lack specificity and the severity is often inconsistent with the severity of the lesion. Some patients may be asymptomatic.
(1) Epigastric pain or discomfort Most patients with gastritis have epigastric pain or discomfort. Most epigastric pain is irregular and not related to diet. The pain is usually diffuse upper abdominal burning, vague pain, and distension.
(2) Upper abdominal distension and early satiety Some patients may feel bloated, especially after meals with a distinct feeling of fullness. This is often due to retained food in the stomach, delayed emptying, and indigestion. Early satiety refers to a feeling of fullness soon after eating despite an obvious hunger, with a significant reduction in the amount of food eaten.
(3) Belching, acid reflux, and nausea Belching indicates an increase in gas in the stomach, which is expelled through the esophagus, resulting in temporary relief of epigastric fullness. Acid reflux is due to increased secretion of gastric acid.
(4) Others Patients with severe atrophic gastritis may have wasting, tongue inflammation, and diarrhea; patients with autoimmune gastritis are accompanied by anemia.
Treatment
1. Acute gastritis
(1) General treatment Rest in bed, remove the cause of the disease, light liquid diet or appropriate fasting. If vomiting and diarrhea are obvious, replenish electrolytes and water in time.
(2) Symptomatic treatment Give gastric mucosal protective agents and acid suppressants; antibiotics should be given to those with bacterial infection.
(3) Special treatment Acute suppurative gastritis should be given early with high-dose sensitive antibiotics, and if the lesion forms abscess locally and drug treatment is ineffective, surgery is feasible. Swallowing strong acid, strong alkali caused by corrosive gastritis can take milk, egg white or other liquid mucosal protective agents, severe pain can be given morphine and other analgesics.
2. Chronic gastritis
(1) General treatment Quit smoking and avoid alcohol; avoid using drugs that damage the gastric mucosa such as aspirin, anti-inflammatory pain, erythromycin, etc.; avoid overheating, salty and spicy food; actively treat chronic oral, nasal and pharyngeal infection lesions.
(2) Drug treatment
(1) Gastric mucosa protection drugs Commonly used drugs include colloidal bismuth subcitrate (CBS), aluminum thioglycollate, metsulin-S, aluminum hydroxide gel, gastrin, etc.
(2) Drugs to adjust the gastrointestinal motor function Epigastric fullness with domperidone, etc. For hiccups, bloating or with reflux as the main phenomenon, use gastric motility drugs.
3）Antibiotics If positive H. pylori is found by gastroscopy, antibiotics should be taken. Clarithromycin, hydroxybenzyl penicillin, etc., all have the effect of clearing Hp, and two are generally available, often in combination with gastric mucosal protectors and acid suppressants.
(4) reduce gastric acid drugs such as alkaline acid producing drugs sodium bicarbonate, aluminum hydroxide; H2 receptor antagonist cimetidine, ranitidine; proton pump inhibitors omeprazole, rasoprazole, etc.
5）Anti-pain medication Those with severe epigastric pain can take oral atropine, probenecid, belladonna tablets or 654-2 to reduce gastric acid secretion and relieve abdominal pain symptoms.
(6) Other symptomatic treatment drugs Available digestive aids, such as pancreatic enzymes, yeast tablets, lactase, dimethicone oil tablets, etc. Prevent bile reflux can take magnesium aluminum carbonate, biliary amine to adsorb bile; with vomiting blood and blood in stool, mecamylguanidine oral.