The clinical manifestations of chronic atrophic gastritis are only indigestive symptoms such as epigastric fullness, belching, and decreased appetite, sometimes resulting in anemia due to decreased secretion of intragastric factors and malabsorption of vitamin B12. Endoscopy and biopsy are the only means to confirm the diagnosis of chronic atrophic gastritis.
There are many ways to treat chronic atrophic gastritis, and the specific kind of treatment that is most effective should be combined with different ways for specific individuals.
1. General treatment.
Patients with chronic atrophic gastritis, regardless of its etiology, should quit smoking and avoid alcohol, avoid using drugs that damage the gastric mucosa such as aspirin, anti-inflammatory pain, erythromycin, etc. It is advisable to eat regularly, avoid overheating, salty and spicy foods, and actively treat chronic oral, nasal and pharyngeal infections lesions.
2. Supplementary digestive enzyme preparations.
Digestive enzyme preparations such as compound azinomide or pancreatic enzyme tablets can be used for treatment to improve the symptoms of indigestion.
3.Anti-Helicobacter pylori treatment.
In chronic atrophic gastritis, gastric acid is reduced or lacking, and the bacteria in the stomach are sinful, especially the positive rate of detection of Helicobacter pylori is high. Application of antibiotic drugs is effective in promoting symptomatic improvement of chronic atrophic gastritis. The eradication of H. pylori helps to reduce and eliminate clinical symptoms, as well as for the simultaneous coexistence of active gastritis also has a certain effect.
4. Inhibition of bile reflux and improvement of gastric motility.
Biliary amines can complex the bile salts that reflux into the stomach to prevent bile acids from destroying the gastric mucosal barrier, by 3-4g each time, 3-4 times a day. Aluminum thioglycollate can bind to bile acid and lysolecithin, and can also be used to treat bile reflux by 05-1g, 3 times a day. Ursodeoxycholic acid (UDCA) can also be given at 100mg 3 times a day. It was found that the most toxic effect of bile on gastric mucosa is deoxycholic acid and lithocholic acid in the gastric juice of patients with bile reflux is dominated by bile acid and deoxycholic acid, and UDCA only accounts for 1%. With UDCA, the bile acid in gastric juice is dominated by UDCA (up to 43±15%), while the concentration of bile acid, deoxycholic acid and lithotriptic acid decreases significantly, thus reducing the damaging effect of the latter two on gastric mucosa. Gastrofacial, morpholine, mosapride and other drugs can enhance gastric peristalsis, promote gastric emptying, assist gastric and duodenal movements, prevent bile reflux, regulate and restore gastrointestinal motility.
5.Strengthen the gastric mucosa nutrition therapy.
Gastric mucosal protective agents increase the renewal of gastric mucosa, improve cell regeneration ability, enhance the resistance of gastric mucosa to gastric acid, and achieve the role of protecting gastric mucosa, you can use thioglycollate, metsulin S, urea capsule, raw gastrone, prostaglandin E, etc.
6.Pentagastrin and hormone.
In addition to promoting the secretion of hydrochloric acid by wall cells and increasing the secretion of pepsinogen, pentagastrin also has obvious proliferative effect on gastric mucosa as well as other upper gastrointestinal tract mucosa, and can be used to treat patients with chronic atrophic gastritis with low acid and no acid or with gastric body atrophy.
7. Glucocorticoids.
Part of 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 especially suitable for PCA positive and pernicious anemia of chronic atrophic gastritis patients, but the clinical effect is not too exact.
8, 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 taken. Folic acid and VitB12 can be supplemented.
9. Surgical treatment.
In patients with chronic atrophic gastritis over middle age, if ulcers, polyps, or bleeding appear during treatment or follow-up, or even if no obvious lesions are seen, but moderate or severe atypical hyperplasia is present in gastroscopic biopsy pathology, endoscopic mucosal resection, or partial gastrectomy can be considered in conjunction with the patient’s clinical condition. This is at the discretion of the patient and the patient’s needs. In addition, early gastric cancer may be detected from the gastrectomy specimens of these patients.