I. Etiology and mechanism of chronic gastritis
Among gastroenterological diseases, chronic gastritis is one of the most common, often manifested as stomach pain, fullness, acidity and other symptoms, and its occurrence is related to the following factors.
① Inappropriate diet: such as long-term consumption of strong alcohol, strong tea, coffee, which is stimulating to the stomach; eating too much pepper and other condiments; eating too salty, too acidic and too rough food, which repeatedly stimulates the gastric mucosa.
②Nutritional deficiency: long-term deficiency of protein and B vitamins, which degenerates the mucosa of the digestive tract.
③Drug stimulation: Long-term use of drugs that stimulate the stomach.
④Bile reflux.
⑤ Helicobacter pylori (HP) infection: recent studies have found that Helicobacter pylori (HP) infection is closely related to the occurrence of chronic gastritis, and more than 90% of patients with chronic gastritis have a combination of HP infection.
Under normal conditions, the epithelial cells of the gastric mucosa secrete a mucus that forms a protective barrier on the surface of the gastric mucosa, which lubricates food, neutralizes gastric acid, and protects the gastric mucosa from mechanical damage. When the gastric mucosa is affected by the above-mentioned factors, it may cause the destruction of the protective barrier of the gastric mucosa, so that the hydrogen ions in the gastric acid reverse osmosis into the gastric mucosa layer, causing the release of histamine, capillary dilation, local congestion and edema, affecting gastric peristaltic function, long-term stimulation can lead to the occurrence of chronic gastritis and various uncomfortable symptoms.
Gastroscopy for chronic gastritis
Gastroscopy is the most reliable way to diagnose various gastric diseases. In the gastroscopy, the stomach is illuminated, not only can you clearly see the morphology of the stomach and mucous membrane color change under the naked eye, you can also clamp a small piece of gastric mucous membrane tissue under the microscope for pathological examination to further understand the subtle lesions of the gastric mucosa, which is conducive to early detection of the disease.
The normal human stomach is like a multilayer structure consisting of a fleshy capsule, which is divided into mucosal layer, submucosal layer, muscular layer and plasma layer from inside to outside, and the mucosal layer is divided into mucosal epithelial layer, mucosal lamina propria and mucosal muscle layer, of which the mucosal lamina propria contains a large number of glands. The gastric mucosa seen under gastroscopy is uniformly bright, smooth, soft and delicate, light orange-red in color, with a layer of transparent mucus on the surface, except for the gastric fundus, where a vascular network can sometimes be seen, and the normal gastric mucosa should not see blood vessels showing.
Gastroscopically, chronic gastritis is divided into two types: superficial gastritis (non-atrophic gastritis) and atrophic gastritis. Chronic superficial gastritis is seen gastroscopically as congestion and edema on the surface of the gastric mucosa, roughness and unevenness of the mucosa, red and white with red as the predominant change, white or yellow secretions may be attached, sometimes limited erosion and small bleeding spots are seen; microscopically there is inflammatory cell infiltration on the surface of the epithelial and lamina propria layers of the gastric mucosa, while the gastric glands are normal. In contrast, chronic atrophic gastritis gastroscopy can be seen in the gastric mucosa red-white interphase white phase is more obvious, the mucosa is granular, gray or grayish, folds are small, sometimes accompanied by limited erosion and small bleeding spots; microscopic manifestations in addition to the mucosal epithelial layer and the superficial layer of the lamina propria have inflammatory cell infiltration, but also can see the gastric glands partly or completely atrophy, or even destruction or disappearance, mucosal thinning.
Will chronic superficial gastritis become cancerous?
In recent years, as people’s awareness of health care and the popularity of gastroscopy in China’s urban and rural hospitals, the gastroscopic detection rate of chronic gastritis is increasing, and studies have shown that in China’s gastroscopy cases, patients with chronic gastritis account for about 80-90% of outpatient gastroscopy patients, so there is a “gastroscope to everywhere there is inflammation”. In addition, chronic superficial gastritis accounts for more than 80% of chronic gastritis.
The vast majority of patients with chronic superficial gastritis can be reversed, and only a small number of patients can continue to develop and turn into chronic atrophic gastritis. The most important thing is to make sure that you have a good idea of what you are getting into.
The treatment of chronic gastritis
Some patients do not pay much attention to the treatment of chronic gastritis and think that it is enough to just buy some drugs on the market; others are very worried and worry all the time that chronic gastritis will turn into gastric cancer or other difficult diseases and seek medical advice everywhere.
The current commercially available acid suppressants such as ranitidine and loxacillin can inhibit the secretion of gastric acid to a certain extent and reduce the stimulation of gastric acid on the gastric mucosa; pro-gastric power drugs such as morpholine can enhance gastric motility and to a certain extent relieve chronic gastritis patients of stomach pain, fullness, acidity and other uncomfortable symptoms, and thus are popular and sold in the market.
The treatment of chronic gastritis should start early with chronic superficial gastritis, and atrophic gastritis should also be treated as soon as possible and should be adhered to. After the diagnosis of chronic gastritis is established, a proper drug treatment plan should be established under the guidance of a gastroenterologist, and the principles of drug treatment are.
1. Eliminate or weaken the attacking factor.
① eradication of H. pylori: for patients with chronic gastritis with erosion, moderate-to-severe atrophy, moderate-to-severe enterosis, and atypical hyperplasia, eradication of HP therapy is very critical, and any of the triple therapy of proton pump inhibitor, bismuth or ranitidine bismuth citrate plus two antibiotics can be used according to the specific situation, and the antibiotics can be used in clarithromycin, amoxicillin, metronidazole, and tetracycline, respectively. Two of them.
(ii) Acid suppression or antacid therapy: for those with gastric mucosal erosion or with symptoms such as heartburn, panacidity, and epigastric hunger pain as the main manifestations, antacids, H2 receptor blockers, or proton pump inhibitors can be used according to the severity of the condition or symptoms, respectively, aluminum hydroxide, ranitidine, or loxacid.
③ for bile reflux, taking non-steroidal anti-inflammatory drugs and other corresponding treatment and treatment, can be given magnesium aluminum carbonate or aluminum hydroxide gel and other drugs, respectively.
2, enhance gastric mucosa defense: for those who have gastric mucosa erosion, bleeding or obvious symptoms, drugs including both bactericidal effect of colloidal bismuth, both antacid and bile salt adsorption of aluminum carbonate preparations and mucosal protective effect of aluminum thioglycollate, etc.
3, gastric power promoter: applicable to the upper abdominal fullness, early satiety and other symptoms, drug selection can be used morpholine or mosapride, etc.
4, antidepressants, sedatives: for poor sleep, there are obvious mental factors, can be given with glutathione or Scholastin, etc. to reduce mental symptoms.
5. Daily life regimen for chronic gastritis
In addition to drug treatment, daily life conditioning plays an important role in the treatment and recovery of the disease and the prevention of recurrence, and the principle of “three points of treatment, seven points of conditioning” as the saying goes, is especially important for patients with chronic gastritis. In daily life, attention should be paid to.
The first is to stop smoking and drinking, and to avoid strong tea and coffee and other stimulating drinks.
② Pay attention to diet regulation, avoid irregular diet, overeating and spicy and cold food.
③Treatment of related diseases: such as diseases of the upper whistle, oral cavity, hepatobiliary system and duodenum.
④ Avoid drug damage: long-term users of non-steroidal drugs such as aspirin, anti-inflammatory pain, and hormonal drugs such as dexamethasone are especially prone to damage the gastric mucosa and should pay special attention to enhance protection.