Overview
Nodular gastritis, an endoscopic special type of chronic gastritis, is a chronic gastritis characterized by endoscopic uniformly elevated nodules in the gastric mucosa. It has been called chicken-skin gastritis and lymphoid follicular gastritis. In 1962, a uniformly sized nodule was found on the gastric camera and named chicken-skin gastritis.
Etiology
The pathogenesis is not completely clear and may be related to Helicobacter pylori infection. It is generally believed that H. pylori infection causes lymphoid follicular hyperplasia, which manifests as elevated nodules. This lesion is a characteristic change of H. pylori infection in children and young women, and the nodules are densely distributed endoscopically. It is found in the gastric sinus to the body of the stomach and has a high rate of carcinoma.
Symptoms
Clinical epigastric pain is the main manifestation, which can be combined with peptic ulcer, gastric cancer, gastric mucosa-associated lymphoid tissue lymphoma, which is a high-risk factor for gastric cancer. With more severe H. pylori infection, obvious lymphoid follicular proliferation, the body reacts to H. pylori, and most of them are diffuse gastritis, so they are prone to undifferentiated gastric cancer.
Examination
1. Endoscopy
Gastroscopy reveals multiple small nodules or particles of uniform size and color in the gastric mucosa.
2. Pathologic examination
Pathologically, it belongs to chronic non-atrophic gastritis, characterized by lymphoid follicular hyperplasia, including the follicles in the center of growth, and infiltration of inflammatory cells mainly by lymphocytes.
Diagnosis
(1) Clinical manifestation is epigastric pain.
(2) Gastroscopy reveals multiple small nodules or granules of uniform size and color distributed in the gastric mucosa.
(3) Pathological biopsy reveals lymphoid follicular hyperplasia with hair growth centers and lymphocyte-based inflammatory cell infiltration. Neutrophil infiltration on the background of chronic inflammation of the gastric mucosa is diagnostic of this disease.
Differential diagnosis
This disease is mainly differentiated from gastric MALT lymphoma (low-grade malignancy). Gastric MALT lymphoma is mainly seen in older people over 50 years of age, often with symptoms of dyspepsia, endoscopic findings are similar to nodular gastritis, and the histological morphology is similar to it, but the histological features of gastric MALT lymphoma are the dense cellular infiltration of the interfollicular infiltrate, the cells are heterotypic, infiltrative, and often involve the submucosal layer, and the immunophenotype is a change in the B-lymphocytes.
Treatment
1. Helicobacter pylori treatment: because of the close relationship between this disease and Helicobacter pylori, eradication of Helicobacter pylori treatment is needed.
2. Acid-suppressing or antacid treatment: for those with gastric mucous membrane erosion or with acid reflux, epigastric hunger pain, epigastric burning sensation and other symptoms, antacids are used.
For those who have gastric mucosal erosion or with acid reflux, epigastric hunger pain, epigastric burning sensation, etc., antacids, H2 receptor blockers or proton pump inhibitors are used.
3. For bile reflux, taking non-steroidal anti-inflammatory drugs and other appropriate treatment and treatment: power promoters such as domperidone, mosapride, itopride, etc. can eliminate or reduce the bile reflux, gastric mucosal protective agents, proton pump inhibitors can reduce the damage of non-steroidal anti-inflammatory drugs on the gastric mucosa.
4. Enhancement of gastric mucosal defense: applicable to those who have gastric mucosal erosion or obvious symptoms, the drugs include colloidal bismuth, magnesium aluminum carbonate preparations, aluminum thioglycollate, Rebapatide, teprenone, gefarate, ekabete, and so on.
5. Power promoters: for those who are mainly suffering from abdominal fullness, early satiety and other symptoms.
6. Antidepressants and tranquilizers: suitable for people with poor sleep and obvious mental factors.
Prevention
Life should be regular, pay attention to the combination of work and rest, avoid going to bed late and waking up late or overwork, and keep a happy mood. Acute attack or obvious symptoms should be bed rest. Ensure adequate nutrition, pay attention to dietary rules and dietary hygiene, choose nutritious and easy-to-digest food. Take small and frequent meals and do not overeat. Avoid stimulating and rough food, do not eat too cold, too hot, easy to produce gas food and drinks. Develop the habit of chewing and swallowing slowly, so that food and saliva are fully mixed to help digestion. Avoid eating thick soup, sour or smoky food when stomach acid is high; for those who lack stomach acid, acidic food such as hawthorn can be consumed as appropriate.