Chronic gastritis refers to chronic inflammatory lesions of the gastric mucosa caused by different etiologies. The disease is common and its incidence increases with age.
The causes may be: long-term use of non-steroidal anti-inflammatory drugs and alcohol abuse; reflux of duodenal fluid; smoking; immune factors; infectious factors (Helicobacter pylori HP infection); long-term use of foods or drugs that strongly irritate the gastric mucosa, such as strong tea, alcohol, coffee, spicy and rough foods and certain drugs. In addition, there are age factors, gastric mucosal nutritional factor deficiency, genetic factors, etc.
Chronic gastritis is divided into the following 7 types.
1, erythematous/exudative gastritis.
2, flat erosive gastritis.
3, augmented erosive gastritis.
4, atrophic gastritis.
5, hemorrhagic gastritis.
6, entero-gastric reflux gastritis.
7, wrinkled wall hyperplastic gastritis.
Clinical manifestations
The symptoms of chronic gastritis are not specific, and a significant proportion of patients have no clinical symptoms.
The course of chronic gastritis is prolonged. The duration of the disease varies, ranging from six months to several decades, and the symptoms are sometimes mild and severe. The symptoms can be exacerbated by weather changes, especially in the fall and winter, cold and hard foods such as fried foods, exertion, and mental factors.
About 50% of patients often have epigastric discomfort, dullness, burning pain, and a feeling of fullness, without obvious rhythm, and usually heavier after eating. Indigestion symptoms such as loss of appetite, belching, acid reflux, nausea, hiccups, and distention or vague pain in the upper abdomen after meals are also more common. In some patients, appetite is not affected, but the symptoms of abdominal distension are significantly worse after eating a little more.
The patient may have a small or large amount of upper gastrointestinal bleeding with gastric mucosal erosion, and the small amount of long-term bleeding may cause iron deficiency anemia. type A gastritis may present with significant anorexia, general weakness, fatigue, weight loss, and apathy. In typical pernicious anemia, tongue atrophy and peripheral neuropathy, such as abnormal sensation in the extremities, can occur. type B gastritis has more pronounced gastrointestinal symptoms, especially in the presence of bilious sweat reflux, sometimes rather like a peptic ulcer, and there can be repeated small amounts of upper gastrointestinal bleeding, even vomiting blood. The signs are not obvious, and sometimes there is light pressure pain in the upper abdomen.
Treatment
Most of the symptoms of superficial gastritis may disappear on their own, and the lesions may also recover completely after several months or years.
Eliminate the causes: All possible causative factors or aggravating factors should be removed, such as quitting smoking and alcohol, reducing salt intake; correcting bad dietary habits, avoiding diets that stimulate the stomach, avoiding diets that are soft and easy to digest, avoiding overly coarse, overly strong spices and overly hot and cold diets. To chew and swallow slowly to achieve easy digestion and reduce the purpose of stomach stimulation, eat less salted, smoked, not fresh food; and stop taking certain drugs that stimulate the gastric mucosa, especially aspirin and other non-steroidal anti-inflammatory drugs; chronic infections in the nasal cavity and pharynx should be removed, chronic bronchitis should avoid swallowing sputum.
1, drug therapy to protect the gastric mucosa drugs commonly used are colloidal bismuth subcitrate, aluminum thiosemicarbazone, Simethicone, Metzolim-S, aluminum hydroxide gel, gastrin and cover gastric equal.
2.Adjustment of gastrointestinal motor function drugs epigastric fullness with gastroflucan or domperidone, etc. Hiccups, bloating or reflux phenomenon is the main, available gastric power drugs, such as gastrofacial, morphine or cisapride.
3, antibiotics if gastroscopy found positive H. pylori test, should take antibiotics, clarithromycin, hydroxybenzyl penicillin, gentamicin, furazolidone, streptomycin, kanamycin, tetracycline, shikimycin, etc., all have the effect of clearing HP, generally can choose two, often combined with gastric mucosal protective agents and acidulants.
4, the acid preparations commonly used drugs are cimetidine, ranitidine, famotidine, sodium bicarbonate, magnesium hydroxide, gastropin, aluminum hydroxide gel, cover stomach and so on.
5, epigastric pain is more severe can be oral atropine, prudensin, belladonna tablets or 654-2 (25-10mg) to reduce gastric acid secretion and relieve abdominal pain symptoms. As these drugs have side effects such as dry mouth, palpitations and difficulty in urination, they should be used with caution or contraindicated in patients with prostate enlargement, glaucoma and cardiovascular disease.
Also available are digestive aids such as yeast tablets, lactase, and anti-bloating tablets. If you have acid reflux, you can also use acid suppressants such as TEGM, Ranitidine, Famotidine, etc. Only one can be used. To prevent bile reflux, biliary amines can be taken to adsorb bile; for those who have vomiting and blood in stool, mecamylguanidine can be taken orally; for those who have atrophic gastritis with bloating, lactobacillin tablets can be taken orally or liver and stomach gas pain tablets, and care should be taken not to take acid suppressants such as gastropin, baking soda, etc.
Surgical treatment
In chronic atrophic gastritis with severe atypical hyperplasia, surgical treatment should be considered. Severe atrophic gastritis and intestinalization in the gastric sinus are not absolute indications for surgery, because the residual stomach after surgery is also prone to chronic atrophic gastritis, intestinalization and carcinoma.
The cancer rate of atrophic gastritis is about 1%, so regular gastroscopic follow-up should be performed. This is especially true for those with polyps, heterogeneous hyperplasia, or those with focal depressions or bulges. Mild atrophic gastritis with very smooth gastric mucosa is less likely to become cancerous.