Chronic gastroenteritis Chronic gastritis refers to chronic inflammation of the gastric mucosa caused by different causes. The most common ones are chronic superficial gastritis and chronic atrophic gastritis. Its main clinical manifestations are loss of appetite, upper abdominal discomfort and dull pain, belching, pantothenic acid, nausea, vomiting, etc. The course of the disease is slow, with repeated attacks and difficulty in recovery.
Chronic gastritis is generally divided into two types: the inflammatory lesions are relatively superficial and are limited to one layer (no more than one-third) of the gastric mucosa surface, which is called chronic superficial gastritis; and the inflammatory lesions spread to The full thickness of the gastric mucosa, accompanied by gastric gland atrophy, is chronic atrophic gastritis. Chronic gastritis is a common disease and frequently-occurring disease. Gastroscopy surveys have confirmed that the incidence of chronic gastritis in the Chinese population is as high as over 60%, of which atrophic gastritis accounts for approximately 20%.
There are many causes of chronic gastritis. Common ones include long-term and heavy drinking and smoking, irregular diet, food that is too cold or too hot, too rough and hard, strong tea, coffee and spicy food. etc. can easily induce or aggravate the condition. Chronic gastritis caused by Helicobacter pylori infection in the gastric mucosa caused by unhygienic diet is not easy to cure. If acute gastritis is not treated thoroughly, it will turn into chronic gastritis. Certain drugs, such as aspirin, phenylbutazone, and glucocorticoids, can destroy the gastric mucosal barrier and induce or aggravate gastritis.
The most common symptoms of this disease are stomach pain and fullness, which worsen especially after meals and are more comfortable on an empty stomach. Although the amount of food eaten each time is not much, he feels overly full and uncomfortable, often accompanied by belching, acid reflux, heartburn, nausea and vomiting, loss of appetite, indigestion and other phenomena. Due to eating less and indigestion, malnutrition, weight loss, anemia and weakness can occur. Some patients are also accompanied by neurological symptoms such as nervousness, irritability, insomnia, palpitations, forgetfulness, etc. These phenomena, in turn, can aggravate the gastric symptoms of chronic gastritis, forming a vicious cycle, making the condition complicated and difficult to cure.
Do gastric juice analysis and examination. Patients with chronic superficial gastritis often have normal or slightly low gastric acidity, while chronic atrophic gastritis has significantly lower gastric acidity and may be accompanied by anemia (hemoglobin lower than normal). Gastroscopy plus gastric biopsy pathology can confirm whether it is superficial or atrophic gastritis; gastric biopsy can also be taken for a test to see whether there is Helicobacter pylori infection.
Generally speaking, the prognosis of chronic superficial gastritis and simple mild chronic atrophic gastritis is good. Chronic atrophic gastritis was once considered a prelude to gastric cancer (precancerous lesion). Now it seems that this understanding is biased. However, there is indeed a certain relationship between atrophic gastritis and gastric cancer. The basis is: 1. Studies have proven that gastroscopic biopsy of atrophic gastritis is accompanied by two types of gastric mucosal lesions: "colonic intestinal metaplasia" and "atypical hyperplasia" It is a recognized fact that patients may develop gastric cancer. 2. Epidemiological survey shows that the incidence of atrophic gastritis is high among people in areas with high incidence of gastric cancer. 3. Pathological examination found that atrophic lesions are common in the mucosa surrounding gastric cancer. Moderate and severe atrophic gastritis, especially those with atrophic gastritis accompanied by colonic metaplasia or atypical hyperplasia on pathological examination, are precancerous lesions. Without active treatment and reasonable maintenance, they are more likely to mutate into gastric cancer. Therefore, chronic atrophic gastritis requires regular gastroscopy review: general chronic atrophic gastritis should be reviewed once every three years, those with incomplete colonic intestinal metaplasia and mild dysplasia should be reviewed once a year, and those with moderate atypical hyperplasia should be reviewed once a year. Patients with atypical hyperplasia should be treated once every 3 months. Those with severe atypical hyperplasia (cancer rate above 10%) should be considered cancerous and can be treated with surgical resection. Only active treatment, lifestyle maintenance, and regular review can make the lesions improve or stop developing, thereby preventing the occurrence of gastric cancer. Even if the disease progresses, if you can insist on regular gastroscopy, you can still find it in time. Preventive resection of gastric lesions or resection of early gastric cancer is still a thorough and radical cure, and the effect is still very good.
Therefore, as long as active treatment, life maintenance, and regular review are done, the initiative is in your own hands. From this point of view, what is there to fear about chronic atrophic gastritis? !
Patients with chronic gastritis should pay great attention to their diet: eat regularly, eat small meals frequently, and mainly eat soft foods; they should chew slowly and swallow slowly and avoid overeating; avoid irritating foods, quit smoking, and drink less alcohol. Drink strong tea and coffee and eat spicy, overheated and rough foods; those with low gastric acidity and bile reflux should eat more high-protein and low-fat diets such as lean meat, poultry, fish, and milk; avoid taking foods that are irritating to the stomach Drugs (such as sodium salicylate, indomethacin, phenylbutazone and aspirin, etc.); relieve mental stress and maintain an optimistic mood, thereby improving immune function and enhancing disease resistance; pay attention to the balance between work and rest, and exercise appropriately.
Western medicine treats this disease mainly based on symptomatic treatment. Those with severe gastric acid deficiency can take dilute hydrochloric acid orally to increase the acidity of gastric juice; those with indigestion can take pepsin mixture, multi-enzyme tablets, etc.; those with fullness, nausea, and vomiting can use gastropamine and domperidone; those with bile reflux Long-term bile reflux can destroy the gastric mucosal barrier, causing chronic superficial gastritis, and then develop into chronic atrophic gastritis. In this case, gastric motility drugs can be used to prevent bile reflux, thereby achieving the purpose of protecting the gastric mucosa. Domperidine or cisapride can resist bile reflux, promote emptying and antiemetics; for patients with obvious stomach pain, take qianqie Tablets, 654-2 for antispasmodic and analgesic; patients with Helicobacter pylori infection should also take Livzon Stomach Sanlian to eliminate bacteria and cure it. Sucralfate is a gastric mucosal protective agent that can reduce the irritating effect of external factors on the gastric mucosa and is beneficial to the recovery of gastric mucosal lesions. It can be used for all types of chronic gastritis. Chronic atrophic gastritis plus taking vitamin E can improve human immunity, enhance the activity of detoxification enzymes in the human body, inhibit the growth of cancer cells and prevent abnormal cell metabolism.
Traditional Chinese medicine has a very good effect in treating chronic gastritis. In traditional Chinese medicine, chronic gastritis is mostly classified as epigastric pain and stomachache. There are 7 common types:
a. Spleen and stomach weakness type: Spleen deficiency in the body, or improper diet, abnormal hunger and fullness, which makes the spleen and stomach injured and weak, manifested as epigastric fullness and pain, loss of appetite, and indigestion. For abdominal distension, fatigue and fatigue, Xiangsha Liujunzi Decoction can be used to strengthen the spleen and stomach;
b. Spleen and stomach deficiency and cold type: severe spleen deficiency, insufficient spleen yang, or gluttony for raw and cold food, damaging spleen yang and causing yin-coldness Internal congestion is manifested by dull pain in the epigastrium, warm massage, pain relief after meals, severe pain on an empty stomach, and cold limbs. Treat with Huangqi Jianzhong Pills (soup) to warm the spleen and stomach, relieve pain and relieve pain;
c . Liver Qi invading the stomach type: poor emotions, depression and anger damaging the liver, liver Qi invading the stomach, blockage of Qi movement, abnormal rise and fall, manifested as abdominal distension and pain, frequent belching, relief of belching or flatulence, or easy upset. Symptoms include anger, chest tightness, neck tightness, and foreign body sensation in the throat. Treatment is with qi stagnation and stomach pain granules to soothe the liver, regulate qi and relieve stomach pain, or add Xiaoyao Pills and Yuanhu Pain Tablets;
d. Liver-fire invading the stomach type: stagnation of liver-qi turns into fire over time, and liver-fire invades the stomach. , causing burning pain in the stomach, bitter taste, upset, and dry stools. To treat the fire in the liver and stomach, use Zuojin Pills; , depleting the stomach fluid, causing dull pain in the epigastrium, inability to eat when hungry, dry mouth and throat, and dry stools. Treatment is to nourish yin and nourish the stomach with Yiguan decoction and peony decoction;
f. Blood stasis in the stomach: liver stagnation and qi stagnation or spleen deficiency, which over time makes the blood flow sluggish and blood stasis stops in the stomach, resulting in epigastrium. Stinging or cutting pain, localized pain, refusal to press the painful area, dark tongue or dark spots with bruises. Shixiao Powder can be used to activate blood circulation and remove blood stasis to relieve pain, combined with warming and nourishing stomach qi;
g. Mixed cold and heat type: bitter mouth, dry mouth, bad breath, stomach burning, craving for cold food, dry stool, etc. There are also symptoms of cold spleen such as stomach discomfort, stomach pain, bloating and other symptoms caused by cold stomach, cold food or cold stomach. I treated it with Banxia Xiexin Decoction and the effect was very good.
Chronic gastritis refers to chronic inflammatory lesions of the gastric mucosa caused by different causes. This disease is relatively common, has a long course, and has persistent or recurring symptoms. The severity of this disease varies. Chronic gastritis can be divided into three types based on gastroscopy and pathological findings: ① Superficial gastritis has congestion and edema on the surface of the gastric mucosa, while erosion and bleeding are less common. Gastric glands often remain normal.
②Atrophic gastritis causes the gastric mucosa to become thinner and the gastric glands to partially or completely disappear. ③ In hypertrophic gastritis, the mucosal layer is enlarged and thickened, appearing in the shape of thick cords or nodules. Epithelial cells and gastric glands proliferate, but hypertrophic gastritis diagnosed by gastroscopy is often not pathologically confirmed, so many people currently doubt the existence of this type of gastritis. In recent years, it is believed that chronic gastritis can often have both superficial and atrophic lesions, but most of them are atrophic, and chronic gastritis is divided into corpus gastritis and antrum gastritis. The mucosal lesions of gastric body gastritis are mostly atrophic and diffuse, and are limited to the gastric body and usually do not involve the gastric antrum. The gastric acid secretion function is severely impaired, the serum gastrin level is increased, and the serum anti-parietal cell antibody is mostly positive. There may be vitamin B12 malabsorption and may cause pernicious anemia. Antral gastritis (also known as antral gastritis) mainly involves the gastric antrum mucosa, which is mostly atrophic lesions limited to the gastric antrum or combined with superficial inflammatory lesions. At the same time, the gastric body mucosa may also be accompanied by focal lesions. Sexual, mild atrophic lesions, mild gastric acid secretion dysfunction, low serum gastrin levels, and serum anti-parietal cell antibodies are often negative, and generally do not cause pernicious anemia.
It is currently believed that body gastritis may be closely related to immunity, while antral gastritis is more related to external stimuli such as smoking and drinking, or bile reflux. In my country, the incidence of antral gastritis significantly exceeds that of corpus gastritis.
Symptoms
The clinical manifestations of chronic gastritis are mainly loss of appetite, upper abdominal discomfort or dull pain, belching, acid reflux, nausea, vomiting, etc., and they are persistent or recurring. Corpus gastritis and antral gastritis can have different clinical characteristics. The former has fewer gastrointestinal symptoms, but is prone to obvious or latent pernicious anemia, and is more prone to iron deficiency anemia. The latter tend to have gastrointestinal symptoms, and the symptoms of some patients can resemble those of peptic ulcers, with periodic and rhythmic upper abdominal pain, which may repeatedly manifest as melena or vomiting of coffee-like liquid, but most of the patients can stop bleeding automatically. It is currently believed that some chronic atrophic gastritis can develop into gastric cancer, and gastric cancer is much more common in antral gastritis than in corpus gastritis. Therefore, these patients should undergo regular follow-up observation.
Gastroscopy combined with biopsy under direct vision is the main method for diagnosing chronic gastritis.
Treatment
Treatment of chronic gastritis:
1. Eliminate the cause of the disease and remove the causative factors, such as smoking cessation, tea and alcohol, and avoiding foods and drugs that are irritating to the gastric mucosa; if gastroscopy reveals obvious bile reflux, patients can be treated with metoclopramide and choletyramine.
2． Drug treatment ① People with lack of gastric acid or low gastric acid can take a mixture of 1 dilute hydrochloric acid and pepsin. ② People with high gastric acid can take aluminum hydroxide gel, Weisuping and cimetidine, etc. ③Atropine, prubencin and belladonna preparations can be taken when pain attacks. ④ Antibacterial drugs: Low gastric acidity or lack of gastric acid can often cause bacterial proliferation in the stomach, which has a certain relationship with the development of this disease. Antibacterial drugs that are not easily absorbed can be taken orally in the short term, such as furazolidine, gentamicin, streptomycin, etc. ⑤Chinese patent medicines: Xiangsha Yangweijiu, Chen Xianglu and Monkey Mushroom Tablets, etc., are effective in improving symptoms such as abdominal pain, bloating, belching, nausea and vomiting. ③Those with iron deficiency anemia can take iron supplements; those with pernicious anemia can take vitamin B12 injections.
3． Surgical treatment: Even if the gastroscopy findings are inflammation, erosion or ulcer, and the pathological examination finds suspicious cancer, surgical treatment should be considered. If the pathological examination shows mild anaplastic gastric mucosa or intestinal metaplasia, surgery should not be rushed. Instead, X-ray or fiberoptic gastroscopy and gastric mucosal biopsy should be followed up every 3 to 6 months.
Health Guide:
1. Actively treat oropharyngeal infection, and do not swallow sputum, nasal mucus and other bacterial secretions into the stomach to cause chronic gastritis.
2. Maintain a happy spirit: Mental depression or excessive stress and fatigue can easily cause pyloric sphincter dysfunction, bile reflux and chronic gastritis.
3. Use with caution and avoid using drugs that may damage the gastric mucosa, such as aspirin, salicylates, phenylbutazone, indomethacin, hormones, erythromycin, tetracycline, and sulfonamides , Benefit and equality. Long-term abuse of such drugs can damage the gastric mucosa, causing chronic gastritis and ulcers.
4. The harmful components in tobacco can increase gastric acid secretion and have a harmful stimulating effect on the gastric mucosa. Excessive smoking can cause bile reflux. Excessive drinking or long-term consumption of hard liquor can cause congestion, edema, and even erosion of the gastric mucosa, significantly increasing the incidence of chronic gastritis. You should quit smoking and avoid drinking.
5. Excessive sour, spicy and other irritating foods, as well as raw and cold foods that are difficult to digest, should be avoided as much as possible. Chew and swallow slowly when eating, so that the food is fully mixed with saliva, which is beneficial to digestion and reduces stomach discomfort. stimulation. The diet should be regular, nutrient-rich, and rich in vitamins A, B, and C. Avoid stimulating drinks such as strong tea and strong coffee.
6. You can practice internal nourishment skills.
Note: Don’t eat anything that is too spicy, too cold, too sweet, or too greasy. You must eat regularly, don’t eat too much, and pay attention to your food intake.