According to the severity of mucosal injury, gastritis can be divided into erosive gastritis and non-erosive gastritis, and can also be classified according to the parts involving the stomach (such as cardia, stomach body and antrum). According to the types of inflammatory cells, gastritis can be further divided into acute gastritis and chronic gastritis in histology. But at present, there is no classification method completely consistent with its pathophysiology, and various classifications still overlap.
Acute gastritis is characterized by neutrophil infiltration in cardia and body mucosa. Chronic gastritis often has a certain degree of atrophy (mucosal dysfunction) and metaplasia, often involving the cardia, accompanied by G cell loss and decreased gastrin secretion, and also involving the stomach body, accompanied by oxyntic gland loss, resulting in decreased gastric acid, pepsin and endogenous factors.
[Edit this paragraph] Classification
I. Acute erosive gastritis
Etiology includes drugs (especially non-steroidal anti-inflammatory drugs), alcohol and acute stress and other serious diseases. Rare causes include radiation, viral infection (such as cytomegalovirus), vascular injury and direct trauma (such as nasal feeding intubation).
Endoscopically, it can be seen that the punctate surface erosion of mucosa does not involve deep layers, and it is often accompanied by a certain degree of bleeding (mostly submucosal petechiae).
Acute stress gastritis is a kind of erosive gastritis, which is more common in patients with serious illness. Clinically, the proportion of obvious upper gastrointestinal bleeding caused by gastric and duodenal mucosal injury has increased. Risk factors include severe burns, central nervous system trauma, sepsis, shock, mechanical ventilation and respiratory failure, liver and kidney failure and multiple organ dysfunction. Other predictors of acute stress gastritis include the length of stay in intensive care unit and the time when patients did not receive enteral nutrition. In short, the more serious the patient's condition, the higher the risk of obvious bleeding.
The pathological mechanism of acute erosive gastritis in severe patients may be the weakening of gastric mucosal barrier function. The decrease of gastric mucosal blood flow and the possible increase of acid secretion (such as burns, central nervous system trauma and sepsis) can promote the formation of mucosal inflammation and ulcer.
Symptoms, signs and diagnosis: Usually, the patient may be too ill to explain the symptoms of the stomach, and even if the symptoms exist, they are often mild and nonspecific. The obvious signs of the first attack are often blood during nasal inhalation and gastric inhalation, which usually occurs 2~5 days before severe stress reaction.
Endoscopic examination can make a definite diagnosis, and some patients (such as burns, shock and septicemia) can have acute erosion within 0/2 hours of acute injury/kloc-. Most of the lesions began at the bottom of the stomach, showing petechiae or ecchymosis, and gradually merged into irregular small ulcers of 2 ~ 20 mm, and bleeding was extremely rare. Histological lesions were confined to mucous membranes, which could heal quickly after treatment or stress relief. The lesion can continue to develop, involving submucosa and even penetrating serosa. More common is multiple bleeding at the bottom of the stomach, and gastric antrum can also be involved. Head injury is different from other situations. At this time, gastric acid secretion is not reduced, but increased. Cushing's ulcer can be isolated or involve the duodenum.
Prevention and treatment: It is reported that once a patient has severe bleeding (accounting for 2% of patients in the intensive care unit), the mortality rate can reach more than 60%. Massive blood transfusion will further weaken hemostasis. Although various surgical and non-surgical methods such as anti-secretory ulcer drugs, vasoconstrictors, angiography techniques (such as arterial embolization) and endoscopic coagulation therapy have been used, the effect is not ideal. Except for total gastrectomy, it is common to continue bleeding after other operations, and the mortality rate is the same as that of medical treatment.
Therefore, it is necessary to find high-risk patients and prevent bleeding. Early enteral nutrition is recommended as one of the methods to prevent bleeding. Although most authorities believe that intravenous injection of H2 antagonists, antacids or both (see treatment of peptic ulcer below) can prevent bleeding, there are still doubts. The standard for intravenous injection of H2 antagonists or antacids in high-risk patients in ICU is intragastric pH > 4.0. However, in critically ill patients, neutral intragastric pH can lead to bacterial overgrowth in the upper digestive tract or oropharynx, thus increasing the incidence of hospital-acquired pneumonia, especially in patients with mechanical ventilation. However, the conclusions in this regard are still inconsistent and need further study.
Second, chronic erosive gastritis
Endoscopic manifestations are often multiple punctate or aphthous ulcers. Chronic non-erosive gastritis can be idiopathic or caused by drugs (especially aspirin and non-steroidal anti-inflammatory drugs, see the treatment of peptic ulcer), Crohn's disease or viral infection. Helicobacter pylori may not play an important role here.
Symptoms are mostly nonspecific and may include nausea, vomiting and epigastric discomfort. Endoscopy showed that there was a little erosion on the edge of the thickened plica uplift, and there was a white spot or depression in the center. Histological changes are diverse. There is no broad curative effect or cure.
The treatment is mainly symptomatic, and the drugs include antacids, H2 antagonists and proton pumps. At the same time, drugs and food that can aggravate symptoms should be avoided. Recurrence and deterioration are common.
Syndrome differentiation of deficiency, cold and heat.
The treatment method is to warm the middle energizer, strengthen the spleen, clear heat and regulate qi.
Prescription for gastritis.
It consists of Pseudostellaria heterophylla10g, Evodia rutaecarpa 3g, Gardenia 9g, Fructus Aurantii 9g, Radix Aucklandiae 9g, Bulbus Allii Macrostemonae 9g, Rhizoma Cyperi 9g, Massa Medicata Fermentata 9g and Radix Glycyrrhizae 5g.
Usage: decoct with water, 1 dose, twice a day.
Source: Dr. Li Chao.
[Edit this paragraph] Chronic gastritis canceration
It is easy for people to understand the canceration of gastric ulcer, but for some types of chronic gastritis, many people will find it incredible. However, the canceration of chronic atrophic gastritis is a fact.
Chronic gastritis can be roughly divided into three types: chronic hypertrophic gastritis, chronic superficial gastritis and chronic atrophic gastritis. Chronic hypertrophic gastritis is rare in clinic and generally does not become cancerous. Chronic superficial gastritis mainly refers to superficial inflammation of gastric mucosa. This kind of inflammation is mainly manifested as the width of the intrinsic membrane of gastric mucosa increases with edema, and inflammatory cells infiltrate, but most of the gastric glands are normal. This kind of gastritis is common in clinic and generally does not cause cancer. Inflammation can subside as long as it is treated properly, but it can often develop into atrophic chronic gastritis if it is not treated properly. Chronic atrophic gastritis refers to the obvious reduction of gastric glands, the expansion of vascular space, the infiltration of full-thickness cells in gastric mucosa, often accompanied by intestinal metaplasia, that is, the gastric epithelium becomes intestinal epithelium. Chronic gastritis of this nature is closely related to gastric cancer, especially those with intestinal metaplasia.
Someone abroad has followed up chronic atrophic gastritis and found that the canceration rate is about 1%. In China, some people summarized 16 10 cases of chronic atrophic gastritis in 22 cooperative units in 5 provinces and cities. After 8- 10 years of follow-up, 9 cases of gastric cancer were found. It can be explained that although the canceration rate of chronic atrophic gastritis is not high, it can indeed become cancerous. Of course, the canceration rate of patients with intestinal metaplasia will increase obviously, so we should be vigilant.
If you suffer from chronic gastritis, you must first have a clear understanding of the types of chronic gastritis, and clearly diagnose what kind of chronic gastritis you belong to through gastroscopy and biopsy. If it belongs to chronic hypertrophic gastritis or chronic superficial gastritis, it should be treated actively to avoid turning into atrophic gastritis. If it is chronic atrophic gastritis, especially with intestinal metaplasia, it is necessary to receive regular examination and strict treatment to prevent canceration or find canceration as soon as possible.
[Edit this paragraph] Treatment
Based on the fact that Helicobacter pylori is one of the main causes of chronic gastritis, choosing drugs that can kill the bacteria can improve symptoms and reduce gastric mucosal inflammation.
Antibiotics that can kill Helicobacter pylori include amoxicillin, metronidazole, furazolidone, tetracycline and clarithromycin.
In order to eradicate Helicobacter pylori in clinic, the above antibiotics are often used in combination with other drugs, and the effect is better. Such as Livzon Dele+Metronidazole, Livzon Stomach Triple, etc.
Chinese patent medicine "Ershuquan" stomach medicine also has a good effect on killing Helicobacter pylori.
[Edit this paragraph] Diet therapy
People often use the dietotherapy method of nourishing viscera to prevent and treat diseases. Although there may not be scientific basis, as long as it is delicious, even if there is no immediate effect, it is full. Why not? I suffer from chronic gastritis, and it is with this mentality that I have explored a delicious and therapeutic diet, that is, the pork belly stewed with Hericium erinaceus.
Practice: pork tripe 1, Hericium erinaceus 100g, lotus seed meat 30g, jujube 10. First, put the washed pork belly in a pressure cooker and cook for 10 minute, then wash the foam with clear water and cut it into strips. At the same time, Hericium erinaceus is soaked in warm water, the lotus seeds are peeled and pitted, and the red dates are pitted. Put the four things into a casserole, add appropriate amount of yellow wine, soy sauce and sugar, add water after boiling, and then stew with slow fire until the pork belly is crisp and rotten, and eat with meals.
This dish is mellow, soft, delicious and nutritious. The pig's belly in the prescription can strengthen the spleen and regulate the stomach. Hericium erinaceus is a kind of medicine and food fungus, which can benefit qi and nourish blood, benefit the five internal organs, help digestion, resist ulcers and diminish inflammation, and can treat chronic gastritis. Coupled with red dates and lotus seeds that help digestion, it is a good diet for treating stomach diseases. I now eat once every ten days and a half months, which can regulate my stomach and stomach, and stomach diseases rarely recur.
[Edit this paragraph] Prevention and control
People often say that "people who eat whole grains don't have to get sick". And the entrance to the diet, the first thing that affects is the stomach. Gastric mucosa is rich in blood vessels and has the functions of storing, digesting and transporting food. Therefore, irregular diet is an important factor causing stomach problems. Chronic gastritis is a very common digestive tract disease, with nonspecific inflammation of gastric mucosa as the main pathological change. According to the histological changes of gastric mucosa, it can be divided into superficial type, atrophic type and hypertrophic type. Some clinical symptoms are: epigastric pain, frequent belching, pantothenic acid, loss of appetite, emaciation, diarrhea and other symptoms. Because dietary factors play an important role in the pathogenesis of chronic gastritis, developing good eating habits is the key to prevent and treat gastritis, which is also different from other diseases. Generally speaking, when eating, you should do the following. Chronic gastritis is cured by half.
It should be slow. Chewing slowly can reduce the irritation of coarse food to gastric mucosa.
A suitable festival. Eat rhythmically, avoid overeating and eating irregularly.
Yi Jie. Pay attention to food hygiene and put an end to the invasion of gastric mucosa by external microorganisms.
It should be no problem. Try to eat fine, digestible and nutritious food.
It should be light. Eat less fat, sweet, thick, greasy, spicy and other foods, and drink less alcohol and strong tea.
For more serious chronic gastritis, especially atrophic gastritis, it is not enough to rely solely on diet, but also need appropriate Chinese medicine treatment. The Chinese Academy of Traditional Chinese Medicine applies the therapeutic principle of "promoting blood circulation and eliminating sores" in clinic, improves the blood circulation in the stomach by promoting blood circulation and removing blood stasis, solves the stomach inflammation by diminishing inflammation and detoxicating, and helps to cure chronic gastritis with correct diet.
[Edit this paragraph] folk prescription
One: Take a cup of sugarcane juice and a cup of wine, morning and evening 1 time to treat chronic gastritis.
Two: 200 grams of ginger and 250 ml of vinegar, sealed and soaked, taken on an empty stomach 10 ml, mainly used for chronic gastritis.
Three: 30-60 grams of fresh daylily root, decocted in water, mainly used for gastritis and toothache.
Four: 65438 Carassius auratus +0-2, 50 grams of glutinous rice, with porridge, mainly for chronic gastritis.