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.
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, with extremely rare bleeding. 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.
Antibiotic treatment of chronic gastritis
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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.
Treatment of Chronic Gastritis by Stewing Pork Belly with Hericium erinaceus
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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.
Treatment of bile reflux gastritis
With the popularization of gastroscopy, bile reflux gastritis is easier to find.
Cholate, bicarbonate in bile, lecithin and trypsin in duodenal juice are indispensable substances for digesting fat and protein. If they stay in the duodenum, bile reflux gastritis will not occur. However, if bile returns to the stomach for various reasons, these reflux liquids will become a group of out-and-out "troublemakers" and can cause many gastritis symptoms.
Drug treatment of bile reflux gastritis is like eliminating the "enemy at the entrance". In order to make it easier for readers to remember, we might as well call some of the latest treatment methods several "ways of playing".
"closing method"
At the junction of stomach and duodenum, there is an annular muscle inner ring, which is called "pyloric sphincter" in medicine. Usually it is closed tightly to prevent the liquid (including bile) in the duodenum from flowing back into the stomach. Only when the food in the stomach has been digested can it be opened in time, so that chyme can enter the intestine for further digestion.
If the pressure of pyloric sphincter drops due to various reasons, the closure is not tight, or the duodenum shows reverse peristalsis, "bad elements" can take advantage of the gap to enter.
Some drugs can close the pyloric sphincter by strengthening the regulation of neuromuscular function.
Commonly used drugs are: (1) motilium, 10 mg each time, 3-4 times a day; ⑵ Prebos, 5- 10 mg, 3-4 times a day; (3) metoclopramide, each time 10 mg, 3-4 times a day.
Choose one of the above drugs. It should be noted that the above drugs should be taken before meals 15-30 minutes, and the taking time should not be less than 2 weeks.
Second, the "expulsion law"
Once bile enters the stomach, if it can strengthen the peristalsis of the stomach, these "uninvited guests" will be driven out of the "gate" before they can contact the gastric mucosa, and naturally they will not cause damage to the gastric mucosa. If we strengthen the forward peristalsis of duodenum and reduce its pathological reverse peristalsis, it will also be beneficial to the treatment of bile reflux gastritis. The commonly used drugs mentioned above have such an effect.
Third, the "collection method"
Bile has entered the stomach, and measures can be taken to dispose of it in the stomach and "contract in place".
Some drugs, such as smecta, have the effect of adsorbing substances such as bile. Smecta's flaky structure, like sandwich wafer, has a lot of adsorption capacity, thus absorbing bile salts and excluding toxic hemolytic lecithin (one of the "culprits" causing gastritis). Smecta can also cover the damaged gastric mucosa thinly to isolate harmful factors.
When taking it, pour 1 bag of smecta (3g) into 50ml warm water and shake it evenly to make it look like milk, and then take it.
If these treatments are used together, the effect is better.
Bile reflux gastritis is partly caused by biliary diseases (such as gallstones, cholecystitis and cholecystectomy). Or related to some duodenal diseases (such as pyloric canal's or duodenal ulcer, after subtotal gastrectomy, etc.). ), it is more effective to treat these diseases.
Health care of bile reflux gastritis
What is bile reflux gastritis?
Bile reflux gastritis is an inflammatory disease caused by bile and other duodenal contents flowing back to the stomach and gastric mucosa in contact with it. The main manifestations are burning pain in the upper abdomen, vomiting bile, and even weight loss and bleeding. This disease is seen after subtotal gastrectomy and gastrojejunostomy. Pyloric dysfunction and chronic biliary diseases can lead to the onset.
How to treat:
Drug health care
① metoclopramide or motilium 10 mg each time, three times a day, taken orally, can promote gastric emptying and reduce bile reflux.
② Cholesteramine 4g each time or aluminum hydroxide gel 10ml each time or sucralfate 1g each time, taken orally three times a day, can cooperate with bile salts to protect gastric mucosa.
③ TAVIMEI 0.8g per night, taken orally. Ranitidine 150 mg or famotidine/20 mg, taken orally twice a day, can inhibit gastric acid, protect mucosa and relieve pain.
(4) benzimidazole and clozapine can also promote intestinal peristalsis and reduce reflux.
⑤ Chinese medicine treatment: soothing the liver and regulating qi, reducing stomach adverse reactions, and decocting with Rhizoma Corydalis, Rhizoma Pinelliae, Rhizoma Coptidis, Rhizoma Atractylodis Macrocephalae, Fructus Aurantii, Cortex Magnolia Officinalis and Radix et Rhizoma Rhei.
Dietary health care
① A low-fat and high-protein diet, such as milk, beans and fish, should be adopted.
2 avoid greasy and full diet, eat a little more.