What is Gastritis?

Gastritis is an inflammation of the gastric mucosa caused by various causes, and is one of the most common digestive diseases. According to the severity of clinical onset, it can be generally divided into two types: acute and chronic gastritis; according to different causes, it can be divided into Helicobacter pylori-related gastritis, stress gastritis, autoimmune gastritis and so on. The pathological changes of gastritis caused by different causes are also different, and usually include three processes: epithelial damage, mucosal inflammatory response and epithelial regeneration. Acute gastritis can be divided into simple, erosive and hemorrhagic, corrosive, and purulent gastritis according to its pathological changes. Chronic gastritis can be divided into non-atrophic, atrophic and special types of gastritis according to its pathological changes. The diagnosis and differential diagnosis of various types of gastritis are mainly based on gastroscopy.

Basic Information

English name

gastritis

Visiting department

Gastroenterology

Multiple groups

Eating Disorders

Common causes

Chemical, physical, microbial infection or bacterial toxin

Common symptoms

Epigastric pain, bloating, belching, repeated bleeding

Contagious

no

Causes of gastritis

Cause of acute gastritis

Can be divided into two categories of external and internal causes. Any bacteria, drugs, toxins, corrosives, etc. that enter the stomach through the mouth are external causes. Where the causative factor spreads to the stomach wall through blood circulation or lymph, it is called internal cause.

(1) Physical and chemical factors Strong tea, strong coffee, spicy food, spirits, cold or hot food, rough food, etc. can damage the gastric mucosa, destroy the mucosal barrier and cause gastric mucosal inflammation. Non-steroidal anti-inflammatory drugs such as aspirin, indomethacin, certain antibiotics, and adrenal corticosteroids can not only stimulate gastric mucosa and cause damage, but also affect the repair of gastric mucosa and increase inflammation. If some strong corrosive agents are swallowed, such as nitric acid, hydrochloric acid, sulfuric acid, potassium hydroxide, sodium hydroxide, etc., it can cause acute corrosive gastritis.

(2) Biological factors are mainly various pathogenic bacteria and toxins, such as Salmonella, E. coli, halophiles, Staphylococcus aureus toxins and botulinum toxins. Gastritis can develop within hours after eating food contaminated with bacteria or toxins. Pyogenic bacteria such as -hemolytic streptococcus and Staphylococcus aureus spread to the stomach wall through blood or lymph, which can cause acute purulent gastritis.

(3) Others Stress states such as systemic infection, severe trauma, major surgery, shock, and severe mood swings. Foreign bodies in the stomach, gastric stones, and radiotherapy of the gastric area can all cause this disease.

2. Causes of chronic gastritis

(1) Biological factors The main pathogenic bacteria of chronic gastritis is H. pylori, and more than 90% of patients with chronic gastritis have H. pylori infection.

(2) Immune factors The incidence of some chronic gastritis is related to immune factors, and parietal cell antibodies can be detected in the patient's serum.

(3) Physical factors such as cold or hot food, rough food, strong tea, espresso, and spirits. The long-term stimulation of gastric mucosa by spicy food can cause repeated damage to gastric mucosa and cause chronic gastritis.

(4) Chemical factors Smoking is one of the causes of chronic gastritis. Nicotine in tobacco can affect the blood circulation of the gastric mucosa, at the same time, it can cause pyloric sphincter dysfunction and cause bile reflux. Long-term use of non-steroidal anti-inflammatory drugs such as aspirin and indomethacin can damage the gastric mucosal barrier.

(5) Others Age increase, malnutrition, heart failure, cirrhosis, diabetes, and thyroid disease are all related to the onset of chronic gastritis.

Clinical manifestations of gastritis

Acute gastritis

The onset is more acute and the clinical symptoms vary. The most common is acute simple gastritis, which is mainly manifested as upper abdominal pain, bloating, belching, loss of appetite, nausea, and vomiting. It is caused by salmonella or staphylococcus toxin, which is often accompanied by diarrhea, fever, and even dehydration and shock. Acute erosive hemorrhagic gastritis may have vomiting and melena. The main clinical manifestations of acute suppurative gastritis are systemic sepsis and acute peritonitis. The symptoms of acute corrosive gastritis are the most obvious, manifested as severe pain in the mouth, throat, back of sternum, and upper abdomen after swallowing corrosives, with nausea and vomiting, and even vomiting. The mucous membranes of the lips, oral cavity, and throat can produce burns of different colors, which is helpful for the identification of various corrosive agents.

2. Chronic gastritis

The clinical manifestations of different types of gastritis will be different, but the symptoms are not specific, and the severity is often inconsistent with the severity of the disease. Some patients may be asymptomatic.

(1) Upper abdominal pain or discomfort Most patients with gastritis have upper abdominal pain or discomfort. Most abdominal pain is irregular and has nothing to do with diet. The pain is generally diffuse upper abdominal burning pain, faint pain, and soreness.

(2) Upper abdominal distension and early satiety Some patients will experience abdominal distension, especially after meals. It is often caused by food retention in the stomach, delayed emptying, and indigestion. Early satiety means that you have a clear sense of hunger but you feel full soon after eating, and the amount of food you eat decreases significantly.

(3) Radon gas , acid reflux, nausea There is radon gas, which indicates that the gas in the stomach increases and is discharged through the esophagus, which temporarily relieves the fullness of the upper abdomen. Acid reflux is caused by increased gastric acid secretion.

(4) Other patients with severe atrophic gastritis may have wasting, glossitis, and diarrhea; patients with autoimmune gastritis are associated with anemia.

Gastritis examination

Gastroscopy

It is the main method to diagnose gastritis, especially chronic gastritis. You can directly observe the esophagus, stomach, duodenal bulb, and descending mucosa. You can also take multiple sites of mucosa for biopsy under direct vision. However, acute corrosive gastritis is contraindicated in the acute period.

2. Pathological examination

It is mainly used for the diagnosis and differential diagnosis of chronic gastritis.

3. Laboratory inspection

(1) Analysis of gastric juice

(2) Determination of pepsinogen

(3) Determination of serum gastrin

(4) Immunological examination

(5) Helicobacter pylori examination

Gastritis diagnosis

Acute gastritis is based on history and symptoms, and diagnosis is not difficult. It should be distinguished from early acute appendicitis, acute cholecystitis, and acute pancreatitis. The diagnosis of acute erosive hemorrhagic gastritis requires emergency gastroscopy. Acute corrosive gastritis is mainly diagnosed based on its history of swallowing corrosives.

The diagnosis of chronic gastritis depends on gastroscopy and biopsy of the gastric mucosa. Gastroscopy can be distinguished from diseases such as gastric cancer and gastric ulcer.

Gastritis Treatment

Acute gastritis

(1) General treatment: rest in bed, remove the cause, light liquid diet or fasting appropriately. Those who have obvious vomiting and diarrhea should add electrolytes and water in time.

(2) Symptomatic treatment Give gastric mucosa protective agent and acid inhibitor; patients with bacterial infection should be given antibiotics.

(3) Special treatment Acute suppurative gastritis should be given a large dose of sensitive antibiotics as early as possible. When abscesses form locally in the lesion and drug treatment fails, surgical treatment is feasible. Corrosive gastritis caused by strong acid and alkali can be swallowed with milk, egg white, or other liquid mucosal protective agents. Analgesics such as morphine can be given in severe pain.

2. Chronic gastritis

(1) General treatment Quit smoking and avoid alcohol; Avoid using drugs that damage the gastric mucosa such as aspirin, indomethacin, erythromycin, etc .; Eat a regular diet to avoid overheating, salty and spicy food; actively treat chronic mouth, nose, and throat infections Lesions.

(2) Drug treatment

1 ) Drugs for protecting gastric mucosa The commonly used drugs are colloidal bismuth citrate (CBS), sucralfate, Mezlin-S, aluminum hydroxide gel, and gastrin.

2 ) Drugs for adjusting gastrointestinal motor function . Domperidone and other drugs for upper abdominal fullness. Snoring, bloating or reflux may be the main cause of gastric motility drugs.

3 ) Antibiotics If gastroscopy is positive for Helicobacter pylori, antibiotics should be taken. Clarithromycin, ampicillin, etc. have the effect of clearing Hp. Generally, two types can be selected. They are often used in combination with gastric mucosal protective agents and acid inhibitors. .

4 ) Drugs for reducing gastric acid, such as basic acid antacids such as sodium bicarbonate and aluminum hydroxide; H ₂ receptor antagonists cimetidine and ranitidine; proton pump inhibitors omeprazole and lansoprazole.

5 ) Analgesics: People with severe upper abdominal pain can take atropine, prubensin, belladonna tablets or 654-2 to reduce gastric acid secretion and relieve abdominal pain symptoms.

6 ) Other symptomatic drugs are available digestive aids, such as pancreatin, yeast tablets, lactase, simethicone tablets and so on. To prevent bile reflux, take magnesium aluminum carbonate, cholestyramine to absorb bile; those with vomiting and blood in the stool, cimetidine orally.