How Do I Choose the Best Gastroenteritis Treatment?

Chronic gastroenteritis is a chronic inflammation of the gastric and intestinal mucosa. Its name is not exact, some people call it chronic gastroenteritis. The main clinical manifestations are loss of appetite, upper abdominal discomfort, belching, nausea, vomiting or recurrent abdominal pain, diarrhea, and indigestion. Due to the different locations, they can be divided into chronic enteritis and chronic gastritis.

Basic Information

nickname

Chronic gastroenteritis

Visiting department

Gastroenterology

Common locations

Gastrointestinal

Common causes

Viral infection, bacterial infection, unclean diet, medicine, etc.

Common symptoms

Loss of appetite, upper abdominal discomfort, belching, nausea, vomiting, recurrent abdominal pain, diarrhea, indigestion, etc.

Contagious

no

Causes of chronic gastroenteritis

Chronic enteritis

(1) Viral enteritis Viral enteritis is found in enteritis caused by canine distemper virus, canine parvovirus, canine and feline coronavirus, and the like. In viral enteritis, rotavirus is the main cause of diarrhea in infants and young children, and Norwalk virus is the main cause of viral viral gastroenteritis in adults and older children.

(2) Bacterial enteritis Bacterial enteritis is the most common pathogenic bacteria, followed by Campylobacter jejuni and Salmonella.

(3) Fungal enteritis See enteritis caused by histoplasma, algae, aspergillus, candida albicans, etc. Fungal enteritis is caused most by Candida albicans.

(4) Parasitic intestines Parasitic enteritis can be seen in enteritis caused by flagellates, coccidia, toxoplasma, ascaris, hookworms, etc. Enteritis caused by parasites is more common in amoeba.

(5) Enteritis caused by diet Contaminated or spoiled food, irritating chemicals, poisoning of certain heavy metals, and certain allergies can cause enteritis.

(6) Enteritis caused by antibiotics Abuse of antibiotics can cause intestinal flora imbalance, or enteritis caused by antibiotic-resistant strains.

2. Chronic gastritis

(1) Helicobacter pylori infection, virus or its toxin are more common after acute gastritis, and gastric mucosal lesions develop into chronic superficial gastritis and chronic atrophic gastritis over time. Mainly refers to Helicobacter pylori infection.

(2) Irritating substances Long-term drinking of irritating substances such as strong alcohol, strong tea, and strong coffee can destroy the protective barrier of the gastric mucosa and cause gastritis.

(3) Drugs Some drugs, such as butazone, indomethacin, simoxifen, salicylate, and digitalis, can cause chronic gastric mucosal damage.

(4) Chronic infections of the mouth and throat

(5) Bile reflux The bile salts contained in bile can damage the gastric mucosal barrier, causing the hydrogen ions in gastric juice to diffuse into the gastric mucosa and cause inflammation.

(6) X-ray irradiation Deep X-ray irradiation on the stomach can cause gastric mucosal damage and gastritis.

(7) Environmental changes If the environment changes or climate changes, if people cannot adapt within a short period of time, they can cause neurological disorders that dominate the stomach, and the secretion of gastric juice and movement of the stomach will not be coordinated, resulting in gastritis.

(8) Long-term mental stress and irregular life

(9) Impact of other lesions.

Clinical manifestations of chronic gastroenteritis

Chronic enteritis

The clinical manifestations are chronic chronic or recurrent abdominal pain, diarrhea, and indigestion. Severe cases may have mucus or watery stools. The severity of diarrhea varies, and those with mild bowel movements have 3 to 4 times of daily defecation, or diarrhea and constipation alternately; those with severe diarrhea can have it every 1 to 2 hours, and even have fecal incontinence. Some patients may have nocturnal diarrhea and / or postprandial diarrhea. When the rectum is severely affected, a sudden sensation may occur. The faeces are mostly mushy, mixed with a lot of mucus, often with pus and blood.

2. Chronic gastritis

Chronic gastritis lacks specific symptoms, and the severity of the symptoms is not consistent with the extent of gastric mucosal lesions. Most patients are asymptomatic or have varying degrees of dyspepsia such as epigastric pain, loss of appetite, postprandial fullness, and acid reflux. Patients with chronic atrophic gastritis may have anemia, weight loss, glossitis, diarrhea, etc. Individual patients with mucosal erosion have more obvious upper abdominal pain and may have bleeding, such as vomiting and melena. Symptoms often recur, with irregular abdominal pain. Pain often occurs during eating or after meals. Most of them are located in the upper abdomen, around the umbilicus, and some patients are not fixed. Mild intermittent pain or dull pain, severe severe colic. .

Chronic gastroenteritis examination

Chronic enteritis

(1) X-ray barium examination Generally, barium examination is not suitable for the acute stage. Special attention is paid to the possibility of intestinal dilatation and perforation when barium enema is used for severe ulcerative colitis. Barium enema is of great value in the diagnosis and differential diagnosis of this disease. Barium enema examination can be used to determine the proximal colonic disease during clinical quiescence period, and those with Crohn's disease should be excluded from barium meal examination of the whole digestive tract. Air-barium double contrast method is easier to find superficial mucosal lesions.

(2) Endoscopic examination Most clinically, the lesions are in the rectum and sigmoid colon. Using sigmoidoscopy is very valuable. For patients with chronic or suspected whole colon, a full colonoscopy should be performed. Generally, no clean enema is used, and those with severe acute stage should be listed as taboo to prevent perforation.

2. Chronic gastritis

(1) Gastric juice analysis The measurement of the basic gastric fluid secretion (BAO) and the histamine test or the pentagastrin gastrin measure the large secreted acid (MAO) and the peak secreted acid (PAO) to determine the function of gastric acid, which is helpful To diagnose chronic atrophic gastritis and guide clinical treatment. Chronic superficial gastritis has more normal gastric acid, and extensive and severe chronic atrophic gastritis has lower gastric acid.

(2) Serological test Serum gastrin is usually moderately increased in chronic atrophic gastritis, which is because gastric acid deficiency cannot inhibit G cell secretion. If the disease is severe, not only the secretion of gastric acid and pepsinogen is reduced, but also the secretion of endogenous factors is reduced, so that the impact of vitamin B12 is also reduced; serum PCA is often positive (more than 75%).

(3) Gastrointestinal X-ray barium meal examination With the development of digestive endoscopy, upper gastrointestinal angiography is rarely used in the diagnosis of gastritis. When using gas-barium double contrast to show the microstructure of gastric mucosa, atrophic gastritis may have relatively flat and reduced gastric mucosa.

(4) Gastroscopy and biopsy Gastroscopy and pathological biopsy are the main methods to diagnose chronic gastritis.

Diagnosis of chronic gastroenteritis

Enteritis

Varies by pathogen. Generally, preliminary judgment should be made based on medical history and clinical manifestations. Further diagnosis depends on laboratory tests. Bacterial enteritis can be used as vomit and stool culture, and the pathogen can be diagnosed.

2. Chronic gastritis

Chronic gastritis has no specific symptoms and few signs. X-ray examination generally only helps to exclude other gastric diseases. Therefore, the diagnosis should be performed by gastroscopy and gastric mucosa biopsy. Helicobacter pylori can be found in gastric mucosa in 50% to 70% of patients in China.

Chronic gastroenteritis treatment

Chronic enteritis

(1) Pathogen treatment Viral enteritis generally does not require pathogen treatment and can heal itself. For bacterial enteritis, it is best to choose antibacterial drugs based on the results of bacterial drug sensitivity tests. When suffering from bacterial dysentery, dysentery bacillus is widely resistant to commonly used antibacterials. Generally, compound sulfamethoxazole (compound neonomine), norfloxacin, gentamicin, amikacin and the like can be used. Campylobacter jejuni enteritis can be treated with erythromycin, gentamicin, and chloramphenicol. Yersinia enterocolitica colitis generally uses gentamicin, kanamycin, compound sulfamethoxazole, tetracycline, chloramphenicol and the like. Antibiotics are not required for patients with mild salmonella enteritis, and chloramphenicol or compound sulfamethoxazole may be used for severe patients. Aggressive E. coli enteritis is treated with neomycin, gentamicin, etc., and good results can be obtained. Enteritis caused by amoebic dysentery, flagellates, and trichomonas can be treated with metronidazole (metridium). Schistosomiasis can be treated with praziquantel. Candida albicans enteritis is administered orally with nystatin, which has a good effect. Patients with systemic fungal infections should be treated with amphotericin B.

(2) Symptomatic treatment Supplement fluids and correct electrolyte and acidosis. Those with mild dehydration and severe vomiting can take oral rehydration salts. The oral solution recommended by WHO is sodium chloride, sodium bicarbonate, potassium chloride, glucose or sucrose, and water. For severe dehydration or vomiting, normal saline, isotonic sodium bicarbonate and potassium chloride solutions, and glucose can be administered intravenously.

2. Chronic gastritis

Most of the chronic superficial gastritis can be reversed, and a small part can be turned into chronic atrophic gastritis. Chronic atrophic gastritis gradually increases with age, but mild cases can be reversed. Therefore, the treatment of chronic gastritis should be started as early as chronic superficial gastritis, and the treatment of chronic atrophic gastritis should also be insisted on.

(1) Eliminate the cause Eliminate various factors that may cause the disease, such as avoiding eating diets and drugs that have a strong irritation to the gastric mucosa, quitting smoking and avoiding alcohol. Pay attention to food hygiene to prevent overeating. Actively treat chronic diseases of the mouth, nose, and throat. Strengthen exercise to improve physical fitness.

(2) Drug treatment Atropine, Prubensin, Belladonna, etc. can be used for pain. PPI proton pump inhibitors such as esomeprazole, rabeprazole, lansoprazole, pantoprazole, and omeprazole can be used to increase gastric acid. H ₂ receptor blockers such as A Cimetidine, ranitidine, famotidine, aluminum hydroxide and the like. Those with gastric acid deficiency or no acid can be given 1% dilute hydrochloric acid or pepsin mixture, and those with indigestion can add pancreatin tablets, multi-enzyme tablets and other digestive aids. ¹³ C-breath test found that patients with H. pylori (+) should be treated with anti-H. Pylori 4-pair 14-day therapy. Those with obvious bile reflux can use metforman and morphine to enhance peristalsis of the gastric antrum and reduce bile reflux. Ursodeoxycholic acid, aluminum magnesium carbonate tablets, cholestyramine, and sucralfate can be combined with bile acids to reduce symptoms.