Chronic superficial gastritis

1. Causes

1. Bacteria, viruses and toxins

It is common after acute gastritis, when the gastric mucosal lesions do not heal for a long time or recur repeatedly, gradually evolving into superficial gastritis. Chronic infection lesions in the nasal cavity, oral cavity, pharynx, etc., such as alveolar pus, tonsillitis, sinusitis, etc., long-term ingestion of bacteria or their toxins, can repeatedly stimulate the gastric mucosa and cause superficial gastritis. It has been found that 90% of patients with chronic tonsillitis have chronic inflammatory changes in the stomach.

2. Smoking

The main harmful component of tobacco is nicotine. Long-term and heavy smoking can cause relaxation of the pyloric sphincter, reflux of duodenal fluid, contraction of gastric blood vessels, and increased secretion of gastric acid, thus destroying the gastric mucosal barrier and leading to chronic inflammatory lesions. According to Edward's discovery, 40% of people who smoke more than 20 cigarettes a day may develop gastric mucosal inflammation.

3. Medication

Certain drugs such as salicylic acid preparations, corticosteroids, digitalis, indomethacin, and phenylbutazone can cause chronic gastric mucosal damage.

4. Spicy food

Long-term consumption of strong liquor, strong tea, coffee, spicy and rough food, as well as irregular eating habits such as being too hungry or too full can damage the protective barrier of the gastric mucosa and cause gastritis.

5. Circulatory and metabolic dysfunction

In case of congestive heart failure or portal hypertension, the stomach is in a state of congestion and hypoxia for a long time, which leads to weakened gastric mucosal barrier function, reduced gastric acid secretion, and massive bacterial reproduction, which can easily cause inflammatory damage to the gastric mucosa. In case of chronic renal failure, urea is excreted from the gastrointestinal tract more, and ammonium carbonate and ammonia are produced through the action of bacteria or intestinal hydrolases, which irritate and damage the gastric mucosa, causing congestion, edema, and even erosion of the gastric mucosa.

6. Bile or duodenal fluid reflux

Gastroscopy has revealed or confirmed that bile reflux is an important cause of superficial gastritis. Due to pyloric sphincter dysfunction or gastric surgery, duodenal fluid or bile can reflux into the stomach and destroy the gastric mucosal barrier, prompting H+ and pepsin to diffuse back into the mucosa, causing a series of pathological reactions and leading to superficial gastritis.

7. Helicobacter pylori (Hp) infection

In 1986, the 8th World Gastroenterology Association Congress proposed that Hp infection is one of the important causes of superficial gastritis. The pathogenic mechanism of Hp may be mainly through destroying the gastric mucosal barrier, causing H+ to diffuse in the opposite direction, and finally causing inflammation of the gastric mucosa.

8. Psychological factors

Due to unhealthy mental health, long-term mental tension, anxiety or depression can cause systemic sympathetic and parasympathetic nerve function imbalance, leading to gastric mucosal vasomotor dysfunction, resulting in reduced gastric mucosal blood flow, damage to gastric mucosal barrier function, and formation of chronic gastric mucosal inflammatory response.

2. Clinical manifestations

1. Upper abdominal pain

The most common symptom is epigastric pain, which is experienced by most patients with chronic superficial gastritis. Epigastric pain is often irregular and unrelated to diet. The pain is usually diffuse, burning, dull, or bloating. Symptoms are often aggravated by eating cold, hard, spicy, or other irritating foods, and a few are related to climate change.

2. Abdominal bloating

Patients with chronic superficial gastritis often have abdominal distension, which is often caused by food retention in the stomach, delayed emptying, and indigestion.

3. Belching

The patient has belching, which indicates that the gas in the stomach increases and is discharged through the esophagus, temporarily relieving the upper abdominal fullness.

4. Recurrent bleeding

It is a common symptom. The cause of bleeding is an acute inflammatory change of the gastric mucosa complicated by chronic superficial gastritis.

5. Others

Loss of appetite, acid reflux, nausea, vomiting, fatigue, constipation or diarrhea, etc.

6. Physical signs

There is upper abdominal tenderness during examination, and a few patients may have weight loss and anemia.

3. Inspection

1. Gastroscopy

It is the main method for diagnosing chronic superficial gastritis.

2. Helicobacter pylori test

The positive rate of Helicobacter pylori infection in chronic superficial gastritis is as high as 70% to 90%. It can be examined by taking gastric mucosal tissue through gastroscopy, or by checking Helicobacter pylori antibodies in the patient's blood. In addition, it can also be checked before and after anti-Helicobacter pylori treatment for superficial gastritis as one of the tracking indicators.

IV. Treatment

1. Eliminate the cause

For example, quit smoking and drinking, reduce salt intake; correct bad eating habits, avoid foods that irritate the stomach, eat soft and easy-to-digest foods, avoid foods that are too rough, too strong in spices, and too hot or too cold. Eat less salted, smoked, and stale foods; and stop taking certain drugs that irritate the gastric mucosa, especially non-steroidal anti-inflammatory drugs such as aspirin; chronic infection foci in the nasal cavity and pharynx should be removed.

2. Drug treatment

(1) Commonly used drugs for protecting the gastric mucosa include colloidal bismuth subcitrate (CBS), sucralfate, smectite, mezilin-S, aluminum hydroxide gel, gastrosin and gastric mucosa.

(2) Drugs for regulating gastrointestinal motility: Metoclopramide or domperidone can be used for upper abdominal distension. For patients with hiccups, abdominal distension or reflux, gastrokinetic drugs such as metoclopramide, metoclopramide and mosapride can be used.

(3) Antibiotics If the gastroscopy shows Helicobacter pylori is positive, antibiotics should be taken. Clarithromycin, amoxicillin, etc., all have the effect of clearing Hp. Generally, two types can be selected, and they are often used in combination with gastric mucosal protectants and antacids.

(4) Commonly used antacids include cimetidine, ranitidine, famotidine, sodium bicarbonate (baking soda), magnesium hydroxide, aluminum hydroxide gel, and gadolinium.

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

(6) Digestive aids such as pancreatic enzymes, yeast tablets, lactase, and anti-bloating tablets can also be used. If there is acid reflux, acid suppressants such as Tagamet, ranitidine, and famotidine can also be used. To prevent bile reflux, aluminum carbonate magnesium and cholestyramine can be taken to absorb bile; for those who have vomiting blood and bloody stools, cimetidine can be taken orally.

3. Diet therapy

The dietary therapy for chronic superficial gastritis should be combined with the patient's constitution and the nature of the disease. For example, people with weak spleen and stomach should eat ginger, pepper and other warm and cold-dispersing foods. People with insufficient stomach yin should eat lily, pear, lotus root, honey, milk and other sweet and moist foods. Patients with qi stagnation can use more carrots, kumquat cakes, orange peels, etc. And those with weak spleen and stomach should eat more red dates, yam, lotus seed heads and other foods.

Eat more soft food. Eat food that is easy to digest, minimize irritation to the gastric mucosa, chew slowly and thoroughly, let the teeth grind the food completely so that the food can be fully mixed with gastric juice. Avoid eating raw, cold, sour, spicy and hard food. Eat small meals frequently and cook coarse grains carefully.

Patients with stomach problems can eat 5 meals. The following are some examples:
Breakfast: 50 grams of rice porridge, 50 grams of steamed buns, 1 boiled egg, and 1 piece of fermented tofu.

Snack 1: 300 grams of milk, 10 grams of sugar and 15 grams of biscuits.

Lunch: 100 grams of rice, 100 grams of steamed fish fillet, spinach and egg soup.

Snack 2: 300 grams of soy milk, 10 grams of sugar, and 25 grams of cake.

Dinner: 50 grams of rice porridge, 50 grams of steamed cake, 150 grams of minced meat and mashed potatoes.

If there is malnutrition or anemia, you should give your baby more eggs, fresh vegetables, animal liver, kidneys, etc.

People with excessive stomach acid should avoid concentrated broth and acidic foods to avoid causing more stomach acid secretion. They can use milk, vegetable puree, starch, bread, etc. The taste should be light and low in salt.

People with too little stomach acid can be given thick broth or gravy to stimulate the secretion of gastric acid, aid digestion and promote appetite.

General principles: non-irritating, low-fiber, easy to digest, and nutritious diet; eat small meals frequently.

The onset of chronic superficial gastritis is often related to dietary factors, such as long-term drinking of strong alcohol, strong tea, coffee, excessive chili condiments, and intake of salty, sour and rough foods that repeatedly irritate the gastric mucosa. More importantly, unreasonable eating habits, irregular diet, overeating, or long-term lack of protein and B vitamins can cause gastric mucosal degeneration.

4. Traditional Chinese medicine

(1) Baohe Pills

Main ingredients: Liushenqu, hawthorn, pinellia, tangerine peel, forsythia, and radish seeds.

Function: Helps digestion, relieves stagnation, soothes the stomach and strengthens the spleen.

Indications: Poor appetite, abdominal distension, heartburn, belching, etc. caused by food stagnation in the stomach.

(2) Yuejuwan

Main ingredients: Cyperus rotundus, Ligusticum chuanxiong, Gardenia jasminoides, Atractylodes macrocephala, and Liushenqu.

Function: Regulate Qi, relieve fullness, relieve depression and reduce bloating.

Indications: chest and epigastric distension, abdominal fullness, belching and acid regurgitation.

(3) Xiangsha Liujunzi Pills

Main ingredients: costus root, amomum villosum, codonopsis pilosula, atractylodes macrocephala, poria, licorice, pinellia tuber, and tangerine peel.

Function: Strengthens the spleen and stomach, regulates qi and relieves pain.

Indications: chest and abdominal distension, vomiting and diarrhea.

(4) Xiangsha Yangwei Pills

Main ingredients: Amomum villosum, costusroot, Atractylodes macrocephala, Poria cocos, Citrus aurantium, cardamom seed, Magnolia officinalis, Cyperus rotundus, tangerine peel, Pinellia ternata, Licorice, and Patchouli.

Function: Strengthens the spleen and stomach, regulates Qi and eliminates stagnation.

Indications: poor appetite, fatigue, stomach pain, abdominal distension, belching, and acid reflux.

(5) Shugan Pills

Main ingredients: Bupleurum, Magnolia officinalis, Ligusticum chuanxiong, Cyperus rotundus, Citrus aurantium, Aquilaria wood, Amomum villosum, Costus root.

Function: Soothe the liver and relieve depression, harmonize the stomach and relieve pain.

Indications: pain and distension in the flanks, abdominal distension, belching, and nausea.

(6) Qi stagnation stomach pain granules

Main ingredients: Bupleurum, Citrus aurantium, Licorice, Cyperus rotundus, etc.

Function: Soothe the liver and promote qi circulation, harmonize the stomach and relieve pain.

Indications: chest distension and pain due to liver depression and qi stagnation, stomach pain, etc.

(7) Liangfu Pills

Main ingredients: Alpinia officinalis, Cyperus rotundus.

Function: Warming the middle and dispelling cold, promoting qi circulation and relieving pain.

Indications: Cold pain in the abdomen due to deficiency-cold in the middle burner, and preference for warmth.

(8) Wenweishu Capsules

Main ingredients: Codonopsis pilosula, Atractylodes macrocephala, Crataegus pinnatifida, Astragalus membranaceus, Cistanche deserticola, etc.

Function: Strengthen the body, warm and nourish the stomach, promote qi and relieve pain, assist yang and warm the earth.

Indications: Treatment of chronic atrophic gastritis, cold pain in the stomach caused by chronic gastritis, bloating, belching, poor appetite and chills.

(9) Yin deficiency stomachache granules

Main ingredients: Adenophora adenophora, Ophiopogon japonicus, Toosendan fruit, Licorice root, etc.

(10) Yangweishu Granule

Main ingredients: Codonopsis pilosula, Polygonatum sibiricum, Panax notoginseng, Prunus mume, Atractylodes macrocephala, Cuscuta australis, etc.

Function: Strengthen the body, nourish yin and stomach, regulate the middle burner, promote qi and promote digestion.

Indications: Used for chronic atrophic gastritis, gastric burning sensation, hot palms and soles, dry and bitter taste in the mouth, poor appetite, etc. caused by chronic gastritis.

(11) Wei Nai An Capsules

Main ingredients: Astragalus, Panax notoginseng, synthetic bezoar, pearl layer powder.

Function: Tonify Qi and strengthen the spleen, calm the mind and soothe the nerves, promote Qi and blood circulation, reduce inflammation and promote tissue regeneration.

Indications: Gastric and duodenal ulcers, chronic gastritis.

(12) Weikangling Capsules

Main ingredients: Eight medicinal herbs including white peony root, licorice, Corydalis yanhusuo, and Panax notoginseng.

Function: Softens the liver and stomach, disperses blood stasis and stops bleeding, relieves acute pain, removes dead tissue and promotes new growth.

Indications: Suitable for chronic gastritis, gastric ulcer, gastric bleeding and duodenal ulcer, etc.

(13) Sanjiu Weitai

Main ingredients: Tripterygium wilfordii, Osmanthus fragrans, White Peony Root, Rehmannia glutinosa, and Costusroot.

Function: Anti-inflammatory and analgesic, regulating qi and strengthening the spleen.

Main indications: various types of chronic gastritis, including superficial gastritis, erosive gastritis, atrophic gastritis, etc.

(14) Monkey mushroom tablets

Main ingredients: Hericium erinaceus.

Function: Anti-inflammatory and analgesic.

Main indications: chronic gastritis, gastric and duodenal ulcers, gastric cancer, and esophageal cancer.

5. Contraindicated drugs

Chronic superficial gastritis patients have certain restrictions on the drugs they can take because their gastric mucosa is already in a state of congestion, edema, punctate bleeding and erosion. If the following drugs are taken or used by mistake, it may aggravate the damage to the gastric mucosa, causing upper abdominal discomfort, nausea and vomiting symptoms; in severe cases, it may cause gastric ulcers and difficult-to-detect gastric bleeding, causing the patient to unknowingly develop anemia, physical decline, low resistance, and easily develop other diseases.

Drugs that patients with chronic superficial gastritis should not take include:

(1) Salicylic acid: aspirin, sodium salicylate.

(2) Aniline: paracetamol, phenacetin.

(3) Pyrazoles: phenylbutazone, aminopyrine.

(4) Other anti-inflammatory organic acids: indomethacin, ibuprofen.

(5) Antibiotics: tetracycline.

(6) Glucocorticoids: prednisone, dexamethasone, cortisone.