Gastrointestinal Stones

　　I. Gastrointestinal stones

　　1. Plant stomach stones are mainly composed of various undigested plant components, including tannins, cellulose, pectin, and gels. Gastric persimmon stones are the most common type of plant stones.

　　2. Hair stones are composed of hair and can also be mixed with yarn and animal hair, and are more common in neurotic women with a habit of swallowing hair, and occur most often between the ages of 20 to 30.

　　3. Lactic acid stones are more common in low birth weight newborns fed with high-concentration milk.

　　4. There is a substance called tannin in persimmons and black jujubes. In unripe persimmons, its content can reach up to 2b%. The astringent feeling in the tongue when eating raw persimmons is caused by tannins. Persimmons also contain resins and pectins. After eating unripe persimmons, tannins can combine with proteins to form tannic acid protein that is not easily soluble in water under the action of stomach acid, precipitate in the stomach, and tannic acid protein, resins, and pectins can stick together persimmon seeds, vegetable plant fibers, and form stomach persimmon stones in the stomach.

　　II. Physiology

　　1. Plant stomach stones: Persimmons contain tannins, resins, and pectins. Under the action of stomach acid, tannins combine with proteins to form tannic acid protein, which then combines with pectin, resin, and cellulose to form stomach persimmon stones. High acid environment is a condition for the occurrence of stomach stones. Hawthorns, black jujubes, and other fruits also contain a large amount of pectin and tannins, which can often form stomach stones. The persimmons produced in the south have loose and juicy flesh, which is not easy to form stones. Stomach stone syndrome in the remnant stomach generally occurs in patients with gastric motility disorders, and is mostly of plant origin. The reasons such as high dietary fiber content, reduced postoperative output drainage, and less food mastication cause the roots, leaves, and bark of plants to condense into stones in the stomach with mucus.

　　2. Hair stones occur when hair enters the stomach and adheres to the mucosa and is not easily expelled. Repeated intake leads to the formation of hair balls due to entanglement and intertwining. Hair stones are often in the shape of J or U, with a rough and uneven surface, coated with mucus, and have a foul smell. Long-term stimulation of the stomach can lead to ulcers or perforations.

　　3. Lactate calculi are more common in low-birth-weight newborns fed with high-concentration milk, as low-birth-weight newborns have weak gastric motility, and high-concentration milk can form lactate calculi in the stomach. Shellac calculi are common in painters with the habit of suckling shellac alcohol, and some drug ingredients such as calcium carbonate, bismuth preparations, and some hard traditional Chinese medicine pills, as well as barium sulfate used for imaging, can also form intestinal calculi in the stomach.

　　In addition to general symptoms, it may also cause other diseases. Once the disease is diagnosed, timely endoscopy and endoscopic碎石术 should be performed to avoid complications such as gastrointestinal ulcer bleeding and obstruction. Therefore, once found, active treatment should be sought, and preventive measures should also be taken in daily life.

　　1. Functional dyspepsia usually has dyspepsia syndrome, such as acid regurgitation, belching, nausea, upper abdominal fullness and discomfort, but endoscopy and barium meal examination often show no positive findings, belonging to functional disorders.

　　2. Chronic gastritis is characterized by chronic irregular upper abdominal pain, which can be differentiated by endoscopy, often showing chronic antral gastritis.

　　3. Gastrinoma, also known as Zollinger-Ellison syndrome, is caused by the secretion of large amounts of gastrin by pancreatic delta cells. The diagnostic criteria are: ①BAO>15mmol/h, BAO/MAO>0.6; ②X-ray examination shows atypical location ulcers, especially multiple ulcers; ③refractory ulcers that are prone to recurrence; ④accompanied by diarrhea; ⑤serum gastrin level increased >200pg/ml (often >500pg/ml).

　　4. The differential diagnosis method for the malignancy of gastric ulcer or gastric cancer is endoscopy combined with biopsy and barium meal examination. Biopsy should be performed during endoscopy to determine the benign or malignant nature.

　　5. For intermittent upper abdominal pain due to gastric mucosal prolapse, antacids may not alleviate the symptoms, but changing the position to the left lateral position may help. Endoscopy and barium meal can be used for differentiation. Barium meal X-ray examination can show a 'mushroom-like' or 'parachute-like' defect shadow in the duodenal bulb.

　　First, the taboo of intestinal calculi

　　1. During the acute attack phase, it is forbidden to eat fried or cooked foods, eggs, meat soup, and drinking alcohol; eating should be limited to low-fat, low-protein, and small amounts of easily digestible fluids or semi-solids.

　　2. Daily meals should mainly consist of light and easily digestible foods. Avoid eating animal brains, kidneys, egg yolks, fried foods, and spicy dishes.

　　3. In terms of diet, it is advisable to eat at regular intervals and in moderate portions, avoiding overeating. In terms of dietary structure, fat and cholesterol-containing foods, such as fatty meat, fried foods, and animal organs, should be strictly controlled. Foods to avoid include strong tea, coffee, curry, scallions, garlic, seafood, fish, shrimp, and crabs, etc.

　　4、不可饮酒和进食辛辣食物，宜多吃萝卜、青菜、豆类、豆浆等副食。萝卜有利胆作用，并能帮助脂肪的消化吸收；青菜含大量维生素、纤维素；豆类含丰富的植物蛋白。

　　4. Do not drink alcohol and eat spicy foods, and eat more vegetables, beans, soy milk, and other side dishes. Radishes have a choleretic effect and can help in the digestion and absorption of fats; vegetables contain a large amount of vitamins and fiber; beans contain abundant plant protein.

　　5. Avoid spicy or gas-producing foods, such as radishes and onions, and smoking is prohibited.

　　6. Adopt small and frequent meals, and pay attention to drinking more water.

　　Second, dietary management of gastrointestinal stones

　　1. In daily life, it is necessary to drink more water, develop the habit of drinking water, and it is best to drink magnetized water.

　　2. Do not overeat or restrict excessive nutrition. Because overeating is usually high-protein, high-sugar, and high-fat diet, which can increase the risk of stone formation. In daily life, it is appropriate to eat more coarse grains and vegetarian food.

　　3. Try not to take or take as few as possible drugs related to stones, such as vitamin C, aspirin, and sulfonamide drugs.

　　First, examination

　　Patients with a history of eating persimmons, hawthorn, and black dates, and symptoms such as recurrent upper abdominal pain, vomiting, and black stools shortly after eating, should be vigilant about gastric stones, which can be diagnosed by gastroscopy and X-ray examination. Laboratory examination: some patients may present with small cell hypochromic anemia. Some patients have positive occult blood test in feces, and initial examination may show persimmon peel-like substances. Gastric acid analysis shows that the free acid in the gastric juice is higher than that in normal people.

　　Second, other auxiliary examinations

　　1. X-ray examination Barium meal X-ray or barium double contrast examination can show the phenomenon of barium separation in the stomach, and display floating free, mass-like, round or elliptical filling defects above the barium, while the gastric mucosal structure is smooth and the gastric wall is soft. After the barium in the stomach is empty, there are still visible barium streaks adhering to the mass shadow, with no significant tenderness when pressing the mass shadow, and the contour shape and position can change with force, indicating that the mass has certain compressibility and mobility.

　　2. Fiberoptic endoscopy Under fiberoptic endoscopy, the morphology and characteristics of gastric stones can be directly observed. Plant gastric stones, due to different components, can be yellow, brown, brown or green, usually circular or elliptical single or multiple free masses. The hair gastric stone is generally black or brownish, in the shape of a 'J' or kidney, which can fill the stomach or extend into the duodenum. Fiberoptic endoscopy can also determine whether there are other signs such as gastritis or ulcer disease in the stomach, and if necessary, it can also remove the mass components or stomach tissue of complications for analysis. Therefore, fiberoptic endoscopy should be the first choice for diagnosing suspected gastric stone disease.

　　3. Ultrasound examination Ultrasound can be helpful in diagnosing gastric stones. Usually, patients are asked to drink 500-1000ml of water, and the examination is performed in a sitting or semi-recumbent position. Clear boundaries can be seen in the stomach, with echoic mass images floating on the water surface, which can change position with body position changes or stomach peristalsis.

　　1. Take 20g of pumpkin seeds, shell and take the kernel, grind into paste, mix with an appropriate amount of sugar, and take with warm water in the morning and evening on an empty stomach.

　　2. Take 100g of walnut kernel and 200g of rice, cook into a thin gruel for drinking.

　　3. Cut 5 fresh starfruit into pieces, add 5 bowls of clear water, decoct to 3 bowls, and drink with honey.

　　4. Take 30g to 60g of water caltrop stem, decoct it as tea to drink.

　　5. Mash the fresh luffa and take its juice, mix with honey, take half a cup each time, twice a day.

　　6. Cut the 100cm of sunflower stem into 3cm long pieces, decoct and take as a decoction, once a day, for a month.

　　Surgical treatment of gastrointestinal stones:There are many methods for the treatment of gastrointestinal stones, and the specific treatment measures adopted are determined according to the nature of the stones, the physiological and pathological conditions of the patients, and the equipment conditions of the hospital, among other specific circumstances.

　　1. The treatment of gastrointestinal stones with internal medicine includes the use of both Chinese and Western medicine to change the internal environment of the stomach, making the stones soft, soluble, and smaller, improving the gastric motility function, and promoting their natural excretion. The treatment of vegetable stones with sodium bicarbonate has a long history, with the usual oral dose being 3 to 4g per time, 3 times a day, and a course of treatment lasting 7 to 10 days. It is also possible to take an equal amount of a foaming agent at the same time to enhance the efficacy and shorten the course of treatment. Some people advocate adding 0.5 to 1g of pepsin or trypsin on top of the aforementioned treatment, or 5 to 10mg of chymotrypsin (alpha-chymotrypsin) dissolved in 50 to 100ml of water for oral administration or injection through a gastric tube. It is also possible to add 0.5g of acetylcysteine dissolved in 50ml of physiological saline and injected through a gastric tube, for a continuous period of 2 to 3 days, to digest some components of the stones, causing the stone structure to disintegrate and dissolve, and then be excreted. For patients with poor gastric motility, metoclopramide (Stomach Comfort), domperidone, or cisapride can be used to promote gastric peristalsis to facilitate stone excretion. In addition, taking 50mg of papain or 5mg of cellulase dissolved in 1000ml of water for 2 consecutive days can also be effective. The treatment of gastrointestinal stones with traditional Chinese medicine is one of the traditional internal medicine treatment methods. Traditional Chinese medicine believes that the pathogenesis of gastrointestinal stones belongs to food retention and stagnation in the stomach, so the treatment methods of resolving food retention, softening and dispersing nodules, harmonizing the stomach and spleen, and promoting Qi and blood circulation are often used, and the decoction for resolving nodules and stones is commonly used. The main ingredients of the prescription are magnolia bark, hawthorn fruit, malt, millet, chicken gizzards, areca nut, rhizoma et radix sparganii, rhizoma et radix curcumae, peach kernel, salvia miltiorrhiza, etc., which are decocted and taken, 2 to 3 times a day, for 5 to 7 consecutive days, and adjustments are made according to the symptoms. For example, add Yuanhu, Bai Shao, and Gancao for abdominal pain; add Banxia and Zhu Ru for vomiting; add Baiji and Stir-fried Dahuang for hidden blood in stool; add Dangshen and Tai Shengshen for weakness; and add Dahuang or Fanchaoye for constipation. Whether it is Western medicine or traditional Chinese medicine treatment, the medication should be taken between meals or on an empty stomach, which is conducive to the full action of the drug with the stones and improves the therapeutic effect.

　　2、手法碎石疗法对于无明显症状和无并发症的胃石患者，如柿石、山楂胃石等，可以试行腹外按摩压挤，使胃结块破碎变成小块状，然后进行洗胃或给予泻剂，加快结块排出。

　　3、X线下网套碎石法早年曾用金属导线制成一网套插入胃管中，在钡剂显示胃石时让套网套住并拉紧导线切割胃石。反复操作使其切成碎块自然排出。也可在此基础上加服碳酸氢钠、甲氧氯普胺(胃复安)等促进排石。

　　4、纤维内镜下碎石应用纤维内镜治疗胃石发展很快，搭配方法很多。可以在镜下用活检钳咬割、钳切、捣击、穿刺破坏胃石包膜或外壳，并反复用水冲洗干净；也可利用内镜手术刀反复剪断胃石包膜和结块。或在纤维内镜下用钢丝圈套器，套切石体，再用兜抓钳抓成碎块，让其自然排出。近年来纤维内镜下激光引爆碎石成为中国外治疗胃石有效的新途径，尤其是较大较硬的胃石，插入纤维内镜看清胃石，用生理盐水冲洗干净使其充分暴露。再注入生理盐水让胃石半浸泡于水中，使其在爆破时有一定的缓冲力。然后经胃镜活检钳管道插入光纤弹头，并使其顶住结石中心部位的表面上，此时使激光器充电引爆，可把结石炸裂或炸开一小洞，再沿裂缝或小洞反复引爆3～5根弹头后，结石可被击成小块或颗粒状。此外，还有在纤维内镜下微波碎石，也是晚近应用于治疗胃石的另一简便方法。常规内镜下暴露结石，通过活检钳孔插入微波天线，选用功率为60～90W，将微波电极头对准胃石，通电进行反复烧灼，并变换结石位置，直到胃石灼成蜂窝状或断裂成碎块为止。上述纤维内镜下碎石过程中，可经活检钳插入细塑管，对着被击碎的胃石注入10％碳酸氢钠150～200ml，有利于胃石的软化排出，提高治愈率。如果胃石患者没有合并胃炎、溃疡病等，碎石后不需特殊处理，建议进食少渣饮食3天，1周后复查；若合并胃炎、溃疡病者，则给予抗生素、胃黏膜保护剂及组胺、H2受体拮抗药等相应治疗。

　　5、体外冲击波治疗体外冲击波从治疗肾结石发展到治疗胆结石，已试用于治疗胃结石获得成功。治疗前2天进流质饮食，治疗时不需任何麻醉，嘱患者饮水500ml使胃充盈，俯卧B超定位后，以12kv电压每分钟放电80次，共冲CDD击1500～2000次，一般结石便呈破碎状影。治疗过程患者无任何不适，也不造成胃黏膜损伤。3天后B超复查，了解胃石是否排尽。

　　6、外科手术治疗胃结石较大、坚硬难溶，经内科治疗、内镜下碎石、微波或冲击波等治疗未能奏效，或并发较严重胃溃疡、出血、穿孔或梗阻者，以采用外科手术治疗为宜。