Chronic superficial gastritis

　　Although the pathogenic factors of chronic superficial gastritis have not been fully clarified, it has been determined that multiple factors may cause superficial gastritis. Common causes include:

　　1. Bacteria, viruses, and toxins It is more common after acute gastritis, where gastric mucosal lesions do not heal for a long time or recur repeatedly, gradually evolving into superficial gastritis.

　　2. Chronic infection in the nasal cavity, oral cavity, and pharynx Chronic infection foci in the nasal cavity, oral cavity, pharynx, etc., such as alveolar abscess, tonsillitis, sinusitis, etc., the 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.

　　3. Gastric acid Gastric acid is the acidic secretion in gastric juice. Normal gastric acid can digest food together with pepsin and kill Helicobacter pylori in the stomach. When there is excessive secretion of gastric acid, more gastric acid remains after neutralizing and digesting food, which can erode the gastric mucosa, eat away at the gastric wall, and lead to the occurrence of ulcers or inflammation of the mucosal layer.

　　4. Smoking The main harmful component in tobacco is nicotine. Long-term and excessive smoking can relax the pyloric sphincter, cause bile reflux from the duodenum, and constrict the blood vessels in the stomach, increase the secretion of gastric acid, and thereby destroy the gastric mucosal barrier, leading to chronic inflammatory lesions.

　　5. Medications Certain drugs such as salicylate preparations, corticosteroids, digitalis, indomethacin, and phenylbutazone can cause chronic damage to the gastric mucosa.

　　6. Irritating foods Long-term consumption of strong alcohol, strong tea, coffee, spicy and coarse foods, as well as irregular dietary habits such as hunger or overeating can all destroy the protective barrier of the gastric mucosa and lead to gastritis.

　　7. Dysfunction of the circulatory and metabolic systems The integrity of the structure and function of the gastric mucosa, as well as its defensive ability against various damage factors, are closely related to sufficient mucosal blood flow. Congestive heart failure or portal hypertension can keep the stomach in a state of congestion and hypoxia for a long time, leading to weakened gastric mucosal barrier function, reduced gastric acid secretion, excessive bacterial growth, and easy inflammation damage to the gastric mucosa. In chronic renal failure, the increased excretion of urea from the gastrointestinal tract, through the action of bacteria or intestinal hydrolytic enzymes, produces ammonium bicarbonate and ammonia, which produce刺激性 damage to the gastric mucosa, leading to congestion, edema, and even erosion of the mucosa.

　　8. Bile or duodenal fluid reflux Bile reflux, confirmed by fiberoptic gastroscopy, is an important cause of chronic gastritis. Due to the dysfunction of the pyloric sphincter or post-gastric surgery, duodenal fluid or bile can reflux into the stomach, destroying the gastric mucosal barrier and causing a series of pathological reactions, leading to chronic gastritis.

　　9. Helicobacter pylori (HP) infection Helicobacter pylori (HP) infection is one of the important causes of chronic gastritis. 60% to 90% of chronic gastritis patients have HP in their gastric mucosa, and the degree of HP infection is positively correlated with the degree of inflammation of the gastric mucosa. The pathogenic mechanism may be mainly through the destruction of the gastric mucosal barrier, making H⁺Backward diffusion, ultimately causing inflammation of the gastric mucosa.

　　10. Psychological factors Long-term stress, anxiety, or depression can cause imbalance in the function of the sympathetic and parasympathetic nervous systems, leading to disorders of the vascular contraction and relaxation of the gastric mucosa, causing a decrease in blood flow to the gastric mucosa, disrupting the protective function of the gastric mucosal barrier, and subsequently forming a chronic inflammatory response of the gastric mucosa.

　　Patients with chronic superficial gastritis may develop disorders of digestion and absorption due to long-term chronic inflammation of the stomach, leading to lesions in the stomach itself and systemic effects on nutrition metabolism, vegetative nerve function regulation, endocrine hormone release levels, growth and development, and overall immune function. This becomes an important potential factor for the development of complications. The complications of superficial gastritis include:

　　1. Ulcer disease

　　Superficial gastritis can cause atrophy, thinning, and erosion or ulceration of the gastric mucosa due to long-term inflammation and stimulation of the gastric mucosa.

　　2. Canceration

　　The canceration of chronic gastritis is closely related to gastritic hyperplasia, especially in patients with chronic gastritis accompanied by pernicious anemia and atrophic gastritis with intestinal metaplasia and severe atypical hyperplasia. If the damage to the gastric mucosa is not treated in time, it can lead to disorders of the vascular contraction and relaxation of the gastric mucosa, causing a decrease in blood flow to the gastric mucosa, disrupting the protective function of the gastric mucosal barrier, aggravating the chronic inflammatory response of the gastric mucosa, and ultimately leading to atrophy, metaplasia, and atypical hyperplasia of the gastric mucosa.

　　3. Anemia

　　Patients with superficial gastritis may develop nutritional or pernicious anemia due to decreased digestive function, reduced diet, and vitamin absorption disorders. Anemia can also occur after secondary gastrointestinal bleeding.

　　Patients with chronic superficial gastritis mainly present with chronic gastrointestinal symptoms, and some may not show any symptoms. Common clinical manifestations include:

　　1. Upper abdominal pain Upper abdominal pain is the most common symptom of chronic superficial gastritis, with abdominal pain often irregular and unrelated to diet. It usually manifests as diffused upper abdominal burning, dull, or bloating pain, and in a few cases, as severe pain that radiates to the back. Symptoms may worsen due to intake of cold, hard, spicy, or other irritant foods, and some may be related to changes in weather. This type of upper abdominal pain is not easily relieved by antispasmodics or antacids.

　　2. Abdominal distension Commonly caused by retention in the stomach, delayed emptying, and poor digestion.

　　3. Belching Due to the lack of gastric acid, fermentation and gas production in the stomach, and other factors, the accumulation of gas in the stomach leads to belching. With an increase in stomach gas, it is expelled through the esophagus, temporarily relieving the feeling of fullness in the upper abdomen.

　　4. Recurrent bleeding It is also a common manifestation of superficial gastritis. The cause of bleeding is an acute inflammatory change of the gastric mucosa on the basis of chronic superficial gastritis.

　　5. Other Loss of appetite, acid regurgitation, nausea, vomiting, fatigue, constipation, or diarrhea, etc. Patients with chronic superficial gastritis often have decreased appetite, or it may be good or bad at times. Inflammatory gastric mucosa is stimulated by physical, biological factors, as well as gastrointestinal motility disorders and retrograde peristalsis, causing nausea and vomiting. Most patients have constipation symptoms, while diarrhea is relatively rare.

　　The prevention of chronic superficial gastritis should mainly focus on attention to lifestyle and diet, actively avoiding and eliminating various pathogenic factors. Specific preventive measures include:

　　1. Early and thorough treatment of acute gastritis should be carried out to prevent the condition from developing into chronic superficial gastritis due to prolonged illness.

　　2. Discontinue or avoid using drugs that damage the gastric mucosa, such as aspirin, phenylbutazone, indomethacin, reserpine, tolbutamide, hormones, etc. If these drugs must be used, they should be taken after meals, or antacids and gastric mucosal protective drugs should be taken at the same time to prevent damage to the gastric mucosa.

　　3. Aggressively treat chronic infections in the oral cavity, nasal cavity, and pharynx to prevent long-term ingestion of bacteria or their toxins from local infection foci, causing inflammation of the gastric mucosa.

　　4. Have a regular diet, eat at fixed times and in fixed amounts, and avoid overeating or under-eating. Food selection should be light and nutritious, and avoid the intake of strong tea, coffee, spices, rough and hard foods. Quit smoking and drinking to prevent damage to the gastric mucosa.

　　5. Avoiding mental stress, depression, and overfatigue, and living a disciplined life with a balance between work and rest, maintaining an optimistic mood. At the same time, strengthen physical exercise, enhance physical fitness, and improve gastrointestinal motility function.

　　6. Aggressive treatment of systemic diseases that can lead to chronic gastritis, such as liver, gallbladder, pancreas, heart, kidney diseases, and endocrine disorders, etc.

　　Common examination items for chronic superficial gastritis include the following:

　　1. Gastroscopy and biopsy Taking a living tissue for pathological tissue examination during gastroscopy is the most reliable method for diagnosing chronic gastritis. Under endoscopy, superficial gastritis is manifested as punctate, patchy, or strip-like erythema on the gastric mucosa, with a rough and uneven mucosal surface, which may be accompanied by出血 spots or hemorrhagic macules, mucosal edema, and exudation.

　　2. Helicobacter pylori detection The positive rate of Helicobacter pylori infection in chronic gastritis is as high as 70-90%, which can be detected through gastroscopy, taking gastric mucosal tissue for examination, or by performing a breath test, or detecting antibodies to Helicobacter pylori in the blood for diagnosis of Helicobacter pylori infection. The rapid urease test is the preferred method for invasive examination, with simple operation and low cost. Histological examination can directly observe Helicobacter pylori and, when combined with the rapid urease test, can improve the accuracy of diagnosis.

　　3, X-ray barium meal造影 Most chronic superficial gastritis patients have no abnormal findings in X-ray barium meal造影.

　　The diet of chronic superficial gastritis patients should be light, nutritious, regular, and with proper timing and quantity. It is forbidden to be too hungry or too full, and to overeat. The following is a brief description of the common dietary therapy for chronic superficial gastritis patients:

　　Therapeutic diet method one

　　Shan Zha, Jin'e jin, fried Mai Ya each 20 grams, fresh山药块丁,小米each 60 grams, and sugar in appropriate amounts. Boil the first three ingredients in water to extract the juice, add小米to cook until dissolved, then add the山药and mix well to cook into a porridge, add sugar to taste. Take one dose daily, divided into two servings. It has the effects of invigorating the spleen and opening the stomach, digesting food and promoting bowel movement, etc. It is suitable for chronic superficial gastritis with weakness of the spleen and stomach, decreased food intake, epigastric and abdominal fullness, bowel sounds, diarrhea, or poor digestion, etc.

　　Therapeutic diet method two

　　Shan Zha 20 grams, fried Gu Ya, fried Shen Qu, Da Liu Zi each 10 grams, radish slices 10 grams, scallion slices, ginger juice, salt, and monosodium glutamate in appropriate amounts. Boil the first four ingredients in water to extract the juice, add the remaining ingredients and cook until the radish is soft and well-flavored. Take one dose daily, divided into two servings. It has the effects of digesting food and harmonizing the stomach, regulating qi and reducing bloating, etc. It is suitable for chronic superficial gastritis with food retention, epigastric distension, especially after eating, sometimes belching, poor appetite, etc.

　　Therapeutic diet method three

　　Coix seed, rice each 60 grams, winter melon peel 30 grams, Tai Zi Shen, Yun Fu Ling, Jiao Shen Qu each 15 grams, Bai zhu, Zhì Gan Cao, Chen Pi, Fa Ban Xia, Mu Xiang each 10 grams, and sugar in appropriate amounts. Boil the last nine ingredients in water to extract the juice, add the first two ingredients to cook into a porridge, then add sugar to taste. Take one dose daily, divided into two servings. It has the effects of clearing heat and promoting diuresis, invigorating the spleen and harmonizing the stomach, etc. It is suitable for chronic superficial gastritis with spleen deficiency and dampness retention, food accumulation and heat.

　　Therapeutic diet method four

　　Coix seed, Euryale ferox, mung bean, rice each 30 grams, Poria cocos, Bai zhu, Huang Bai, Zhishi each 10 grams, and sugar in appropriate amounts. Boil Poria cocos, Bai zhu, Huang Bai, and Zhishi in water to extract the juice, add the first four ingredients to cook into a porridge, then add sugar to taste. Take one dose daily, divided into two servings. It has the effects of clearing heat and promoting diuresis, invigorating the spleen and harmonizing the stomach, etc. It is suitable for chronic superficial gastritis with spleen deficiency and dampness.

　　Therapeutic diet method five

　　Jin'e jin, Huang Qi each 20 grams, carrot cubes, white radish cubes each 100 grams, scallion slices, ginger shavings, salt, monosodium glutamate, and vegetable oil. Boil the first two ingredients in water to extract the juice, add the remaining ingredients to cook until the radish is soft and well-flavored. Take one dose daily, divided into two servings. It has the effects of invigorating the spleen and digesting food, regulating qi and promoting bowel movement, etc. It is suitable for chronic superficial gastritis of the disharmony of the spleen and stomach type.

　　Therapeutic diet method six

　　Jin'e jin, Bai zhu each 20 grams, Zhishi 10 grams, cooked pork stomach shreds, rice each 100 grams, cooking wine, scallion slices, ginger shavings, salt, and monosodium glutamate in appropriate amounts. Boil the first three ingredients in water to extract the juice, add rice to cook until dissolved, then add the remaining ingredients and cook to a porridge. Take one dose daily, divided into two servings. It has the effects of invigorating the spleen and digesting food, regulating qi and promoting bowel movement, etc. It is suitable for chronic superficial gastritis of the disharmony of the spleen and stomach type.

　　Chronic superficial gastritis is often caused by irregular diet, so patients should eat light, nutritious, regular, and moderate food during treatment, with fixed times and amounts. Avoid overeating and overeating, and avoid strong tea, coffee, spices, rough and hard foods, quit smoking and drinking, and avoid drugs that damage the gastric mucosa, such as aspirin, phenylbutazone, indomethacin, reserpine, tolbutamide, hormones, etc. If these drugs must be used, they should be taken after meals or taken with antacids and gastric mucosal protective drugs to prevent damage to the gastric mucosa. Try to avoid stress, depression, and overwork, and maintain a regular lifestyle, combine work and rest, be optimistic, and strengthen physical exercise to enhance physical fitness and strengthen gastrointestinal motility. Commonly used drug treatments for chronic superficial gastritis include:

　　1. Gastric parietal cell receptor antagonists H2 histamine receptor antagonists, gastrin receptor antagonists, and acetylcholine receptor antagonists can all reduce gastric acid secretion and are used to treat gastritis, especially suitable for those with high gastric acid levels. Commonly used drugs include cimetidine, ranitidine, famotidine, etc. Omeprazole, rabeprazole, pantoprazole, and other drugs are proton pump inhibitors and can effectively inhibit gastric acid secretion.

　　2. Drugs for protecting the gastric mucosa This class of drugs can quickly establish a protective layer for the gastric mucosa, resist acid erosion, and prevent further damage to the gastric mucosa. Common drugs include sucralfate, colloidal bismuth subcitrate, and Meiziling-S granules, etc.

　　3. Controlling Helicobacter pylori (HP) infection Helicobacter pylori (HP) is closely related to superficial gastritis, and drugs that kill HP are beneficial for the treatment of superficial gastritis. Common drugs include omeprazole, metronidazole, amoxicillin, clarithromycin, bismuth potassium citrate, and others. Generally, a combination of three to four drugs is used to enhance the effect of clearing HP.

　　4. Medications for controlling and improving bile reflux Gastroesophageal reflux disease can cause gastritis due to the destruction of the gastric mucosal barrier, so it can be treated with medications such as antacids, antiemetics, domperidone, cisapride, and cholestyramine to control and improve bile reflux.