Chronic gastritis

　　Chronic gastritis is caused by various factors. It has been clearly established that Helicobacter pylori infection is the most common cause of chronic gastritis, and some people refer to it as Helicobacter pylori-associated gastritis. However, other physical, chemical, and biological harmful factors that act repeatedly and continuously on susceptible individuals can also cause this disease. The persistence or recurrence of the etiology can lead to chronic lesions.
　　1. Long-term use of drugs, foods, and rough foods that irritate the stomach, as well as smoking, and other factors. These factors repeatedly act on the gastric mucosa, causing congestion and edema.
　　2. Long-term congestion and hypoxia of the gastric mucosa. For patients with congestive heart failure or portal hypertension, the gastric mucosa is in a state of congestion and hypoxia for a long time, causing nutritional disorders and leading to gastritis.
　　3. If acute gastritis is not treated properly and does not heal, it can transform into chronic gastritis.
　　4. Lack of gastric acid makes bacteria easy to reproduce in the stomach and can also cause chronic gastritis.
　　5. Nutritional deficiency, endocrine dysfunction, and immune function abnormalities can all cause chronic gastritis.
　　6. Infection with Campylobacter jejuni and other pathogens may be a pathogenic factor for chronic gastritis.
　　7. The action of bacteria and their toxins. Due to the continuous ingestion of bacteria or toxins from infection foci in the nose, mouth, throat, and other parts; or the lack of gastric acid in the stomach, bacteria are prone to reproduce in the stomach, leading to chronic gastritis due to long-term action.
　　8. Mental factors. Excessive mental stimulation, depression, and other mental factors repeatedly acting on the cerebral cortex cause dysfunction of the cerebral cortex, leading to spastic contraction of the gastric wall vessels, inflammation, or ulceration of the gastric mucosa.

　　1. Gastric hemorrhage:Bleeding in chronic gastritis is not uncommon, mainly manifested as melena. If the amount of bleeding is large, it may suddenly cause hematemesis, with severe cases presenting with dizziness, palpitations, dark vision, profuse sweating, and even shock.

　　2. Anemia:After a large amount of bleeding in chronic gastritis, two types of anemia may occur. Megaloblastic anemia, also known as pernicious anemia, presents with anemia symptoms such as dizziness, fatigue, palpitations, and pale complexion; iron-deficiency anemia is caused by chronic bleeding, and is also related to the fact that chronic gastritis patients eat less and have insufficient nutrition. The lack of gastric acid also affects the digestion and absorption of hematopoietic raw materials.

　　3. Gastric ulcer:Gastric ulcer, superficial gastritis, and erosive gastritis occur together, with obvious inflammatory stimulation. The gastric mucosa atrophies and becomes thin, and complications such as erosion and ulceration occur. Gastric endoscopy should be performed in a timely manner to avoid delay in diagnosis and treatment.

　　4. Precancerous stage of gastric cancer:The canceration of chronic gastritis is closely related to gastritis-associated hyperplasia. There are two types of chronic gastritis that are prone to canceration. Chronic gastritis with pernicious anemia has a canceration rate 20 times higher than that of other gastrointestinal diseases, which should be paid attention to by gastrointestinal disease patients; atrophic gastritis with intestinal metaplasia and severe atypical hyperplasia.

　　The most common symptoms of chronic gastritis are upper abdominal pain and fullness. Unlike peptic ulcers, patients feel more comfortable when fasting and uncomfortable after meals, which may be due to dysfunction of the receptive relaxation. Even though the amount of food intake is not much, patients feel full. Patients often complain of 'weak stomach' or 'soft stomach'. These symptoms are often caused or exacerbated by cold food, hard food, spicy food, or other irritant foods. These symptoms are not easily relieved by antacids and antispasmodics. Most patients complain of loss of appetite.
　　Patients with chronic atrophic gastritis may have symptoms such as reduced gastric acid, poor digestion, anemia, weight loss, glossitis, diarrhea, and so on. Some patients with mucosal erosion may have more obvious upper abdominal pain and may also have bleeding. Bleeding is also one of the symptoms of chronic gastritis, especially when combined with erosion. It can be recurrent small bleeding, or even massive bleeding. Patients with gastric mucosal erosion and bleeding may have hematemesis and melena.

　　1. Maintain a cheerful spirit
　　Depression or excessive tension and fatigue can easily cause dysfunction of the pyloric sphincter, bile reflux, and chronic gastritis.

　　2. Quit smoking and avoid alcohol
　　The harmful components in tobacco can promote the increase of gastric acid secretion, produce harmful stimulatory effects on the gastric mucosa, and excessive smoking can cause bile reflux; excessive drinking or long-term consumption of strong spirits can cause the gastric mucosa to become congested, swollen, and even eroded, significantly increasing the incidence of chronic gastritis. Quit smoking and avoid alcohol.

　　3. Be cautious and avoid using drugs that damage the gastric mucosa
　　Long-term abuse of such drugs can damage the gastric mucosa, causing chronic gastritis and ulcers.

　　4. Actively treat the infection focus in the oropharynx
　　Do not swallow sputum, nasal mucus, and other pathogenic secretions into the stomach, which can lead to chronic gastritis.

　　5. Pay attention to diet
　　Try to avoid overly acidic, spicy, and other irritating foods as well as raw and cold, difficult-to-digest foods. Chew food slowly while eating to mix it well with saliva, which is beneficial for digestion and reducing the stimulation of the stomach. Eat on time and in proper amounts, and eat a diet rich in vitamins A, B, and C. Avoid drinking strong tea and strong coffee and other stimulating beverages.

　　1. Gastric juice analysis
　　Measure the basic gastric juice secretion volume (BAO) and histamine test, or measure the large acid output (MAO) and peak acid output (PAO) after the pentagastrin test, to judge the gastric acid secretion function, which is helpful for the diagnosis of chronic atrophic gastritis and guiding clinical treatment. Gastric acid is usually normal in chronic superficial gastritis, while in widespread and severe chronic atrophic gastritis, gastric acid decreases.

　　2. Serological testing
　　The serum gastrin level in chronic atrophic gastritis is often moderately elevated, which is due to the lack of gastric acid, which cannot inhibit the secretion of G cells. If the lesion is severe, not only will the secretion of gastric acid and pepsinogen decrease, but also the secretion of intrinsic factor will decrease, thereby affecting the decrease in vitamin B12; the serum PCA is often positive (over 75%).

　　3. Gastrointestinal X-ray barium meal examination
　　With the development of digestive endoscopy, currently, upper gastrointestinal contrast radiography is rarely used for the diagnosis of gastritis. When using barium double-contrast radiography to display the fine structure of the gastric mucosa, atrophic gastritis may show relatively flat and reduced gastric mucosal folds.

　　4. Gastroscopy and biopsy
　　Gastroscopy and pathological biopsy are the main methods for diagnosing chronic gastritis. Surface gastritis is often most evident in the antrum, with diffuse increase in the surface mucus of the gastric mucosa, showing grayish or whitish exudates; the mucosa at the lesion site is red and white intermingled or speckled, resembling measles-like changes, and sometimes there is erosion. The mucosa of chronic atrophic gastritis is usually pale or grayish, may also be red and white intermingled, with concave white areas; the folds become finer or flat, and due to the thinning of the mucosa, the submucosal blood vessels can be seen through as purple-blue vessels; the lesions can be diffuse or mainly in the antrum, and if there are hyperplastic changes, the mucosal surface may be granular or nodular.

　　Foods suitable for chronic gastritis
　　Soft, tender, and easily digestible foods: staple foods, vegetables, and meat dishes such as fish, especially beans, peanuts, and other hard nuts should be cooked thoroughly and well-done to make them soft and tender, which is beneficial for digestion and absorption. Eat less rough and fibrous foods. The food should be well-prepared and nutritious.
　　Keep food fresh and light: All kinds of food should be fresh and not stored for too long before consumption. Eat fresh vegetables and fruits with little fiber, such as winter melon, cucumber, tomato, potato, spinach leaves, Chinese cabbage, apple, pear, banana, orange, etc. Eat light and low-fat diets. Light diets are easy to digest and absorb and are conducive to the recovery of stomach diseases.

　　Unsuitable Foods for Chronic Gastritis
　　Patients with chronic gastritis should avoid spicy alcohol (other types of alcohol should also be drunk less or not at all), cigarettes, strong tea, coffee, chili, mustard, and other strong spices. It is not advisable to eat too sweet, salty, strong, cold, hot, or sour soups and dishes to prevent injury to the gastric mucosa. Excessive consumption of carbonated drinks may also cause varying degrees of damage to the gastric mucosa.

　　Common methods of Western medicine for treating gastritis include:

　　(1) Eradication of Helicobacter pylori
　　Although there is currently no unified opinion on whether to routinely eradicate Helicobacter pylori in chronic gastritis caused by Helicobacter pylori, successful eradication of Helicobacter pylori can improve the histology of the gastric mucosa, prevent peptic ulcers, and may reduce the risk of gastric cancer. Some patients with dyspepsia symptoms may also improve. The consensus of Chinese chronic gastritis suggests that the eradication of Helicobacter pylori is particularly suitable for: ① Patients with gastric mucosal erosion, atrophy, intestinal metaplasia, and atypical hyperplasia; ② Patients with dyspepsia symptoms; ③ Patients with a family history of gastric cancer.

　　(2) Treatment for Improving Dyspepsia Symptoms
　　For patients with dyspepsia symptoms accompanied by chronic gastritis, there is no clear relationship between the symptoms and chronic gastritis, so the symptomatic treatment in fact belongs to the empirical treatment of functional dyspepsia. Acid-suppressing or antacid drugs, gastrointestinal motility drugs, and gastric mucosal protective drugs can all be tried. In addition to the symptomatic treatment, these drugs may also have certain effects on the repair of gastric mucosal epithelium and inflammation.

　　(3) Treatment of Autoimmune Gastritis
　　There is currently no specific treatment, and anemia can be corrected after the injection of vitamin B12 in cases of malignant anemia.

　　(4) Treatment of Atypical Hyperplasia
　　Atypical hyperplasia is a precancerous lesion of gastric cancer and should be highly regarded. In addition to the above active treatment for mild atypical hyperplasia, the key is regular follow-up. For confirmed severe atypical hyperplasia, prophylactic surgery is recommended, and currently, endoscopic submucosal resection of the gastric mucosa is most commonly used.