Erosive gastritis

　　The etiology and pathogenesis of erosive gastritis have not been fully elucidated. Most people believe that it may be due to various exogenous or endogenous pathogenic factors that cause a decrease in mucosal blood flow or the destruction of normal mucosal defense mechanisms, along with the damaging effects of gastric acid and pepsin on the gastric mucosa. The specific details are as follows:

　　1. Exogenous factors:Certain drugs such as non-steroidal anti-inflammatory drugs like aspirin, phenylbutazone, indomethacin, adrenocortical corticosteroids, certain antibiotics, alcohol, and others can damage the gastric mucosal barrier, leading to increased mucosal permeability. Hydrogen ions from gastric juice backdiffuse into the gastric mucosa, causing mucosal erosion and bleeding. Adrenocortical corticosteroids can increase the secretion of hydrochloric acid and pepsin, reduce the secretion of gastric mucus, and slow down the renewal rate of gastric mucosal epithelial cells, leading to this disease.

　　2. Endogenous factors:Including severe infection, severe trauma, intracranial hypertension, severe burns, major surgery, shock, excessive tension and fatigue, and others. Under stress conditions, the sympathetic and vagus nerves can be excited, the former causing vasoconstriction of the gastric mucosal vessels and a decrease in blood flow, and the latter causing short-circuiting of submucosal arteries and veins to promote further ischemia and hypoxia of the mucosa, leading to damage to the gastric mucosal epithelium, erosion, and bleeding. Severe shock can lead to the release of serotonin and histamine, among others, the former stimulating the release of lysosomes by gastric wall cells, directly damaging the gastric mucosa, and the latter increasing the secretion of pepsin and gastric acid to damage the gastric mucosal barrier.

　　Erosive gastritis is characterized by multiple erosions of the gastric mucosa. Erosive gastritis is one of the important causes of upper gastrointestinal bleeding, accounting for about 20% of the phenomenon of upper gastrointestinal bleeding. Erosive gastritis should not be ignored, and it is easy to cause the following complications:

　　1. Gastric hemorrhage

　　Erosive gastritis is not uncommon, and patients often present with hematemesis symptoms, and some are mainly hematochezia. Patients may have nausea before vomiting blood, and have a sense of defecation before hematochezia, followed by darkening of the eyes, palpitations, and even fainting. If it is chronic and mild bleeding, it can cause anemia.

　　2. Gastric cancer

　　A small number of patients with erosive gastritis who do not receive timely treatment have a high possibility of developing into gastric cancer.

　　3. Gastric perforation

　　Gastric perforation is one of the most serious complications of erosive gastritis patients. The main cause of gastric perforation in patients is the increase of gastric acid and pepsinogen due to overeating, which is easy to induce gastric perforation.

　　4. Upper gastrointestinal bleeding

　　Before vomiting blood, there is often nausea and discomfort in the upper abdomen (commonly known as the heart窝). If a large amount of blood is vomited and accompanied by severe shock symptoms such as dizziness, palpitations, thirst, cold sweat, and fainting.

　　5. Body emaciation

　　Due to long-term abdominal pain, many patients have irregular eating habits, sometimes eating and fasting, which is easy to lead to weight loss. Weight loss refers to the weight loss of the human body due to disease or certain factors, and when it is more than 10% below the standard body weight, it is considered weight loss.

　　The symptoms of erosive gastritis are mostly non-specific, which may include nausea, vomiting, and discomfort in the upper abdomen. The harm of chronic erosive gastritis to human health should not be ignored. If timely treatment is not carried out and the development of the disease is not effectively controlled, digestive ulcers may occur, even leading to upper gastrointestinal bleeding, which directly threatens the patient's life.

　　Most patients often have no symptoms or varying degrees of dyspepsia, such as epigastric pain, acid regurgitation, postprandial fullness, decreased appetite, and others. Patients with atrophic gastritis may have anemia, diarrhea, glossitis, and emaciation, and some patients with mucosal erosion may have more pronounced epigastric pain and even bleeding. Therefore, it is reminded that once gastrointestinal symptoms appear, patients should seek treatment as soon as possible.

　　Erosive gastritis has an acute onset, and sudden upper gastrointestinal bleeding may occur during the course of the primary disease, manifested as vomiting blood and black stools, with rare occurrence of black stools alone. Bleeding is often intermittent. Massive bleeding can cause fainting or shock, accompanied by anemia. There may be hidden pain or tenderness in the upper abdomen during bleeding. Endoscopic examination, especially emergency endoscopic examination within 24-48 hours of onset, can show gastric mucosal erosion, bleeding, or superficial ulcers, especially in the upper part of the corpus of the stomach.

　　During the course of the primary disease, sudden upper gastrointestinal bleeding may occur, manifested as vomiting blood and black stools, with rare occurrence of black stools alone. Bleeding is often intermittent. Massive bleeding can cause fainting or shock, accompanied by anemia. There may be hidden pain or tenderness in the upper abdomen during bleeding. Endoscopic examination, especially emergency endoscopic examination within 24-48 hours of onset, can show gastric mucosal erosion, bleeding, or superficial ulcers, especially in the upper part of the corpus of the stomach.

　　With the rapid development of the economy and the significant improvement of people's living standards, the pace of life has accelerated, and the pressure of work and life has increased. Many people have no time to pay attention to their own healthy diet, so that gastric disease has become a common problem for many people. Erosive gastritis is a type of chronic gastritis and also a relatively serious one. The clinical symptoms are often hidden or severe pain in the upper abdomen, accompanied by nausea and other symptoms, and it is one of the important causes of upper gastrointestinal bleeding, accounting for about 20% of upper gastrointestinal bleeding. All diseases are preventable, so how should erosive gastritis be prevented? To prevent erosive gastritis, it is necessary to pay more attention to diet and lifestyle, and specifically, the following six aspects should be done well:

　　1. Appropriate exercise:Appropriate exercise is a good way to increase gastrointestinal motility, which can effectively promote gastric emptying, enhance the secretion function of the gastrointestinal tract, improve digestion, and help the recovery of gastritis.

　　2. Relax your mood:Stress is a promoting factor for chronic gastritis and should be avoided. Emotional instability and irritability are easy to cause gastric mucosal disorders and dysfunction of gastric function. Therefore, it is necessary to avoid emotional stress responses as much as possible, relieve tension, remain calm, and not be angry when facing things, not anxious in the midst of things, not worried in a hurry, and maintain a pleasant mood, which is very beneficial for the recovery of gastritis.

　　3. Quit alcohol:Alcohol can directly destroy the gastric mucosal barrier, invade the gastric mucosa, causing mucosal congestion, edema, and erosion.

　　4. Take antibiotics:Helicobacter pylori can cause gastritis and other digestive tract problems. Taking antibiotics for two weeks can defeat these bacteria. Helicobacter pylori can be detected through blood and saliva tests.

　　5. Quit smoking:Smoking can promote the onset of stomach pain. After smoking, nicotine can stimulate the gastric mucosa, causing an increase in gastric acid secretion and harmful stimulation to the gastric mucosa. Excessive smoking can lead to dysfunction of the pyloric sphincter, causing bile reflux, damaging the gastric mucosa, and affecting the blood supply to the gastric mucosa as well as the repair and regeneration of gastric mucosal cells. Therefore, it is necessary to quit smoking.

　　6. Use of antacids:For the treatment of mild gastritis, antacids are commonly used. It is best to take the medicine about 1-2 hours after eating, as this is when the stomach acid level is at its peak, which can effectively play an anti-acid role. If it is possible to take another dose at 9-10 PM before going to bed, the effect will be even better.

　　Atrophic gastritis usually requires X-ray examination and emergency endoscopic examination, as follows:

　　1. X-ray examination

　　Gastrointestinal barium meal examination often cannot detect erosive lesions and is not suitable for patients with acute active bleeding because barium can be spread on the mucosal surface, making it impossible to perform endoscopy or angiography in the near future; during acute bleeding, superselective mesenteric artery angiography can be used for localization diagnosis of bleeding; during the interval of bleeding, it is often negative.

　　2. Emergency endoscopic examination

　　Emergency endoscopic examination within 24-48 hours after bleeding can show acute gastric mucosal lesions characterized by multiple erosions and bleeding foci, which is of diagnostic value.

　　Atrophic gastritis is another common type of chronic gastritis, mainly characterized by irregular surface epithelium, inflammatory cell infiltration, and partial disappearance of glands. The atrophy of the固有腺体, thickening of the mucosal muscular layer, metaplasia or pseudopyloric metaplasia are the three major characteristics of atrophic gastritis, among which the metaplasia of the gastric mucosa has the potential to develop into cancer tissue. The diet of atrophic gastritis should be cautious and important, as follows:

　　1. Pay attention to balanced nutrition:Choose foods that are rich in nutrition, easy to digest, and soft. Eat more foods rich in plant proteins and vitamins. You can eat cooked millet, rice porridge, goat's milk, yogurt, white cheese, and cream. If the symptoms are severe, eat some soft foods, such as rice porridge, avocados, bananas, potatoes, and pumpkins. All vegetables should be blended before cooking. Occasionally, you can eat some steamed vegetables, such as carrots, carrots, and broccoli.

　　2. You can use traditional Chinese medicine tea therapy for conditioning:The ancient Chinese medicine tea treatment considers the spleen and stomach as a whole, taking both into account. Pure herbal ingredients, with no side effects.

　　3. Regular diet:Pay attention to dietary adjustment and maintenance, eat regularly and in fixed amounts to maintain the rhythm of normal digestive activity. Do not eat irregularly or skip breakfast, especially avoid overeating and overdrinking.

　　4. Avoid rough and刺激性 foods:Avoid eating hard, spicy, salty, hot, rough, and strongly刺激性 foods. This includes fried foods, preserved meats, chili, garlic, etc. Whether citrus juices, tomato products, coffee, alcohol, and all foods that directly stimulate the esophagus will cause stomach acid, it is best to avoid eating them.

　　5. Avoid high-fat foods:High-fat foods, alcohol, sugars, and chocolate can relax the sphincter, causing reflux. Therefore, if you have heartburn symptoms, you should avoid these foods.

　　6. Increase fiber intake:Eat foods rich in fiber. Fiber is considered an anticancer component, and a high-fiber diet can also reduce the chance of duodenal ulcer occurrence. Fiber is believed to promote mucus secretion, which can protect the duodenal mucosa.

　　7. Control water intake:People with insufficient stomach acid should avoid diluting stomach juice. They should add vinegar, lemon juice, and acidic seasonings to their diet, and eat less indigestible and gas-forming foods. Try to drink less water before and after meals.

　　Atrophic gastritis is generally treated with medication, and the specific treatment is as follows:

　　1. General Treatment

　　Eliminate the predisposing causes and treat the primary disease. Patients should rest in bed, avoid food or liquid diet, maintain tranquility, and give appropriate sedatives such as diazepam when restless; for patients with obvious bleeding, keep the respiratory tract unobstructed and oxygen therapy if necessary; strengthen nursing care, closely observe changes in consciousness, respiration, pulse, blood pressure, and bleeding, and record the intake and output for 24 hours.

　　2. Mucosal Protective Drugs

　　Patients with no obvious bleeding can use mucosal protective drugs, such as aluminum sulfate suspension, 2 packets, taken orally, 3-4 times/d; magnesium trisilicate, 3 tablets, taken orally, 3-4 times/d. In recent years, tegoprazole (trade name: Sivextide) capsules, 50mg, taken orally, 3 times/d; or misoprostol (misoprostol, trade name: Cimetidine), commonly used dose is 200μg, taken 4 times/d, before meals and before bedtime; colloidal bismuth subcitrate, gatifloxacin, or compound glutamine (Mizulin-S) granules, etc., can also be used as mucosal protective drugs.

　　3. H2 Receptor Antagonists

　　Mild cases can take H2 receptor antagonists orally, such as cimetidine (1.0-1.2)g/d, taken four times; ranitidine 300mg/d, taken twice; famotidine 40mg/d, taken twice; severe cases can be treated with intravenous drip. H₂Receptor antagonists can effectively inhibit the secretion of gastric acid and reduce H⁺Counterdiffusion, attention must be paid to H₂Side effects of receptor antagonists.

　　4. Proton Pump Inhibitors

　　Generally speaking, its acid-suppressing effect is stronger than that of H2 receptor antagonists. Mild cases can choose oral preparations, such as omeprazole 20-40mg/d, lansoprazole 30-60mg/d, pantoprazole 40mg/d. In recent years, preparations with stronger acid-suppressing effects have been applied in clinical practice, mainly rebaprazole (rebaprazole, trade name: Politec) 10-20mg/d, due to its pharmacokinetic characteristics of non-enzyme metabolism (i.e., not fully dependent on the metabolism of the cytochrome P450 isoenzyme CYP2C19 in liver cells), so its acid-suppressing effect has no significant individual differences; esomeprazole (esomeprazole, trade name: Nexium), 20-40mg/d, taken orally, this drug is the levorotatory isomer of omeprazole.