Gastric persimmon stone

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

　　2. Hair stone is composed of hair and can also contain wool and animal hair, and is more common in neurotic women with the habit of swallowing hair, usually occurring between the ages of 20 to 30.

　　3. Lactic stone is more common in low birth weight newborns fed with high concentration milk.

　　The complications of gastric persimmon stone include compression of the gastric wall by the persimmon stone leading to necrosis and perforation of the gastric wall, and can also cause intestinal obstruction if they are excreted into the intestines. Gastric persimmon stone should not be underestimated, and patients should seek timely treatment as soon as they discover symptoms.

　　1. Gastric stones are prone to occur in patients with partial gastrectomy, vagotomy, and gastric atony syndrome, which seems to be related to the dyskinesia of the gastric motor function in these patients. It can be divided into acute and chronic types. The course of the disease within 6 months is acute, and more than 6 months is chronic. Acute type is more common. The acute type appears symptoms within 1-2 hours after eating a large amount of persimmons, hawthorn, etc., more than half of the patients have upper abdominal pain, distension, nausea, and vomiting, usually with little vomiting, and can have coffee-colored or bloody vomiting, but massive hemorrhage is rare. Physical examination has 30% of cases with palpable sliding masses in the upper abdomen. Due to the stimulation and injury caused by gastric stones to the local mucosa, complications such as gastric ulcer, gastric mucosal erosion, pyloric stenosis, intestinal obstruction, and occasionally perforation and peritonitis may occur.

　　2. The clinical symptoms and signs of gastric stone patients are related to the size, shape, nature, and the degree of impact on human digestion and motor function of the gastric stones. Patients can have no symptoms at all, or have symptoms such as discomfort in the upper abdomen, loss of appetite, halitosis, nausea, vomiting, or varying degrees of abdominal distension and pain. During physical examination, mobile masses can often be felt in the upper abdomen, which are generally not painful.

　　The incidence of gastric persimmon stone disease is high in the northern persimmon producing areas of China, which is related to factors such as eating methods and excessive intake. As long as attention is paid not to eat un-fermented persimmons, especially on an empty stomach, and not to eat acidic foods immediately after eating, the disease can be prevented. From the results of Google search, there are no such reports in countries such as Japan and South Korea that produce a lot of persimmons, which may be related to the proper eating methods of the people in these countries and the market supply of all desorbed commercial persimmons.

　　I. Laboratory examination

　　Some patients may present with small cell hypochromic anemia. Some patients have positive fecal occult blood test, and in the early stage, persimmon peel-like substances can be seen. Gastric acid analysis shows that the free acid in gastric juice is higher than that of normal people.

　　II. Other auxiliary examinations

　　1. X-ray examination X-ray barium meal radiography or barium double contrast, can be found that barium in the stomach produces a分流现象，and shows floating on the barium upper free, mass-like, circular or elliptical filling defect area, while the gastric mucosal structure is smooth, the gastric wall is soft. When the barium in the stomach is empty, the barium spots on the mass shadow can still be seen as strips, networks, or sheet-like. Pressing the mass shadow has no obvious tenderness and can change the contour shape and position with force, indicating that the mass has certain compressibility and mobility.

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

　　3. Ultrasound examination Ultrasound can help in the diagnosis of gastric stone. Usually, patients are asked to drink 500-1000ml of water, sit or semi-recumbent for examination, and clear boundaries can be seen in the stomach, strong echo mass images floating on the water surface, which can change position with the change of body position or gastric peristalsis.

　　Experts remind that since unripe persimmons contain a large amount of persimmon tannin, do not eat unripe persimmons, pay attention not to eat the persimmon skin, and do not eat excessive amounts each time, especially not to eat a large amount of persimmons on an empty stomach. In addition, the tannin in persimmons combines with iron, which will interfere with the absorption of iron, so it is better for anemia patients to eat less.

　　There are many methods of treating gastric stone, and the specific treatment measures adopted are decided according to the nature of the gastric stone, the physiological and pathological condition of the patient, and the equipment conditions of the hospital, etc.

　　1. Internal medicine drugs

　　The treatment selects Chinese and Western medicine to change the internal environment of the patient's stomach, so that the gastric stone becomes soft, dissolves, and becomes smaller, improves the gastric motility function, and promotes its natural excretion. The history of using sodium bicarbonate to treat vegetable gastric stones is long-standing, and the oral dose is usually 3-4g per time, 3 times/d, for 7-10 days as one course. It can also be taken with an equal amount of effervescent agent at the same time to enhance the efficacy and shorten the course. Some people advocate adding 0.5-1g of pepsin or trypsin on the basis of the above treatment, or 5-10mg of papain (alpha-trypsin) dissolved in 50-100ml of water for oral administration or injected into the stomach tube, or 0.5g of acetylcysteine (acetylcysteine) dissolved in 50ml of normal saline injected into the stomach tube for 2-3 days to digest some components of the gastric stone, so that the structure of the gastric stone is disintegrated and dissolved and excreted. For patients with poor gastric motility function, metoclopramide (Stomachun), domperidone, or cisapride can be used to promote gastric peristalsis to facilitate stone excretion. In addition, it has been reported that adding 50mg of papain or 5mg of cellulase dissolved in 1000ml of water can also be effective for 2 days.

　　Traditional Chinese medicine and Chinese herbal medicine treatment of gastric stone is one of the traditional internal medicine treatment methods in China. Chinese medicine believes that the pathogenesis of gastric stone belongs to indigestion, accumulation and binding in the stomach, so the methods of digestion, softening and dissolving, softening and dispersing, harmonizing the stomach and spleen, and promoting Qi and blood circulation are often used, and Sanjie Pai Shi decoction is commonly used. The main drugs in the formula are magnolia bark,枳实,shenqu, millet, chicken gizzards, areca nut, three-cornered leaf, Curcuma rhizome, peach kernel, salvia miltiorrhiza, etc., boiled with water for administration, 2-3 times/d, for 5-7 days, and adjusted according to symptoms. For example, add Yuanhu, Baishao, and Gancao for abdominal pain; add Banxia and Zhuru for vomiting; add Baiji and fried rhubarb for hidden blood in stool; add Dangshen and Tai shen for weakness; add rhubarb or senna leaves for constipation. Whether it is Western medicine or Chinese medicine treatment, the administration time should be between meals or on an empty stomach, which is conducive to the full effect of the medicine with the gastric stone 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35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. Extracorporeal Shock Wave Therapy

　　From treating kidney stones to treating gallstones, it has been tried in the treatment of gastric stones in recent years and has achieved success. Two days before treatment, a liquid diet should be consumed. No anesthesia is needed during treatment. Instruct the patient to drink 500ml of water to fill the stomach, then lie on the stomach for B-ultrasound positioning. With a voltage of 12kv, discharge 80 times per minute, a total of 1500 to 2000 times of CDD impact, and the stones are generally broken into fragments. The patient has no discomfort during the treatment and does not cause damage to the gastric mucosa. Three days later, a B-ultrasound examination is performed to determine whether the gastric stones have been completely excreted.

　　6. Surgical Treatment

　　For large and hard gallstones that are difficult to dissolve, which have not achieved results through internal medicine treatment, endoscopic碎石, microwave or shock wave therapy, or have complications such as severe gastric ulcers, bleeding, perforation, or obstruction, it is advisable to use surgical treatment.

　　7. Traditional Chinese Medicine Remedies

　　Houxiang 10 grams, Fashai 12 grams, Shahe 10 grams, Baizhu 10 grams, Binglang 12 grams, Cangzhu 10 grams, Chenpi 10 grams, Shenqu 10 grams, Jineijin 10 grams, Renshen 6 grams, Maiya 15 grams, Shengjiang 10 grams. Method of administration: Decoct in water for oral administration.