Drug-induced gastric disease

　　The pathogenesis of drug-induced gastric disease mainly includes the following aspects:

　　1. The drugs interfere with the synthesis of mucin by gastric mucosal epithelial cells, affecting the quality and quantity of gastric mucus; inhibit the synthesis of prostaglandins in the mucosa, inhibit the normal proliferation, renewal, and granulation tissue formation of mucosal epithelial cells, causing the gastric mucosal barrier to be damaged, renewal and granulation tissue formation to be impaired, and leading to gastric mucosal erosion and ulcer formation.

　　2. The drugs affect the normal secretion of gastric mucosal glands, stimulate the secretion of gastric acid and pepsin. Some drugs reduce platelet count, inhibit platelet aggregation, and lower prothrombin, leading to upper gastrointestinal bleeding.

　　3, Some drugs have a stimulating and corrosive effect on the gastric mucosa, such as potassium chloride and iron salts. Some drugs affect gastrointestinal motility and the blood and lymphatic circulation of the gastric mucosa, thereby damaging the normal function of the gastrointestinal tract.

　　Drug-induced gastritis is prone to gastric ulcers or gastritis, gastrointestinal bleeding, and other complications, as follows:

　　1, Gastric ulcer

　　Chronic gastritis is prone to complications of peptic ulcers, and ulcers generally occur on the basis of gastritis. The onset of gastric ulcers is related to diet, occupation, smoking, and genetic factors, while functional disorders of the pyloric sphincter or bile reflux can cause increased secretion of gastric acid and destruction of the gastric mucosal barrier, which can also further lead to the formation of ulcers on the basis of gastritis.

　　2, Upper gastrointestinal bleeding

　　Upper gastrointestinal bleeding is the most common complication of peptic ulcers, and peptic ulcers are also the most common cause of upper gastrointestinal bleeding. If peptic ulcer disease is not treated in a timely manner, or if there is excessive drinking, overeating, excessive fatigue, or unreasonable medication, it can lead to rupture and bleeding.

　　3, Acute perforation

　　Acute perforation refers to the sudden perforation of the gastric wall when the ulcer reaches the muscular layer and serosal layer, causing the contents of the stomach or duodenum to flow into the peritoneal cavity, leading to diffuse peritonitis.

　　4, Pyloric obstruction

　　Pyloric stenosis caused by inflammation, edema, pyloric spasm, gastric mucosal prolapse, or scar contraction due to duodenal or pyloric channel ulcers, which obstructs the passage of food, is called pyloric obstruction.

　　5, Bilirubin reflux gastritis after gastric resection

　　Bilirubin reflux gastritis after gastric resection refers to the gastritis that occurs after gastric resection due to incomplete pyloric function, leading to bile reflux.

　　The clinical manifestations of drug-induced gastritis vary depending on the type of medication, dosage, and whether irritant gastric drugs are used in combination, but mainly involve the stimulation of the stomach and varying degrees of damage to the gastric mucosal barrier, leading to gastrointestinal symptoms, with severe cases developing gastric ulcers and bleeding.

　　1, Antipyretic and analgesic drugs

　　Drugs such as aspirin, indomethacin, nimesulide, phenylbutazone, and ibuprofen can easily cause upper abdominal pain and discomfort, and in severe cases, bleeding in the upper gastrointestinal tract. Endoscopy often shows inflammation, erosion, and ulcers, as well as bleeding of the gastric mucosa. Upper gastrointestinal bleeding is more common in adults and occasionally seen in infants.

　　2, Antibiotics

　　Many oral antibacterial drugs such as tetracyclines, erythromycin, metronidazole, and furan derivatives can easily cause nausea, vomiting, abdominal pain, and decreased appetite, exacerbating peptic ulcers and even bleeding; Bralow et al. reported that after taking penicillin orally, in addition to general gastrointestinal symptoms, acute abdominal pain and gastrointestinal bleeding can also occur. Intravenous injection of erythromycin, amphotericin, mitomycin, and other drugs can also cause gastrointestinal symptoms, and there are occasional cases of gastrointestinal bleeding. Polymyxin has a significant toxic effect on the gastric mucosal epithelial cells, causing local ischemia of the gastric mucosa, promoting histamine release, and leading to gastritis and gastric mucosal injury.

　　3, Antitumor drugs

　　Ammonia methotrexate, 6-mercaptopurine, 5-fluorouracil and other drugs can stimulate the mucosal membrane of the gastrointestinal tract to produce diffuse inflammation, leading to edema, erosion, or the formation of ulcers, resulting in symptoms such as nausea, vomiting, and decreased appetite, and may lead to gastritis or gastric ulcer.

　　4. Adrenocortical hormones

　　Including ACTH and various glucocorticoids, which can induce the formation of ulcers in the gastrointestinal tract, or cause the recurrence or deterioration of ulcers. Boland reported that the incidence of peptic ulcer disease was 37% in patients with rheumatoid arthritis treated with prednisone. Gastrointestinal ulcers caused by adrenocortical hormones are also known as steroid ulcers (Steroid Ulcer), and their clinical symptoms are slightly different from those of general peptic ulcers. The pain is not regular, often occurring insidiously, and may not be discovered until the lesion is very serious, even with bleeding or perforation, due to the increased pain perception threshold and decreased inflammatory response caused by adrenocortical hormones. Therefore, gastrointestinal reactions should be closely observed before and during medication, especially in patients with a history of ulcers, and they should be treated with caution. Corticosteroid drugs should be avoided when used with salicylates, antipyretic analgesics, and anticoagulants. It is not advisable to drink alcohol during medication, and a diet high in protein and vitamins and suitable for ulcer disease should be provided. Acid-suppressing and anti-ulcer drugs can be used concurrently if necessary.

　　5. Other drugs

　　Sympathetic nervous blockers such as guanabenz, guanethidine, etc., can promote gastric acid secretion and increase gastrointestinal motility, making it more likely to develop gastric ulcers. Phentolamine, phenylprazine, and others have histamine-like effects and can exacerbate the symptoms of gastric ulcers. Histamine drugs stimulate the secretion of gastric acid and pepsin, and frequent use can cause ulcer disease or worsen existing ulcer disease. Oral hypoglycemic agents such as tolbutamide and insulin injections can increase gastric juice secretion and raise gastric acid levels, making it more likely to develop ulcer disease. Betahistine (Antivert) is an H1-receptor agonist that stimulates gastric acid secretion and exacerbates gastric ulcers. In addition, high-dose niacin and vitamin B6 can promote histamine release; caffeine, thyroid hormones, aminophylline, estrogens, and thiazides, among others, can all cause gastric symptoms, promote the formation and occurrence of gastric ulcers, and increase the risk of bleeding.

　　There are many drugs that can cause drug-induced gastric disease, so prevention is very important. The main preventive measures include the following aspects:

　　1. Before medication, it is necessary to understand whether the patient has a history of ulcer disease or other gastric diseases, and whether there is liver disease.

　　2. Medication should have clear indications, and drugs that irritate the stomach should be used with caution.

　　3. When using adrenocortical hormones, antipyretic analgesics, and antibiotics, close observation of gastric symptoms should be made during the medication process.

　　4. Some drugs should be chosen in safe formulations, such as taking potassium in aqueous solution, and using enteric-coated aspirin for long-term use.

　　Avoid taking multiple medications at the same time, especially those that irritate the stomach.

　　The main diagnostic criteria for drug-induced gastric disease are the occurrence of gastric symptoms during the medication process and the exclusion of other causes. Fiberoptic gastroscopy shows widespread congestion of the gastric mucosa, multiple erosions, bleeding spots, superficial ulcers, and sometimes active bleeding within the stomach. The lesions are mostly located in the gastric body, with a few affecting the lower esophagus and duodenum. Biopsy of the lesion site often shows inflammatory cell infiltration, superficial mucosal necrosis, and bleeding.

　　Patients with medication-induced stomach disease should eat food that protects the gastric mucosa, is alkaline, and is rich in nutrients that enhance human immunity. Avoid eating acidic, spicy, stimulating, and difficult-to-digest food, such as mochi, rice cakes. Patients with medication-induced stomach disease can also improve symptoms through the following dietary methods:

　　1. Develop good eating habits and eat regularly. Take three meals a day as the main part, choose easily digestible food, avoid eating hard, cold, rough, and fibrous food, such as leeks, celery, etc. Do not overeat at each meal, eat less snacks to avoid increasing the burden on the stomach.

　　2. Pay attention to eating more foods rich in protein and vitamins. Such as eggs, milk, meat, fish and shrimp, tofu, soy milk, and green vegetables to increase protein and vitamins, which is beneficial to the repair of the gastric mucosa.

　　3. Reduce the damage to the gastric mucosa. Eat slowly and chew thoroughly to mix the food with saliva. This helps digestion, reduces the burden on the stomach, and protects the sick gastric mucosa.

　　4. For those with low stomach acid, they should eat some sour food regularly. Chronic atrophic gastritis and patients with low stomach acid can eat some like sour milk, cooked dishes with vinegar, and acidic fruits (hawthorn, apple, orange, strawberry) to stimulate the secretion of gastric juice, help digestion, and increase appetite.

　　5. For those with excessive stomach acid, they should avoid eating food that is easy to produce acid. Such as sucrose, sweet pastries, sweet potatoes, and strong tea, coffee, alcohol, strong meat soup, etc. that stimulate the secretion of stomach acid. You can eat more baking soda biscuits to neutralize stomach acid. When there is obvious bloating, try to eat less or no food that is easy to produce gas, such as potatoes, sweet potatoes, onions, boiled soybeans, etc. Patients with anemia should eat more liver, kidney, lean meat, animal blood, black fungus, and green vegetables rich in iron.

　　6. Reduce the adverse stimulation of food to the stomach, avoid smoking and drinking, do not eat spicy and刺激性 strong food, avoid long-term eating hot and sour and smoked food.

　　Medication-induced stomach disease is caused by the stimulation of the stomach, and the mucosal barrier of the stomach is damaged to varying degrees, resulting in stomach symptoms. In severe cases, gastric ulcers and bleeding may occur. The main treatment methods are to stop taking medication as soon as possible, pay attention to dietary regulation, and reduce刺激性 food. Symptomatic treatment, protect the gastric mucosa, such as oral aluminum hydroxide gel, 10-15ml each time, 3-4 times a day, or take sucralfate, H2-receptor blockers, and Losec, etc.