How is superficial gastritis caused?

First, about the diagnosis of chronic superficial gastritis

Chronic gastritis is generally divided into three types: chronic non-atrophic gastritis (formerly known as chronic superficial gastritis), atrophic gastritis and special types of gastritis.

In order to unify the endoscopic diagnosis and pathological diagnosis, the chronic superficial gastritis diagnosed in the past has been abandoned and changed to chronic non-atrophic gastritis. China Chronic Gastritis Knowledge 20 12 clearly points out that the concept of "chronic superficial gastritis" no longer appears in China Chronic Gastritis Knowledge 20 17. But in clinic, some hospitals are still used to using the name "chronic superficial gastritis".

Endoscopic manifestations of chronic non-atrophic gastritis (or chronic superficial gastritis);

The basic manifestations such as mucosal erythema, bleeding point, rough mucosa, edema, congestion and exudation can be seen under endoscope.

When accompanied by bile reflux, erosion and mucosal bleeding, it is described as: chronic non-atrophic gastritis with bile reflux, chronic non-atrophic gastritis with erosion, chronic non-atrophic gastritis with mucosal bleeding, etc.

It is true that more than 60% of gastroscopy is diagnosed as chronic non-atrophic gastritis (or chronic superficial gastritis), so should the disease be diagnosed?

1. People need to eat every day, and their stomachs will be stimulated mechanically and chemically, such as: diet (long-term or heavy drinking, smoking, irregular diet, too cold or too hot diet, rough and hard, strong tea, coffee and spicy food), stomach acid, pepsin, bile, Helicobacter pylori, drugs, etc. Of course, the gastric mucosa also has a protective mechanism. When the damage factor exceeds the protective factor, the gastric mucosa will be damaged. We do things that hurt our stomachs every day, don't we?

2. From the above gastroscopy standards of chronic non-atrophic gastritis, it is true that this kind of patients are different from normal gastric mucosa.

3. Pathological examination of routine gastroscopy showed that chronic inflammation existed in gastric mucosa of these patients.

Lymphocytes and plasma cells are chronic inflammatory cells. According to the amount and depth of infiltration in gastric mucosa, gastric mucosal inflammation can be divided into normal, mild, moderate and severe. The infiltration of inflammatory cells is limited to gastric mucosa 1/3. At high magnification, less than 5 inflammatory cells are normal and more than 5 are mild. Inflammatory cells are more than 1/3 of mucosa, but not more than 2/3 of the whole layer. If it exceeds 2/3 to the whole layer, the infiltration of inflammatory cells is serious.

Patients with chronic non-atrophic gastritis (or chronic superficial gastritis) diagnosed by gastroscopy have routine biopsy and pathological examination, and I have never seen normal people.

In short, from the above three aspects of etiology, endoscopic manifestations and pathological examination, chronic non-atrophic gastritis (or chronic superficial gastritis) does exist and should be quite common, so there is a saying that "ten people have nine stomachs"!

Should chronic superficial gastritis be treated?

The symptoms of the disease are nonspecific, which can be manifested as stomachache, fullness and congestion, often accompanied by belching, acid regurgitation, heartburn, nausea, loss of appetite and emaciation, which can be caused by improper diet, emotional stimulation, fatigue and climate change.

There is no obvious correlation between the presence and severity of symptoms and the severity of gastric mucosal inflammation, and some patients may be asymptomatic.

0 1, Helicobacter pylori positive people, no matter what symptoms need to be eradicated!

It is clear that chronic gastritis related to Helicobacter pylori is an infectious disease, an infectious disease! Looking at the domestic and foreign policies, it is considered that it needs to be eradicated. A large number of studies have also confirmed that eradication of Helicobacter pylori can significantly reduce the incidence of gastric cancer, especially before eradication of atrophy and intestinal metaplasia. Helicobacter pylori-associated gastritis, after eradication of Helicobacter pylori, most of the symptoms of patients can be controlled and gastric mucosal inflammation can be significantly improved.

20 17 the last indication of helicobacter pylori eradication put forward by the knowledge of helicobacter pylori treatment in China: confirm that helicobacter pylori is positive; It is pointed out that the quadruple therapy is used to eradicate Helicobacter pylori: double dose proton pump inhibitor+two antibiotics+bismuth, and the course of treatment is 10 ~ 14 days; Recommended antibiotics: amoxicillin, furazolidone, tetracycline, metronidazole, clarithromycin and levofloxacin.

However, I think: amoxicillin, furazolidone, tetracycline, the drug resistance rate is still relatively low in various places, can be used as first-line treatment drugs, and can still be used in retreatment; Metronidazole, clarithromycin and levofloxacin have high drug resistance rates in many areas, which are the main reasons for the failure of eradication of Helicobacter pylori, and are not suitable for routine use as first-line drugs in high drug resistance areas. Tetracycline is scarce in many areas, and our experience can be replaced by doxycycline.

02, symptomatic chronic superficial gastritis, of course, needs treatment.

This is divided into two situations:

1. If the above symptoms appear in a short time, it is the relationship that chronic inflammation of gastric mucosa is aggravated under the inducement, mainly to remove the inducement, treat the symptoms in a short time and protect the gastric mucosa.

1) When abdominal pain, heartburn, acid reflux and other symptoms are the main symptoms, drugs can be selected:

The first is proton pump inhibitors (such as omeprazole, pantoprazole, rabeprazole, etc.). ) is selected. When the symptoms are mild, H2 receptor antagonists (such as ranitidine and famotidine) or antacids (such as aluminum hydroxide, compound aluminum hydroxide and aluminum magnesium carbonate) can be selected.

2) Dyspepsia symptoms such as fullness or blockage of the upper abdomen, early satiety, anorexia, belching, nausea, etc. The main symptoms are that the drugs available are:

Dynamic drugs (such as domperidone, mosapride, itopride);

Digestive AIDS (such as compound digestive enzymes, Aspergillus oryzae pancreatin tablets, pancreatin enteric-coated capsules, compound azintamide enteric-coated tablets, pancreatin tablets, multienzyme tablets, etc.). ).

The combination of the two can improve the curative effect.

3) Appropriate addition of gastric mucosal protective agents, such as sucralfate, rebamipide, aluminum magnesium carbonate, teprenone, allantoin aluminum, etc., can isolate the damage of gastric mucosa caused by injury factors and promote the repair of gastric mucosa.

However, it should be noted that gastric mucosal protective agents with anti-inflammatory effect, such as rebamipide, can antagonize oxygen free radicals, inhibit inflammatory factors, reduce inflammatory cell infiltration and alleviate gastric mucosal inflammation; The combination of aluminum magnesium carbonate and H2 receptor antagonist will affect the absorption of the latter, so the interval between them must be 1 ~ 2 hours.

2. Repeated epigastric discomfort is often accompanied by mental stress, irritability, depression, dizziness, insomnia, palpitations, forgetfulness, etc. These phenomena, in turn, will aggravate the symptoms of chronic gastritis, form a vicious circle, complicate the condition and make it difficult to cure. At this time, it should be diagnosed as "functional dyspepsia".

Simple treatment of chronic gastritis is not effective, and it needs to be treated according to functional dyspepsia. If these patients are not treated, their quality of life will obviously decline!

1) Symptomatic treatment and protection of gastric mucosa (as mentioned above) are equally important for such patients.

2) Drugs that reduce visceral sensitivity must be added, mainly droperidol, melitracen and tricyclic antidepressants (such as doxepin, fluoxetine and paroxetine).

Doxepin is very cheap, but dizziness and drowsiness are obvious, which will be obviously relieved in a few days. We must start with a small dose and gradually increase the dose in order to control the symptoms and tolerance of patients. We should take1/8tid1/4tid1/3tid orally half an hour before meals. Some patients with mild symptoms can be controlled by 1/8 tid, and then gradually reduced after the symptoms are controlled stably. Drug reduction is also relatively slow, generally to 65438.

Flupentixol-melitracen has both antidepressant and anxiolytic effects, mainly antidepressant. The daily dosage is 1 ~ 4 tablets, and most patients can take 1 tablet orally half an hour before breakfast. Note: This medicine has mild excitability and should not be taken orally at night, otherwise it will affect sleep. However, if a few patients feel dizzy and sleepy, they can take it before going to bed. The drug takes effect quickly, which can take effect in about 4 days and stabilize the curative effect in 2 weeks. It emphasizes the use of a small dose, gradually increasing the dose, controlling the symptoms with the minimum dose, and gradually reducing the dose to prevent recurrence after the symptoms are controlled stably. According to personal experience, it is reduced to 1/4 capsules per day, and most patients can stop using it. The drug is addictive after long-term use, but most patients with functional dyspepsia can stop taking it for 2 ~ 3 months.

Fluoxetine and paroxetine have antidepressant effects, especially for patients with depression, but their effects are slow.

3) Functional dyspepsia. Some patients are accompanied by anxiety. If necessary, add small doses of sedatives (such as lorazepam and clonazepam). It is also emphasized that small doses should be used first, gradually increased doses, and symptoms should be controlled with the minimum dose. After the symptoms are controlled stably, the dosage should be gradually reduced to prevent recurrence, but the patient must sleep!

4) Doctors must communicate with patients more, explain the mechanism of patients' symptoms, emphasize that it has a great relationship with emotional and psychological factors, tell patients to relax and divert their attention, and encourage patients to do more relaxation exercises, such as walking, jogging, playing Thai boxing and practicing yoga. This is as important as taking drugs!

03. Should asymptomatic chronic superficial gastritis be treated?

It depends on the pathological examination, because:

1. There is no obvious correlation between the degree of gastric mucosal inflammation and the symptoms of patients.

2. The existence and severity of patients' symptoms are also related to patients' tolerance.

3. Long-term chronic inflammation of gastric mucosa can further develop into atrophic gastritis and increase the incidence of gastric cancer. According to research, 50% of chronic superficial gastritis will evolve into chronic atrophic gastritis, while 40% of chronic atrophic gastritis will evolve into intestinal metaplasia, while 8% of patients with intestinal metaplasia will evolve into dysplasia, and dysplasia will evolve into gastric cancer.