How is gastritis caused?

Gastritis is inflammation of gastric mucosa caused by various reasons, and it is one of the most common digestive system diseases. According to the urgency of clinical onset, it can be generally divided into acute and chronic gastritis; According to different etiology, it can be divided into helicobacter pylori-associated gastritis, stress gastritis, autoimmune gastritis and so on. The pathological changes of gastritis caused by different reasons are also different, which usually include three processes: epithelial injury, mucosal inflammatory reaction and epithelial regeneration. According to its pathological changes, acute gastritis can be divided into simple, erosive hemorrhagic, corrosive and suppurative gastritis, while chronic gastritis can be divided into three types: non-atrophic, atrophic and special type gastritis. The diagnosis and differential diagnosis of various types of gastritis are mainly based on gastroscopy.

The cause of disease

1. Etiology of acute gastritis

It can be divided into exogenous and endogenous categories. Any bacteria, drugs, toxins and corrosive agents that enter the stomach through the mouth belong to external causes. Any pathogenic factor that spreads to the stomach wall through blood circulation or lymph is called internal cause.

Physical and chemical factors (1) Strong tea, strong coffee, spicy food, strong liquor, over-cooled or over-heated food and coarse food can all damage the gastric mucosa, destroy the mucosal barrier and lead to gastric mucosal inflammation. Non-steroidal anti-inflammatory drugs such as aspirin and indomethacin, some antibiotics and adrenocortical hormones can not only stimulate gastric mucosa to cause damage, but also affect the repair of gastric mucosa and aggravate inflammation. If you swallow some strong corrosive agents such as nitric acid, hydrochloric acid, sulfuric acid, potassium hydroxide, sodium hydroxide, etc. Can lead to acute corrosive gastritis.

(2) Biological factors are mainly pathogenic bacteria and toxins, such as Salmonella, Escherichia coli, halophilic bacteria, Staphylococcus aureus toxin and botulinum toxin. Eating food contaminated by bacteria or toxins can lead to gastritis after a few hours. Suppurative bacteria such as α -hemolytic streptococcus and Staphylococcus aureus spread to the stomach wall through blood or lymph, which can cause acute suppurative gastritis.

(3) Other stress states such as systemic infection, severe trauma, major surgery, shock and violent mood swings. Foreign bodies in the stomach, stomach stones and radiotherapy in the stomach can all cause this disease.

2. Etiology of chronic gastritis

(1) Biological factors Helicobacter pylori is the main pathogen of chronic gastritis, and more than 90% patients with chronic gastritis are infected with Helicobacter pylori.

(2) Immune factors The pathogenesis of chronic gastritis is related to immune factors, and parietal cell antibodies can be detected in patients' serum.

(3) Physical factors, such as supercooled or overheated food, coarse food, strong tea, strong coffee, strong liquor, spicy food, etc., can cause repeated damage to gastric mucosa and cause chronic gastritis.

(4) Chemical factors Smoking is one of the causes of chronic gastritis. Nicotine in tobacco can affect the blood circulation of gastric mucosa, and at the same time make pyloric sphincter function disorder, resulting in bile reflux. Long-term use of non-steroidal anti-inflammatory drugs such as aspirin and indomethacin can destroy the gastric mucosal barrier.

(5) Other age, malnutrition, heart failure, liver cirrhosis, diabetes and thyroid diseases are all related to the onset of chronic gastritis.

clinical picture

1. Acute gastritis

Acute onset, different clinical symptoms. The most common is acute simple gastritis, mainly manifested as epigastric pain, abdominal distension, belching, anorexia, nausea and vomiting. Diseases caused by salmonella or staphylococcus aureus toxins are usually accompanied by diarrhea, fever, even dehydration and shock. Acute erosive hemorrhagic gastritis may include hematemesis and melena. Acute suppurative gastritis is characterized by systemic sepsis and acute peritonitis. The most obvious symptoms of acute corrosive gastritis are severe pain in the mouth, throat, sternum and upper abdomen after swallowing corrosive agents, accompanied by nausea and vomiting, and even hematemesis. The mucosa of lips, mouth and throat can produce eschar with different colors, which is helpful to identify various corrosive agents.

2. Chronic gastritis

The clinical manifestations of different types of gastritis are different, but the symptoms are not specific, and the severity is often inconsistent with the severity of the lesion. Some patients may have no symptoms.

(1) Upper abdominal pain or discomfort Most gastritis patients have upper abdominal pain or discomfort. Upper abdominal pain is mostly irregular and has nothing to do with diet. Pain is generally diffuse upper abdominal burning pain, dull pain, swelling pain and so on.

(2) Some patients with upper abdominal distension and early satiety will feel abdominal distension, especially after meals. It is often caused by food retention in the stomach, delayed emptying and indigestion. Early satiety means that you are obviously hungry, but you feel full soon after eating, and your food intake is obviously reduced.

(3) belching, acid regurgitation, nausea and belching indicate that the gas in the stomach is increased and discharged through the esophagus, which temporarily relieves the feeling of fullness in the upper abdomen. Gastric acid reflux is caused by increased gastric acid secretion.

(4) Other patients with severe atrophic gastritis may have emaciation, glossitis and diarrhea; Patients with autoimmune gastritis are accompanied by anemia.

cheque

1. Gastroscopy

It is the main method to diagnose gastritis, especially chronic gastritis. You can directly observe the mucosa of esophagus, stomach, duodenal bulb and descending part, or take multiple parts of mucosa for biopsy under direct vision. However, gastroscopy is prohibited for acute corrosive gastritis.

2. Pathological examination

Mainly used for the diagnosis and differential diagnosis of chronic gastritis.

3. Laboratory inspection

Analysis of (1) gastric juice

(2) Determination of pepsinogen

(3) Determination of serum gastrin

(4) Immunological examination

(5) Helicobacter pylori examination

diagnose

It is not difficult to diagnose acute gastritis according to the history and symptoms, and it should be differentiated from early acute appendicitis, acute cholecystitis and acute pancreatitis. The diagnosis of acute erosive hemorrhagic gastritis depends on emergency gastroscopy. Acute corrosive gastritis is mainly diagnosed according to its history of swallowing corrosive agents.

The diagnosis of chronic gastritis depends on gastroscopy and gastric mucosal biopsy. It can be differentiated from gastric cancer, gastric ulcer and other diseases by gastroscopy.

treat cordially

1. Acute gastritis

(1) The general treatment is bed rest, removing the cause, light liquid diet or appropriate fasting. If vomiting and diarrhea are obvious, electrolyte and water should be supplemented in time.

(2) symptomatic treatment with gastric mucosal protective agent and acid inhibitor; People infected by bacteria should take antibiotics.

(3) For the special treatment of acute suppurative gastritis, large doses of sensitive antibiotics should be given as soon as possible. Surgical treatment is feasible when abscess is formed locally and drug treatment is ineffective. Corrosive gastritis caused by swallowing strong acid and alkali can be taken with milk, egg white or other liquid mucosal protective agents, and morphine and other analgesic drugs can be given when severe pain occurs.

2. Chronic gastritis

(1) general treatment for quitting smoking and drinking; Avoid using drugs that damage gastric mucosa, such as aspirin, indomethacin and erythromycin. Eat regularly and avoid overheated, salty and spicy food; Actively treat chronic oral, nasal and pharyngeal infections.

(2) drug therapy

1) Commonly used drugs for protecting gastric mucosa include colloidal bismuth subcitrate (CBS), sucralfate, Maizilin -S, aluminum hydroxide gel, gastrin, etc.

2) Domperidone is used to regulate gastrointestinal motility. Gastric motility drugs can be used for patients with hiccup, abdominal distension or reflux.

3) Antibiotics If Helicobacter pylori is found to be positive by gastroscopy, you should take antibiotics, such as clarithromycin and amoxicillin, which can remove Hp. Generally, you can choose two kinds, often combined with gastric mucosal protective agent and acid inhibitor.

4) Drugs for lowering gastric acid, such as alkaline acid-making drugs such as sodium bicarbonate and aluminum hydroxide; H2 receptor antagonists cimetidine and ranitidine; Proton pump inhibitor omeprazole, Laasola azole, etc.

5) Analgesics: Patients with severe epigastric pain can take atropine, propofol, belladonna tablets or 654-2 orally to reduce gastric acid secretion and relieve abdominal pain symptoms.

6) Other symptomatic drugs can be used as digestive AIDS, such as pancreatin, yeast tablets, lactase and dimethicone tablets. In order to prevent bile reflux, aluminum magnesium carbonate and cholestyramine can be taken to adsorb bile; For those who vomit blood and have blood in the stool, take cyanoguanidine orally.

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