How to check if it is chronic gastroenteritis

Patient's question:

Dr. Zhou: Hello! Thank you for your help! I trust your answer very much. Now, what I really want to know is: How can I accurately check if it is chronic gastroenteritis? If it truly is chronic gastroenteritis, how should I take care of it and treat it?

Doctor's answer:

Chronic gastritis refers to chronic inflammation of the gastric mucosa caused by various etiologies. The most common types are chronic superficial gastritis and chronic atrophic gastritis. Its main clinical manifestations include reduced appetite, discomfort and in the upper abdomen, belching, acid reflux, nausea, and vomiting. The course of the disease is slow, with recurrent attacks and difficulty in healing.
Health Guide:
1. Actively treat oral and pharyngeal infection foci to avoid swallowing bacteria-laden secretions such as sputum or nasal mucus, which can lead to chronic gastritis.
2. Maintain a cheerful mood. Depression, excessive tension, or fatigue can easily cause dysfunction of the pyloric sphincter, leading to bile reflux and chronic gastritis.
3. Use and avoid medications that damage the gastric mucosa, such as aspirin, salicylates, phenylbutazone, indomethacin, hormones, erythromycin, tetracycline, sulfonamides, and hydralazine. Long-term misuse of these drugs can damage the gastric mucosa, leading to chronic gastritis and ulcers.
4. Harmful components in tobacco can increase gastric acid secretion and cause harmful stimulation to the gastric mucosa. Excessive smoking can lead to bile reflux. Overconsumption of alcohol or long-term heavy drinking can cause congestion, edema, or even erosion of the gastric mucosa, significantly increasing the incidence of chronic gastritis. Quit smoking and avoid alcohol.
5. Avoid overly acidic, spicy, or cold, indigestible foods. Chew food thoroughly to mix it well with saliva, which aids digestion and reduces irritation to the stomach. Meals should be regular, balanced, and rich in nutrients, especially those high in vitamins A, B, and C. Avoid stimulating drinks like strong tea and coffee.
6. Practice internal cultivation exercises.
Chronic gastritis is generally divided into two types:
- Chronic superficial gastritis: Inflammation is superficial, limited to the surface layer of the gastric mucosa (not exceeding two-thirds).
- Chronic atrophic gastritis: Inflammation affects the entire layer of the gastric mucosa and is accompanied by atrophy of gastric glands.
Chronic gastritis is a common and frequently occurring disease. Endoscopic screening in China has confirmed that the incidence of chronic gastritis in the population is as high as 60% or more, with atrophic gastritis accounting for about 20% of cases. There are many triggers for chronic gastritis, including long-term and excessive alcohol and tobacco consumption, irregular eating habits, consumption of overly cold or hot food, rough or hard food, strong tea, coffee, and spicy foods, all of which can exacerbate the condition. Chronic gastritis caused by Helicobacter pylori infection due to poor hygiene is difficult to cure. If acute gastritis is not treated thoroughly, it may develop into chronic gastritis. Certain medications, such as aspirin, phenylbutazone, and corticosteroids, can damage the gastric mucosal barrier, leading to gastritis or exacerbation of the condition.
The most common symptoms of chronic gastritis are stomach pain and a feeling of fullness, which worsen after meals but are more comfortable on an empty stomach. Even with small amounts of food, patients may feel overly full and uncomfortable, often accompanied by belching, acid reflux, heartburn, nausea, vomiting, reduced appetite, and indigestion. Due to poor appetite and indigestion, malnutrition, weight loss, anemia, and weakness may develop. Some patients may also experience neurological symptoms such as nervousness, irritability, insomnia, palpitations, and forgetfulness. These symptoms can, in turn, worsen the stomach symptoms of chronic gastritis, creating a vicious cycle that makes the condition complex and difficult to treat.
Gastric juice analysis shows that patients with chronic superficial gastritis often have normal or slightly low gastric acid levels, while those with chronic atrophic gastritis have significantly reduced gastric acid and may also have anemia (hemoglobin below normal). Gastroscopy combined with gastric biopsy can confirm whether the gastritis is superficial or atrophic. During gastroscopy, gastric biopsies can also be taken to check for Helicobacter pylori infection.
Generally, the prognosis for chronic superficial gastritis and simple mild chronic atrophic gastritis is good. Historically, chronic atrophic gastritis was considered a precursor to gastric cancer (premalignant lesion), but this view is now considered biased. However, there is a definite relationship between atrophic gastritis and gastric cancer, based on the following:
1. Studies have shown that biopsies of atrophic gastritis with "colonic-type intestinal metaplasia" and "dysplasia" have the potential to develop into gastric cancer, which is a well-recognized fact.
2. Epidemiological surveys show a high incidence of atrophic gastritis in populations with a high incidence of gastric cancer.
3. Pathological examinations reveal that atrophic lesions are common in the mucosa around gastric cancer. Moderate to severe atrophic gastritis, especially with colonic-type intestinal metaplasia or dysplasia on pathological examination, is considered a premalignant lesion. Without active treatment and proper dietary management, it is relatively easy to progress to gastric cancer.
Therefore, regular gastroscopic follow-ups are necessary for chronic atrophic gastritis:
- General chronic atrophic gastritis: checked every 3 years.
- With incomplete colonic-type intestinal metaplasia and mild dysplasia: checked annually.
- With moderate dysplasia: checked every 3 months.
- With severe dysplasia (over a 10% risk of malignancy): should be considered for surgical resection.
Only with active treatment, dietary management, and regular follow-ups can the lesion improve or stabilize without progression, thereby preventing the occurrence of gastric cancer. Even if the condition progresses, regular gastroscopic follow-ups can detect it early, allowing for preventive resection of the gastric lesion or early-stage gastric cancer, which remains an effective and curative method. Thus, with active treatment, dietary management, and regular follow-ups, the initiative is in your hands. So, what is there to fear from chronic atrophic gastritis?!
Chronic gastritis patients must pay close attention to their diet:
- Eat regularly, in small meals, and prioritize soft foods.
- Chew food thoroughly and avoid overeating.
- Avoid stimulating foods, quit smoking and alcohol, and limit consumption of strong tea, coffee, and spicy, overly hot, or rough food.
- For those with low gastric acid or bile reflux, it is advisable to consume high-protein, low-fat foods such as lean meat, poultry, fish, and dairy products.
- Avoid medications that irritate the stomach, such as sodium salicylate, indomethacin, phenylbutazone, and aspirin.
- Relieve stress and maintain a positive mood to improve immunity and enhance disease resistance.
- Pay attention to work-life balance and engage in appropriate exercise.
Western medicine treatment focuses on symptomatic relief. For severe hypochlorhydria, oral dilute hydrochloric acid can be used to increase gastric juice acidity. For indigestion, pepsin mixture or multi-enzyme tablets can be taken. For fullness, nausea, and vomiting, Domperidone or Cisapride can be used to prevent bile reflux and protect the gastric mucosa. For significant pain, belladonna tablets or 654-2 can be used for spasm relief. For Helicobacter pylori infection, Lanzu triple therapy should be added for eradication.
Sucralfate is a gastric mucosal protectant that reduces external irritation and aids in the healing of gastric mucosal lesions. It is suitable for all types of chronic gastritis. Adding Weizymes to chronic atrophic gastritis can enhance immunity, activate detoxifying enzymes, inhibit cancer cell growth, and prevent abnormal cell metabolism.
Traditional Chinese medicine (TCM) treatment is effective for chronic gastritis. In TCM, chronic gastritis is often classified as stomach pain or stomach distention, with seven common types:
a. Spleen and stomach deficiency type: Chronic weakness due to poor diet or irregular eating habits, leading to stomach distention, pain, poor appetite, post-meal bloating, fatigue, and weakness. Treatment involves Xiang Sha Liu Jun Zi Tang to strengthen the spleen and stomach.
b. Spleen and stomach cold deficiency type: Severe weakness, insufficient spleen Yang, or consumption of cold food, leading to internal cold and hidden stomach pain, relief with warmth, reduced pain after meals, severe pain on an empty stomach, and cold limbs. Treatment involves Huang Qi Jian Zhong Wan (Decoction) to warm the spleen and stomach and relieve spasms.
c. Liver Qi invading stomach type: Emotional distress, liver Qi stagnation, and stomach pain, frequent belching, relief after belching or defecation, or accompanied by irritability, chest tightness, sighing, and a foreign body sensation in the throat. Treatment involves Qi Zhi Wei Tong Chong to regulate liver Qi and relieve stomach pain, or Xiao Yao Wan or Yuan Hu Zhi Tong Pian.
d. Liver fire invading stomach type: Liver Qi stagnation turning into fire, causing stomach burning pain, bitter taste, irritability, dry stools. Treatment involves Qing Xie Gan Wei Huo to clear liver fire.
e. Stomach yin deficiency type: Liver fire damaging stomach Yin or excessive consumption of spicy food, leading to hidden stomach pain, loss of appetite, dry mouth and throat, and dry stools. Treatment involves Yi Guan Jian combined with Pao Ye Tang to nourish Yin and stomach.
f. Blood stasis in stomach collaterals type: Liver Qi stagnation or spleen deficiency causing poor blood circulation and stasis in the stomach, leading to sharp or cutting stomach pain, fixed pain, and dark or purplish spots on the tongue. Treatment involves Shi Xiao San to promote blood circulation and relieve pain, combined with warming stomach Qi.
g. Cold and heat mixed type: Symptoms of stomach heat (bitter taste, dry mouth, stomach burning, desire for cold food, dry stools) and spleen cold (fear of cold, stomach discomfort, pain, and distention after eating cold food). Treatment involves Ban Xia Xie Xin Tang (modified) for good results.
Chronic gastritis refers to chronic inflammatory lesions of the gastric mucosa caused by different etiologies. It is relatively common, with a long course and persistent or recurrent symptoms. The severity of the condition varies, and based on gastroscopic and pathological findings, chronic gastritis can be classified into three types:
1. Superficial gastritis: Mild congestion and edema in the superficial gastric mucosa, with rare erosion or bleeding. Gastric glands are usually normal.
2. Atrophic gastritis: Thinning of the gastric mucosa layer, with partial or complete loss of gastric glands.
3. Hypertrophic gastritis: Thickened and coarse mucosa, appearing as coarse strands or nodules. Epithelial cells and gastric glands are hyperplastic, but gastroscopic diagnosis of hypertrophic gastritis is often not confirmed pathologically, leading to skepticism about its existence.
In recent years, it is believed that chronic gastritis often involves both superficial and atrophic lesions, but atrophic changes are more prominent, and chronic gastritis is classified as gastric body gastritis or gastric antrum gastritis.
- Gastric body gastritis: Mucosal lesions are mostly atrophic and diffuse, limited to the gastric body and not involving the antrum. Gastric acid secretion is severely impaired, serum gastrin levels are elevated, serum anti-parietal cell antibodies are often positive, and vitamin B12 absorption may be impaired, potentially causing pernicious anemia.
- Gastric antrum gastritis (also called antritis): The antrum mucosa is primarily affected, often with localized atrophic lesions or combined superficial inflammatory lesions. The gastric body mucosa may also have focal, mild atrophic lesions. Gastric acid secretion dysfunction is lighter, serum gastrin levels are low, serum anti-parietal cell antibodies are usually negative, and pernicious anemia is not typically caused.
Currently, it is believed that gastric body gastritis is more closely related to immunity, while gastric antrum gastritis is more associated with external stimuli such as smoking, drinking, or bile reflux. In China, the incidence of gastric antrum gastritis significantly exceeds that of gastric body gastritis.
Symptoms
The clinical manifestations of chronic gastritis mainly include reduced appetite, discomfort or hidden pain in the upper abdomen, belching, acid reflux, nausea, and vomiting, which are persistent or recurrent. Gastric body gastritis and gastric antrum gastritis may have different clinical characteristics. The former has fewer digestive symptoms but is more prone to overt or occult pernicious anemia and iron deficiency anemia. The latter has more digestive symptoms, with some patients exhibiting symptoms similar to peptic ulcer, such as periodic, rhythmic upper abdominal pain, and repeated black stools or vomiting of coffee-ground-like fluid, which can often stop spontaneously. It is believed that some chronic atrophic gastritis can progress to gastric cancer, and gastric antrum gastritis has a higher incidence of gastric cancer compared to gastric body gastritis, so these patients should undergo regular follow-up.
Diagnosis
Gastroscopy combined with direct visual biopsy is the main method for diagnosing chronic gastritis.
Treatment
1. Eliminate the cause: Quit smoking, drinking, and avoid foods and medications that irritate the gastric mucosa. If gastroscopy reveals significant bile reflux, Domperidone and Cholestyramine can be used.
2. Medication:
- For hypochlorhydria or low gastric acid, 1% dilute hydrochloric acid and pepsin mixture can be taken.
- For hyperchlorhydria, aluminum hydroxide gel, Gastric, and cimetidine can be used.
- For pain, atropine, propantheline, or belladonna preparations can be taken.
- Antibiotics: Low or absent gastric acid often leads to bacterial overgrowth in the stomach, which is related to the progression of the disease. Short-term oral administration of poorly absorbed antibiotics such as furazolidone, gentamicin, or streptomycin can be considered.
- Traditional Chinese medicine: Xiang Sha Yang Wei Wan, Chen Xiang Lu, and Monkey Mushroom Tablets are effective for relieving abdominal pain, distention, belching, nausea, and vomiting.
- For iron deficiency anemia, iron supplements can be taken. For pernicious anemia, vitamin B12 injections are recommended.
3. Surgery: If gastroscopic findings show inflammation, erosion, or ulcers with pathological evidence of malignancy, surgical treatment should be considered. For mild dysplasia or intestinal metaplasia, surgery should not be rushed, and follow-up with X-ray, fiberoptic gastroscopy, and gastric mucosal biopsy every 3–6 months is recommended.
Acute gastroenteritis is the most common disease in summer, often causing vomiting, diarrhea, and severe abdominal pain. Doctors usually recommend fasting for half a day or a day and increasing fluid intake. However, doctors also remind that fluid supplementation is not just about drinking plain water; it is better to drink electrolyte solutions with appropriate salt and water. Drinking too much plain water may lead to electrolyte imbalance and muscle cramps.
Prevention
- Any dairy products or processed fish and meat should not be consumed if left at room temperature for too long.
- Pay attention to the center temperature of food heated in a microwave; it should be sufficiently hot before consumption. Microwaves themselves do not sterilize.
- Avoid suspected unhygienic food, especially from unlicensed food stalls or improperly handled seafood, sushi, etc. It is a good habit to visit a restaurant’s toilet first and wash hands afterward. (Don’t really think that what you can’t see is clean!)
- When traveling, it is even more important to be cautious, as bacteria vary by region, and the intestinal tract’s resistance may be lower.
- Fully cooked chilled meat should be eaten. If a can is damaged or the food inside looks abnormal, it should be discarded.
- The expiration date of dairy products should not be ignored. Do not eat green potato sprouts.
What is gastroenteritis?
Gastroenteritis is inflammation of the gastric and intestinal mucosa, often caused by food poisoning. Symptoms include severe vomiting and diarrhea, often accompanied by abdominal pain, cramps, fever, sweating, and dehydration, which may lead to shock. Vomiting and diarrhea symptoms usually subside within 2–4 days but may persist longer. Bacterial infections (e.g., Salmonella) may last for months or even years, with patients becoming asymptomatic carriers who can transmit the infection.
Causes of gastroenteritis
The cause can be bacteria, viruses, pesticides, toxins in food itself, chemical reactions in food, or other inorganic substances.
- Bacterial causes: The most common is food contaminated with bacteria, especially undercooked or partially cooked food. Flies and unhygienic cooking utensils can also cause contamination. Food stored at room temperature is likely to be severely contaminated. Refrigerators should be kept at 4°C or below, and hot cabinets at 60°C or above, to stop bacterial growth. Staphylococcus, E. coli, and Salmonella are the most common pathogens. is often found in contaminated poultry, meat, and fish, causing diarrhea and severe abdominal pain. E. coli has many varieties, most of which are harmless, but some can cause acute gastroenteritis in newborns, often spreading in nurseries, related to milk bottle sterilization procedures.
- Viral infections: Often cause gastroenteritis and colitis. Rotavirus is the most common cause of childhood diarrhea. Other viruses include adenovirus, enterovirus, and hand, foot, and mouth virus. These infections can develop within 2 days.
- Toxins in plants: Some plants produce toxins during growth, such as yew, green nightshades, morning glories, and poison ivy. Green potatoes are also toxic.
- Chemicals: Green chemicals like arsenic, lead, and various pesticides can cause symptoms within hours of ingestion.
- Other diseases: Amoebiasis, giardiasis, etc., can also cause symptoms of gastroenteritis.
How to handle gastroenteritis?
Mild gastroenteritis can resolve on its own without treatment. Most gastroenteritis is toxic, but in most cases, the toxicity is mild. However, certain strains of Clostridium perfringens and poisoning from plants or chemicals require immediate medical attention. If accompanied by abdominal pain, bloody stools, or other unexpected symptoms; symptoms are severe or prolonged; or if toxic plants or chemicals have been ingested, seek medical help immediately. High fever, double vision, convulsions, or paralysis also require immediate medical attention.
Medication
- Children should not take anti-diarrheal medication—it is dangerous. Always consult a doctor.
- Children’s gastroenteritis is more complex than adult gastroenteritis. Adult patients can take appropriate anti-diarrheal and pain medications.
- Diarrhea itself has a function but also side effects. If there is acute vomiting and diarrhea, avoid milk-based drinks and drink only a little water. After the stomach symptoms begin to subside, nutritional supplements can be started. Rice porridge is the best choice. However, avoid tea, coffee, and acidic drinks like lemon or orange juice to prevent further vomiting.
- Most gastroenteritis improves within 3 days. After vomiting and diarrhea subside, patients can gradually eat more diverse foods but should still avoid things.
How doctors handle it?
If the condition is severe, the patient will be admitted to the hospital for examination and treatment. Dry retching may occur after the stomach is empty, and doctors may inject anti-emetics. At this stage, vomiting is useless and may hinder eating and medication. If diarrhea persists, doctors may prescribe anti-diarrheal or spasm-relieving medication. Doctors generally do not use antibiotics unless the pathogen is known to be treatable with antibiotics. If effective antibiotics are used, the treatment is very effective.
- If children or elderly patients lose too much fluid due to vomiting, diarrhea, and sweating, doctors may use intravenous fluids to replenish fluids.
Prevention methods
- Any dairy products or processed fish and meat should not be consumed if left at room temperature for too long.
- Pay attention to the center temperature of food heated in a microwave; it should be sufficiently hot before consumption. Microwaves themselves do not sterilize.
- Avoid suspected unhygienic food, especially from unlicensed food stalls or improperly handled seafood, sushi, etc. It is a good habit to visit a restaurant’s toilet first and wash hands afterward. (Don’t really think that what you can’t see is clean!)
- When traveling, it is even more important to be cautious, as bacteria vary by region, and the intestinal tract’s resistance may be lower.
- Fully cooked chilled meat should be eaten. If a can is damaged or the food inside looks abnormal, it should be discarded.
- The expiration date of dairy products should not be ignored. Do not eat green potato sprouts.