Patient's question:
Suffering from erosive gastritis for nearly two years, half a year ago the examination results showed erosive gastritis HP++, after half a year of treatment it was ineffective, and the follow-up results showed that the condition had not improved.Doctor's answer:
Chronic erosive gastritis, also known as verrucous gastritis or maculopapillary gastritis, is often associated with peptic ulcers, superficial or atrophic gastritis, and can also occur independently. Chronic gastritis is typically classified into superficial gastritis, atrophic gastritis, and hypertrophic gastritis. The course of chronic gastritis is prolonged, and most patients exhibit no obvious symptoms or signs, with only digestive discomfort such as postprandial fullness, acid reflux, belching, and irregular abdominal pain. Diagnosis primarily relies on endoscopic examination and gastric mucosal biopsy. This condition is more common in adults, and various factors can irritate the stomach, such as improper diet, viral and bacterial infections, and drug irritation. The best approach to treating gastritis is self-care. With consistent treatment, timely medication, and adherence to a regular lifestyle and dietary habits, not only can symptoms be alleviated, but the condition may even be completely cured.The main features include multiple verrucous, swollen rugal folds, or papillomatous elevations on the gastric mucosa, with a diameter of 5–10 mm. The tops show mucosal defects or umbilical depressions, with central erosion. The elevations are often surrounded by no erythema but are frequently accompanied by similar-sized erythematous spots, more common in the antrum. It can be classified as persistent or. In the Sydney system for chronic gastritis classification, it falls under a special type of gastritis, with endoscopic types being raised erosive gastritis and flat erosive gastritis. Chronic gastritis lacks specific symptoms, and the severity of symptoms does not always correlate with the extent of gastric mucosal lesions. Most patients are asymptomatic or experience varying degrees of digestive discomfort, such as dull upper abdominal pain, reduced appetite, postprandial fullness, and acid reflux. Patients with atrophic gastritis may exhibit anemia, edema, glossitis, and diarrhea. In some cases with mucosal erosion, upper abdominal pain is more pronounced, and bleeding may occur. Endoscopically, it often presents as multiple punctate or aphthous ulcers.
Chronic non-erosive gastritis can be idiopathic or caused by drugs (especially aspirin and non-steroidal anti-inflammatory drugs, see the section on peptic ulcers), Crohn's disease, or viral infections. Helicobacter pylori may play a minor role here. Symptoms are often non-specific, including nausea, vomiting, and upper abdominal discomfort. Endoscopically, it shows point-like erosion at the edges of thickened rugal folds, with central leukoplakia or depression. Histological changes vary. Currently, no single method offers broad efficacy or a cure. Treatment is primarily symptomatic, with medications such as antacids, H2 blockers, and proton pump inhibitors, while avoiding drugs and foods that exacerbate symptoms. Recurrence and worsening are common. Avoiding strong tea, coffee, alcohol, and foods that produce gas (such as potatoes, sweet potatoes, onions, and boiled soybeans) is recommended.
### Nutrition and Diet Therapy
- Liquids for acute gastritis: Remove the cause, rest in bed, and avoid all irritating foods or medications. Consider fasting or a liquid diet for those with bleeding, with hemostatic treatment administered if necessary.
- Avoid rough and irritating foods: Avoid hard, spicy, salty, hot, overly rough, or irritating foods like fried foods, preserved meats, chili peppers, and garlic. Regardless of whether citrus juices, tomato products, coffee, or alcohol directly stimulate the esophagus, it is best to avoid them.
- Avoid high-fat foods: High-fat foods, alcohol, sugars, and chocolate can relax the sphincter, causing reflux. If you experience heartburn, avoid these foods.
- Chew slowly: Chewing thoroughly helps digestion by mixing food fully with saliva. Avoid stress during meals to ensure proper digestion.
- Regular meals: Maintain a regular, timed, and quantified diet to preserve the rhythm of normal digestive activity. Avoid skipping meals, irregular eating habits, or skipping breakfast. Avoid overeating.
- Balanced nutrition: Choose nutrient-rich, easily digestible, and soft foods, emphasizing plant protein and vitamin-rich foods. Cooked chestnuts, rice porridge, goat milk, yogurt, and kefir are suitable. For severe symptoms, soft foods like rice soup, avocados, bananas, potatoes, and pumpkin can be consumed. Blend all vegetables before cooking. Occasionally, steam vegetables like carrots, carrots, and broccoli.
- Small, frequent meals: Have more than three meals a day, such as six small meals, as long as it feels comfortable. Avoid eating before bed, as excessive food intake can lead to excessive gastric expansion and increased acid secretion.
- Increase fiber intake: Consume fiber-rich foods. Fiber is considered an anticancer component, and a high-fiber diet can also reduce the risk of duodenal ulcers. Fiber is believed to promote mucin secretion, which protects the duodenal and gastric mucosa.
- Control fluid intake: Those with low stomach acid should avoid diluting gastric juice. Add vinegar, lemon juice, or acidic seasonings to the diet. Limit water intake before and after meals.
- Drink vegetable juice: Fresh cabbage juice is rich in glutamine, which promotes the growth of cells that produce mucin, benefiting gastric mucosal protection. Drink the juice immediately after preparation and do not store it. For those with excess stomach acid, drinking a cup can dilute the acid when stomach pain occurs.
- Limit milk: Milk has long been considered an excellent antacid, but while it temporarily buffers stomach acid, the calcium and protein in milk later stimulate more acid production, causing discomfort. Almond milk is a good alternative.
- Avoid iron supplements: If you have gastritis, taking iron supplements may cause severe nausea. Iron is irritating to the stomach.
- Supplement nutrients:
① Vitamin B12: Take as per product instructions. Chronic gastritis may cause anemia due to a lack of Vitamin B12.
② Vitamin E and zinc: 400 IU of Vitamin E daily, gradually increasing. 50–80 mg of zinc daily. They increase mucin production, protect the gastric mucosa, and relieve pain.
③ Aloe vera juice: 120 cc daily. It helps relieve pain and accelerates healing.
④ Proteolytic enzymes: Take between meals to break down residual food in the colon and reduce inflammation. Note: Do not use brands containing hydrochloric acid.
⑤ Vitamin A emulsion or capsules: 5000 IU for the first month, then reduce to 2500 IU. It protects the gastric mucosa and aids in recovery.
### Ginger for Pain Relief
Ginger is a traditional remedy used by Native Americans to treat digestive discomfort, gas, and joint inflammation. Ginger powder can calm the stomach. A typical dose is between half a teaspoon and one teaspoon (1–2 grams) per serving, and it can be taken daily if necessary.
### Health-preserving Diets
① Prickly pear pork stomach soup: 30–60 grams of prickly pear and one pork stomach. Stuff the prickly pear into the pork stomach, add water, and simmer until tender. Drink the soup and eat the pork stomach. Benefits: Promotes qi and blood circulation, strengthens the spleen and stomach. Suitable for stagnant qi and blood, chronic stomach pain.
② Cabbage porridge: 500 grams of cabbage and 50 grams of glutinous rice. Boil the cabbage for half an hour, remove it, and cook the rice with the cabbage water. Serve warm, twice daily. Benefits: Relieves pain. Suitable for acute stomach pain.
③ Potato porridge: 250 grams of fresh potatoes (unpeeled), with honey. Wash and chop the potatoes, cook until porridge-like, and add honey when serving. Eat on an empty stomach in the morning for 15 days. Benefits: Relieves pain. Suitable for dull stomach discomfort.
④ Pepper and scallion soup: 2 grams of pepper, 3 grams of scallions, and 6 grams of ginger. Boil water, add ginger and scallions, and simmer. Use the hot ginger and scallion soup to deliver the pepper or mix the pepper into the soup. Drink warm to relieve stomach pain. Benefits: Warming stomach, promotes qi and relieves pain. Suitable for cold stomach pain. Avoid for hot stomach pain.
⑤ Cinnamon and hawthorn soup: 6 grams of cinnamon, 10 grams of hawthorn, and 30 grams of brown sugar. Boil the hawthorn for 15 minutes, add cinnamon, and turn off the heat when the hawthorn is almost done. Strain the liquid and mix with brown sugar. Drink warm. Benefits: Warming stomach, aids digestion, relieves pain. Suitable for stomach pain.
### Home Treatment Measures
- Relax and de-stress: Mental tension is a contributing factor to chronic gastritis. Avoid stress. Emotional instability and irritability can lead to gastric mucosal and functional disorders. Try to avoid stress responses and relieve tension. Stay calm and maintain a positive mood for better recovery.
- Antibiotics: Helicobacter pylori can cause gastritis and other digestive issues. Two weeks of antibiotics can eliminate these bacteria. Helicobacter pylori can be detected through blood or saliva tests.
- Antacids: For mild gastritis, antacids are commonly used. It is best to take them 1–2 hours after eating, when stomach acid is at its peak, for maximum effect. Taking another dose before bedtime (9–10 PM) is even better.
- Use medications cautiously: Avoid aspirin, acetaminophen, phenylbutazone, indole drugs, tetracycline, erythromycin, and prednisone, especially during active chronic gastritis.
- Moderate exercise: Proper exercise stimulates gastrointestinal motility, effectively promotes gastric emptying, enhances secretion, improves digestion, and aids recovery.
- Quit smoking: Smoking can trigger stomach pain. Nicotine irritates the gastric mucosa, increasing acid secretion and causing harmful effects. Excessive smoking disrupts the pyloric sphincter, leading to bile reflux and gastric mucosal damage, as well as impairing blood supply and cell regeneration. Quit smoking.
- Avoid alcohol: Alcohol directly destroys the gastric mucosal barrier, causing congestion, edema, and erosion.
- Pay attention to daily health care: Chronic liver disease, diabetes, and biliary tract diseases can weaken local gastric mucosal defense and cause gastritis. Additionally, bacterial secretions from tonsillitis, sinusitis, or dental infections can reduce the mucosal barrier function, triggering gastritis. Therefore, controlling these conditions is crucial for recovery.
### Other Therapies
- Massage and acupressure: Use fingers and palms to massage the stomach (GV4), liver (GV13), spleen (GV12), and abdominal points (ST36, CV12, ST25). Apply pressure to the back points with the palm from top to bottom, then use the thumb to press in a circular motion. Next, press the abdominal points with four fingers, not too hard, just comfortable. Heat ginger or garlic on these points for additional benefit.
- Colon cleansing: Maintain a clean colon by using enemas regularly (see Chapter 8 of the next volume).
- Warning signs: Vomiting blood, black, tarry stools, or severe stomach pain indicate internal bleeding. Seek medical attention immediately.
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