Patient's question:
Dr. Zhou: Hello! Thank you for your help! I trust your answers, and now I just want to know: 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 a 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 dull pain 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 irritation to the gastric mucosa. Excessive smoking can lead to bile reflux. Overconsumption of alcohol or long-term drinking of strong spirits 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 irritating foods, as well as cold and 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 foods high in vitamins A, B, and C. Avoid stimulating drinks such as strong tea and coffee.
6. Practice internal cultivation exercises.
Chronic gastritis is generally divided into two types:
- Chronic superficial gastritis: Inflammation is superficial and 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 prevalent condition. Endoscopic screening has confirmed that the incidence of chronic gastritis in the Chinese 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, consuming overly cold or hot food, rough or hard food, strong tea, coffee, and spicy irritating 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.
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 poor digestion. Due to reduced food intake and poor digestion, patients may experience malnutrition, weight loss, anemia, and weakness. Some patients may also have neurological symptoms such as nervousness, irritability, insomnia, palpitations, and forgetfulness. These symptoms can further worsen gastric symptoms, 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 levels and may also have anemia (hemoglobin below normal). Gastroscopy combined with endoscopic 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-known 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 more likely to progress to gastric cancer.
Therefore, patients with chronic atrophic gastritis should undergo regular gastroscopic follow-ups:
- General chronic atrophic gastritis: checked every 3 years.
- With incomplete colonic-type intestinal metaplasia and mild dysplasia: checked every year.
- 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, lifestyle adjustments, and regular follow-ups can the lesions improve or stabilize without progression, thereby preventing the development 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, as long as active treatment, lifestyle adjustments, and regular follow-ups are maintained, the initiative is in your hands. So, what is there to fear about chronic atrophic gastritis?
Patients with chronic gastritis must pay close attention to their diet:
- Maintain regular eating habits, eat small meals frequently, and prioritize soft foods.
- Chew food thoroughly and avoid overeating.
- Avoid irritating foods, quit smoking and alcohol, and limit consumption of strong tea, coffee, and spicy, overly hot, or rough foods.
- For those with low gastric acid or bile reflux, high-protein, low-fat diets such as lean meat, poultry, fish, and dairy products are recommended.
- Avoid medications that irritate the stomach, such as sodium salicylate, indomethacin, phenylbutazone, and aspirin.
- Relieve stress, maintain a positive mood, and improve immunity and 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 poor digestion, pepsin mixture or multi-enzyme tablets can be taken. For fullness, nausea, and vomiting, Domperidone or Metoclopramide can be used. If bile reflux is present, long-term bile reflux can damage the gastric mucosal barrier, leading to chronic superficial gastritis, which may progress to atrophic gastritis. In such cases, gastric motility drugs can be used to prevent bile reflux and protect the gastric mucosa. Domperidone or Cisapride can counteract bile reflux, promote emptying, and stop vomiting. For significant stomach pain, belladonna tablets or 654-2 can be used for spasm relief and pain reduction. If Helicobacter pylori infection is present, Lanzoprazole triple therapy should be added for eradication.
Sucralfate is a gastric mucosal protectant that reduces irritation from external factors and aids in the healing of gastric mucosal lesions. It can be used for all types of chronic gastritis. Adding Viosterol 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," with seven common types:
a. Spleen-stomach deficiency type: Congenital spleen deficiency or irregular eating habits (overeating or undereating) damage the spleen and stomach,,,,. Treatment involves Xiang Sha Liu Jun Zi Tang to strengthen the spleen and regulate the stomach.
b. Spleen-stomach cold type: Severe spleen deficiency with insufficient spleen Yang, or overeating cold foods, damages spleen Yang, leading to internal cold and coldness.,,,,4. Treatment involves Huang Qi Jian Zhong Wan (Decoction) to warm the spleen and stomach and relieve spasms and pain.
c. Liver-gas stagnation type: Emotional distress, depression, or anger damages the liver, causing gas stagnation and dysfunction.,,,,,,. Treatment involves Qi Zhi Wei Tong Chong to regulate liver Qi and relieve stomach pain, or adding Xiao Yao Wan or Yuan Hu Zhi Tong Pian.
d. Liver-fire type: Liver Qi stagnation turning into fire, attacking the stomach, causing burning pain in the stomach, bitter taste, restlessness, dry stools. Treatment involves Qing Xie Gan Wei Zhi Huo to clear liver-fire and stomach-fire, using Zuo Jin Wan.
e. Stomach-yin deficiency type: Liver-fire damages stomach Yin or excessive consumption of spicy foods depletes stomach fluids.,,,. Treatment involves Yi Guan Jian He Shao Yao Tang to nourish Yin and stomach.
f. Blood-stasis type: Liver Qi stagnation or spleen deficiency over time causes poor blood circulation and stagnation in the stomach.,,,. Treatment involves Shi Xiao San to activate blood and resolve stasis, combined with warming the stomach.
g. Cold-heat mixed type: Symptoms of stomach heat (bitter taste, dry mouth, halitosis, burning stomach pain, desire for cold food, dry stools) coexist with symptoms of spleen-cold (fear of cold, stomach discomfort after eating cold food, or stomach pain after exposure to cold). 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. This condition 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: The superficial layer of the gastric mucosa shows congestion and edema, with less erosion and bleeding. Gastric glands are usually normal.
2. Atrophic gastritis: The gastric mucosa becomes thin, with partial or complete loss of gastric glands.
3. Hypertrophic gastritis: The mucosal layer is thickened and coarse, appearing as coarse cords or nodules. Epithelial cells and gastric glands are hyperplastic, but gastroscopic diagnosis of hypertrophic gastritis is often not confirmed by pathology, so many doubt 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 divided into gastric body gastritis and gastric antrum gastritis.
- Gastric body gastritis: Mucosal lesions are mostly atrophic and diffuse, limited to the gastric body and usually 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 leading to pernicious anemia.
- Gastric antrum gastritis (also called antritis): The antrum is primarily affected, with atrophic lesions limited to the antrum or combined with 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 often 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 main clinical manifestations of chronic gastritis include reduced appetite, discomfort or dull pain in the upper abdomen, belching, acid reflux, nausea, and vomiting, which persist or recur. Gastric body gastritis and gastric antrum gastritis may have different clinical characteristics. The former has fewer of the above digestive symptoms but is more prone to significant or occult pernicious anemia and iron deficiency anemia. The latter has more digestive symptoms, with some patients' symptoms resembling peptic ulcer, presenting with periodic, rhythmic upper abdominal pain, and recurrent black stools or coffee-ground vomiting, which can often stop spontaneously.
It is believed that some cases of chronic atrophic gastritis can progress to gastric cancer, and gastric antrum gastritis is more likely to develop into gastric cancer than gastric body gastritis. Therefore, 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: Remove pathogenic factors, such as quitting smoking, drinking, and avoiding foods and medications that irritate the gastric mucosa. If gastroscopy shows 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 attacks, atropine, propantheline, and belladonna preparations can be taken.
- Antibiotics: Low or absent gastric acid often leads to bacterial overgrowth in the stomach, which is related to the development of the disease. Short-term oral administration of poorly absorbed antibiotics such as furazolidone, gentamicin, or streptomycin can be used.
- Traditional Chinese medicine: Xiang Sha Yang Wei Wan, Chen Xiang Lu, and Monkey Fruit Tablets are effective for relieving abdominal pain, bloating, 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, but pathological examination suggests possible 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. Once bacteria or viruses invade the gastrointestinal tract, patients often experience vomiting, diarrhea, and severe abdominal pain, which can be very uncomfortable. When visiting a gastroenterologist, 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 an electrolyte solution with appropriate salt and water. Drinking too much plain water may lead to insufficient electrolytes in the body, causing cramps.
Over-the-counter oral rehydration salts can also be purchased and prepared at home. As summer approaches, in addition to respiratory infections, acute gastroenteritis is the most common condition. The causative agents include Salmonella, adenovirus, enterovirus, etc. Patients may experience vomiting, diarrhea, abdominal pain, fever, severe abdominal cramping, high fever with chills, anorexia, and fatigue. Generally, treating acute gastroenteritis takes 3–7 days. In addition to medication and fasting for 12–24 hours, patients may experience dehydration due to continuous diarrhea, so sufficient fluids must be supplemented during the fasting period.
It is worth noting that children with vomiting and diarrhea not only lose fluids but also lose electrolytes. Therefore, it is best to supplement with over-the-counter oral rehydration salts rather than plain water. Some parents may only give children plain water, which can dilute electrolytes in the body and cause cramps or "water intoxication." Sports drinks on the market also contain salt, but the high sugar content can worsen diarrhea in children, causing persistent diarrhea. In contrast, oral rehydration salts contain appropriate amounts of sugar and salt, which can replenish lost fluids and salt without causing persistent diarrhea due to excessive sugar.
Additionally, during recovery from acute gastroenteritis, patients may experience poor appetite and can eat light, easily digestible foods. Young children can eat porridge, noodles, soda crackers, apples, and bananas. For infants under one year old who primarily consume infant formula, the formula can be diluted or switched to a lactose-free special formula. Once symptoms improve, the formula can be adjusted back to its original concentration.
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 or cramping. Fever, sweating, and dehydration may occur due to prolonged and excessive fluid loss, potentially leading to shock. Small amounts of blood may be present in vomit or stool. Vomiting and diarrhea symptoms typically subside within 2–4 days but may persist longer. Salmonella infection can last for months or even years, during which patients may show no symptoms but act as carriers, transmitting the infection to others.
Why does gastroenteritis occur?
The cause can be bacterial, viral, pesticide contamination, toxins in food itself, chemical reactions in food, or other inorganic substances. Bacterial causes include:
- The most common cause is bacterial contamination of food that is undercooked or partially cooked, especially easily contaminated by flies or unsanitary cooking utensils. Storing food at room temperature can lead to severe bacterial contamination. Freezers should be kept at 4°C or below, and hot cabinets at 60°C or above, to stop bacterial growth. Staphylococcus aureus and Campylobacter are often transmitted by food handlers, especially in dairy products, processed meats, and raw fish sushi. Staphylococcus aureus, E. coli, and Salmonella are the most common pathogens. can be found in contaminated poultry, meat, and fish, often causing diarrhea and severe abdominal pain. Many types of E. coli are harmless, but some can cause acute gastroenteritis in newborns, often spreading in nurseries, related to milk bottle sterilization procedures. Viral infections can also cause gastroenteritis and colitis. Rotavirus is the most common pathogen causing diarrhea in children. Other viruses that can cause gastroenteritis include adenovirus, enterovirus, and hand, foot, and mouth virus, etc. These infections can develop within 2 days. Some plants produce toxins during growth, which can also cause gastroenteritis, such as yew, green bell peppers, morning glories, and poison ivy. Green chemicals like arsenic, lead, and various pesticides can cause symptoms within hours of ingestion. Diseases such as amebiasis and giardiasis can also cause symptoms of gastroenteritis.
How to handle gastroenteritis?
Mild gastroenteritis can resolve on its own without treatment. Gastroenteritis is often toxic, but in most cases, the toxicity is mild. However, conditions like Clostridium perfringens poisoning or poisoning from certain plants or chemicals require immediate medical attention if not treated promptly, as they can be fatal. If accompanied by abdominal pain, bloody stools, or other unexpected symptoms; if symptoms are severe or persist for a long time; or if toxic plants or chemicals have been ingested, seek medical attention immediately. Symptoms like high fever, double vision, convulsions, or paralysis should also be treated immediately.
Medication
Children should not take anti-diarrheal medication—it is dangerous. They must see a doctor. Children's gastroenteritis is more complex than adults'. Adult patients can take small doses of anti-diarrheal and pain medications. Diarrhea itself has a function, but it also has side effects. If there is acute vomiting and diarrhea, avoid milk-based drinks and drink only small amounts of water. Once gastric symptoms begin to subside, nutritional supplementation can start. Porridge is the best choice for easily digestible foods. However, avoid tea, coffee, and acidic drinks like lemon or orange juice, as they may irritate the stomach and cause vomiting again. Most gastroenteritis cases improve within 3 days. After vomiting and diarrhea subside, patients can gradually return to a more varied diet but should still avoid irritating foods.
How doctors handle it?
If the condition is severe, patients may be hospitalized for examination and treatment. After gastric emptying, patients may experience dry vomiting, and doctors may administer anti-emetic injections. At this point, vomiting is useless and may hinder eating and medication. If diarrhea persists, doctors may prescribe anti-diarrheal or antispasmodic medications. Doctors generally do not use antibiotics unless the pathogen is confirmed to be treatable with antibiotics. In such cases, using a targeted antibiotic can be 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
Milk products and processed fish and meat should not be consumed if left at room temperature for too long. Pay attention to foods heated in microwaves—ensure the center is hot enough before eating. Microwaves themselves do not sterilize food. Avoid eating suspected unsanitary food, especially from unlicensed food stalls or improperly handled seafood, sushi, etc. It is a good habit to check the restaurant's toilet first and wash hands afterward. Don't really believe that "out of sight, out of mind"!) When traveling, it is even more important because bacteria vary by region, and the intestinal tract's resistance may be lower. Cooked meat stored in the refrigerator should be thoroughly cooked before eating. If canned food containers are damaged or the food inside looks abnormal, discard it. Do not eat green potato sprouts.