Patient's question:
Main symptoms: mild pain, constipation, dry mouth, poor appetite. Onset time: over 2 years. Test results: erosive gastritisDoctor's answer:
The etiology of acute erosive gastritis includes drugs (especially nonsteroidal anti-inflammatory drugs), alcohol, and acute stress, such as in severely ill patients. Uncommon causes include radiation, viral infections (e.g., cytomegalovirus), vascular injury, and direct trauma (e.g., nasogastric intubation). Endoscopically, it appears as superficial punctate mucosal erosion, not involving deeper layers, often accompanied by varying degrees of bleeding (mostly submucosal petechiae). Acute stress gastritis is a type of erosive gastritis and can be seen in severely ill patients. Clinically, it is characterized by an increased proportion of upper gastrointestinal bleeding due to gastric and duodenal mucosal damage. Risk factors include severe burns, central nervous system trauma, sepsis, shock, respiratory failure with mechanical ventilation, liver and kidney failure, and multiple organ dysfunction. Other predictive factors for acute stress gastritis include the duration of ICU stay and the time without enteral nutrition during the hospitalization. In summary, the more severe the patient's condition, the higher the risk of significant bleeding. The pathogenesis of acute erosive gastritis in severely ill patients may be due to a weakened gastric mucosal barrier function. Reduced blood flow to the gastric mucosa and possible increased acid secretion (as in burns, central nervous system trauma, and sepsis) can promote mucosal inflammation and ulcer formation. Chronic erosive gastritis is often characterized endoscopically by multiple punctate or aphthous ulcers. Chronic non-erosive gastritis can be idiopathic or caused by drugs (especially aspirin and nonsteroidal anti-inflammatory drugs, see the section on peptic ulcer treatment), Crohn's disease (see Section 31), or viral infections. Helicobacter pylori may play a minor role in this context. Symptoms are often non-specific and may include nausea, vomiting, and upper abdominal discomfort. Endoscopically, it shows punctate erosion at the margins of thickened rugal folds, with central white plaques or depressions. Histological changes are diverse. Currently, no method is widely effective or curative. Treatment is primarily symptomatic, with medications including antacids, H2 antagonists, and proton pump inhibitors, while avoiding drugs and foods that may exacerbate symptoms. Recurrence and worsening are common.