Atrophic gastritis

　　The etiology of atrophic gastritis is not yet fully clear and may be related to the following factors:

　　1. Helicobacter pylori infection

　　Hp can be cultured in the gastric mucosa of 60% to 90% of chronic gastritis patients. In the 8th World Congress of Gastroenterology in 1986, it was proposed that Hp infection is one of the important etiologies of chronic gastritis.

　　2. Diet habits

　　Smoking, drinking, food stimulation, drugs that damage the gastric mucosa, etc.

　　3. Immune factors

　　In the blood, gastric juice, or plasma cells of the atrophic gastritis patients, especially those with corpus gastritis, wall cell antibodies or intrinsic factor antibodies can often be found, so it is believed that autoimmune reaction is related to the etiology of atrophic gastritis.

　　4. Bile or duodenal juice reflux

　　5. Physical factors

　　The clinical statistics show that the occurrence of this disease is significantly positively correlated with age. The older the age, the worse the function of the gastric mucosal 'resistance', and it is easy to be damaged by adverse external factors.

　　28. Genetic factors

　　The status of genetic factors in the pathogenesis of A-type atrophic gastritis has been confirmed, and the positivity rate of PCA and IFA is high in families with pernicious anemia, and atrophic gastritis is common.

　　26. Metal contact

　　Workers engaged in lead work have a high incidence of gastric ulcer, and the incidence of atrophic gastritis is also increased according to the examination of gastric mucosal biopsy. In addition to lead, many heavy metals such as mercury, copper, and zinc have a certain degree of damage to the gastric mucosa.

　　24. Radiation

　　Radiation therapy for ulcer disease or other tumors can cause damage to the gastric mucosa, even atrophy.

　　22. Iron deficiency anemia

　　Many facts show that iron deficiency anemia and atrophic gastritis are closely related.

　　20. Chronic superficial gastritis continues, etc.

　　Atrophic gastritis should attract the attention of patients, and once treatment is delayed, atrophic gastritis can lead to cancerous changes. The common complications of atrophic gastritis are as follows: four types:

　　16. Gastric hemorrhage.

　　15. Anemia.

　　14. Gastric ulcer.

　　13. Precancerous lesions, etc.

　　Most patients with atrophic gastritis have no obvious自觉 symptoms, and those with symptoms also lack specificity. Generally speaking, the following clinical manifestations often occur:

　　9. Epigastric distension: In chronic atrophic gastritis, epigastric distension and discomfort are more common, and some patients feel bloated or have a feeling of obstruction in the epigastric region, even in the abdomen, hypochondrium, or chest, with frequent belching.

　　8. Epigastric pain: Epigastric pain can occur alone, but in most cases, it occurs simultaneously with epigastric distension. It presents as distending pain, hidden pain, or dull pain, and can also appear as severe pain or colic during acute attacks. The pain location is usually in the epigastric region, and a few may appear in the hypochondrium, abdomen, back, or chest, with localized tenderness or deep pressure discomfort in the epigastric region. Some patients may only feel discomfort or uneasiness in the epigastric region, without any specific name.

　　7. Heartburn and indigestion symptoms: Patients feel a burning or discomfort in the epigastric region, and some have acid regurgitation. It often occurs with decreased appetite, even no appetite, or although there is appetite, there is a feeling of fullness and discomfort in the epigastric region after eating, or indigestion.

　　6. Abnormal defecation and weakness symptoms: Constipation is common, often occurring once every few days, while a few patients may present with loose stools. Patients with a long course of the disease may appear emaciation, fatigue, lack of strength, and weak symptoms such as malaise.

　　5. Anemia: It can be iron deficiency anemia or megaloblastic anemia. The former is caused by long-term malnutrition and insufficient iron supplementation, and the latter is caused by a lack of intrinsic factor leading to a decrease in vitamin B12. It is usually mild to moderate anemia, manifested as dizziness, fatigue, pale conjunctiva, sallow complexion, pale or pale nail beds, and so on.

　　The main prevention of atrophic gastritis is to reduce the damage to the stomach in diet, and seek medical attention immediately if there is stomach discomfort. The following are preventive measures that are more recognized in clinical practice:

　　1. The food consumed should be fresh and nutritious, ensuring adequate intake of protein, vitamins, and iron. Eat on time, avoid overeating and binge eating, and do not eat cold or hot food, or use or limit the use of刺激性 spices such as fresh chili powder.

　　2. Moderately drink alcohol, do not smoke, to avoid the damage of nicotine to the gastric mucosa; avoid long-term use of anti-inflammatory analgesics such as aspirin and corticosteroid drugs, etc., to reduce the damage to the gastric mucosa.

　　3. Regular check-ups, and fiberoptic gastroscopy should be performed if necessary.

　　4. In case of symptoms worsening, weight loss, anorexia, melena, and other conditions, it is necessary to seek medical attention in a timely manner.

　　The symptoms and signs of chronic atrophic gastritis are non-specific and cannot be used as a basis for diagnosis. Endoscopy and biopsy are the most reliable diagnostic methods, and the diagnosis mainly relies on fiberoptic gastroscopy and pathological examination of gastric mucosal tissue. Clinically, there are mainly the following five diagnostic methods:

　　1. Age: Most are middle-aged or older, with a long course of disease and a history of chronic superficial gastritis is common.

　　2. Symptoms and signs: Long-term indigestion, discomfort in the epigastric area, loss of appetite, fatigue, weight loss, anemia, etc.

　　3. Fiberoptic gastroscopy: The gastric mucosa shows color changes, thinning, visible blood vessels, and proliferative changes. Normal gastric mucosa is orange-red, while atrophy presents as grayish-white, grayish-yellow, or gray-green. The color of the mucosa in the same area may also differ, with stronger red areas also having a grayish-white hue, and there may also be slightly elevated small red spots or macules in the grayish-white and grayish-yellow areas. The range of atrophic mucosa is also inconsistent, it can be diffuse, localized, or even灶状, and the boundary is often not distinct. The atrophy of the glands causes the gastric mucosa to thin, the blood vessels are faintly visible, and in the early stage of atrophy, small blood vessels within the mucosa can be seen. In severe cases, large blood vessels under the mucosa can be seen, showing a dark red branched tree-like pattern. After the glands atrophy, the gland pits may proliferate and elongate or show signs of intestinal metaplasia, the mucosal layer thickens, and at this point, submucosal blood vessels cannot be seen, only the mucosal surface is rough and uneven, with granules or nodules, and a sense of rigidity, as well as changes in luster.

　　4. Pathological examination: The manifestations include atrophy of the固有腺体, thickening of the mucosal muscular layer, inflammation of the固有膜, lymphoid follicle formation, intestinal metaplasia, or pseudopyloric gland metaplasia (which may or may not be present).

　　5. Barium meal X-ray examination: visible changes include reduced and flattened mucosal folds, the gastric antrum in antral gastritis shows a blunt serrated outline, spasm of the antrum, and other changes such as mucosal disorganization, filling defects, and concentric narrowing. Gastric acid analysis shows normal or insufficient acid secretion.

　　Patients with atrophic gastritis should quit smoking and drinking, avoid using drugs that damage the gastric mucosa, especially NSAIDs such as aspirin. The diet should be regular, avoid overly hot, salty, and spicy foods, and actively treat oral, nasal, and pharyngeal infection foci.

　　Avoid high-fat foods, as high-fat foods, alcohol, sugars, and chocolates can relax the sphincter muscles, causing backflow. Therefore, if you have symptoms of heartburn, you should avoid these foods.

　　Meanwhile, chew slowly to aid digestion. Chewing slowly is absolutely beneficial for digestion. You should thoroughly chew the food to ensure that it is fully mixed with saliva. Avoid stress during meals to allow your digestive process to start off well.

　　Maintain a regular eating schedule, pay attention to dietary adjustment and care, and eat at regular intervals in fixed amounts to maintain the rhythm of normal digestive activity. Never eat irregularly, skip meals, or skip breakfast, especially avoid overeating and overdrinking.

　　According to the different pathogenesis of atrophic gastritis, the treatment methods are also different. Currently, the clinical treatment methods mainly include the following:

　　1. General Treatment

　　Quit smoking and drinking, avoid using drugs that damage the gastric mucosa such as aspirin, indomethacin, erythromycin, etc., eat and drink regularly, avoid hot, salty, and spicy foods, actively treat chronic infections in the mouth, nose, and throat.

　　2. Weak Acid Treatment

　　Patients with low or no acid confirmed by gastrin pentapeptide testing can take apple cider vinegar in appropriate amounts, 1 to 2 spoons each time, three times a day; or 10% dilute hydrochloric acid 0.5 to 1.0 ml, taken before or during meals, while taking pepsin mixture, 10 ml each time, three times a day; or one can also choose to treat with polyenzyme tablets or pancreatin tablets to improve dyspepsia symptoms.

　　3. Helicobacter pylori Treatment

　　During atrophic gastritis, gastric acid decreases or is lacking, and bacterial proliferation occurs in the stomach, especially a high detection rate of Helicobacter pylori. Anti-Hp treatment should be performed.

　　4. Inhibit Bile Reflux and Improve Gastric Motility

　　Cholestyramine can complex the bile salts refluxed into the stomach, prevent the destruction of the gastric mucosal barrier by bile acids. Sulphated aluminum can combine with bile acids and hemolytic lecithin, and can also be used to treat bile reflux. Ursodeoxycholic acid can also be given. Medications such as Metoclopramide, Domperidone, Cisapride can enhance peristalsis, promote gastric emptying, assist in the movement of the stomach and duodenum, prevent bile reflux, regulate and restore gastrointestinal motility.

　　5. Increase Mucosal Nutrition

　　Coniferyl alcohol can increase the renewal of gastric mucosa, improve cell regeneration ability, enhance the resistance of gastric mucosa to gastric acid, and achieve the protective effect of gastric mucosa. One can also choose活血素；or choose 硫糖铝、尿素囊、生胃酮、prostaglandin E, etc.

　　6. Gastrin Pentapeptide

　　In addition to promoting the secretion of hydrochloric acid by parietal cells and increasing the secretion of pepsinogen, gastrin pentapeptide also has a significant proliferative effect on gastric mucosa and other upper gastrointestinal mucosa. It can be used to treat patients with atrophic gastritis with low or no acid or atrophic body atrophy, by intramuscular injection half an hour before breakfast, once a day, and changing to every other day in the third week, twice a week in the fourth week, and once a week thereafter, with a course of 3 months. For mild to moderate atrophic gastritis, the application is effective, effectively promoting gland repair.