Antral gastritis

　　Etiology and pathogenesis of chronic gastritis:

　　One, the sequelae of acute gastritis

　　After acute gastritis, if the mucosal lesions persist for a long time without healing or recur repeatedly, chronic gastritis can be formed.

　　Two, irritant foods and drugs

　　Long-term use of foods and drugs that have a strong irritant effect on the gastric mucosa, such as strong tea, strong alcohol, spicy foods, or salicylate drugs, or insufficient mastication during meals, repeated injury to the gastric mucosa by rough foods, or excessive smoking, which directly acts on the gastric mucosa by tobacco acid.

　　Three, the reflux of duodenal juice

　　The study finds that due to the dysfunction of the pyloric sphincter in chronic gastritis patients, bile reflux often occurs, which may be an important pathogenic factor. Phospholipids in pancreatic juice, together with bile and pancreatic digestive enzymes, can dissolve mucus and destroy the gastric mucosal barrier, promoting the reverse diffusion of H+ and pepsin into the mucosa, thereby causing further injury. The chronic gastritis caused by this is mainly located in the antrum of the stomach. It is very common for patients with gastrojejunal anastomosis to develop gastritis due to bile reflux. Almost all patients with peptic ulcers have chronic antral gastritis, which may be related to the dysfunction of the pyloric sphincter. Nicotine in tobacco can relax the pyloric sphincter, so long-term smokers can promote bile reflux and cause antral gastritis.

　　Four, common causes of gastric antrum inflammation

　　1. Gastric antrum inflammation is closely related to psychological factors, and symptoms can be exacerbated during emotional fluctuations or fear and tension. Attacks are also more likely when the parasympathetic nervous system is excited. Some patients with gastric antrum inflammation have upper abdominal pain symptoms similar to duodenal ulcer.

　　2. Gastric antrum inflammation often occurs in males over 30 years old, characterized by a feeling of fullness in the upper abdomen, hidden or severe pain, often presenting as periodic attacks, and may be accompanied by belching, acid regurgitation, vomiting, loss of appetite, weight loss, and chronic gastric antrum inflammation can also manifest as anorexia, persistent abdominal pain, hemorrhagic anemia, and so on.

　　3. The lesions of gastric antrum inflammation are mostly confined to the mucosal and muscular layers, and can also spread to the muscular and serosal layers. The gastric antrum mucosa shows edema, congestion, inflammatory cell infiltration, and fibrous tissue hyperplasia, with the submucosal layer being most obvious.

　　4. When there is mucosal erosion, atrophy of the glands, and hyperplasia of intestinal glands, gastric antrum inflammation rarely exists alone and often coexists with peptic ulcer or gastric cancer, because gastric antrum inflammation is closely related to atrophic gastritis, gastric ulcer, and gastric cancer, so it should be paid attention to.

　　Gastric antrum inflammation is a chronic inflammation occurring in the gastric antrum, which can generally be divided into superficial and atrophic types. Through many years of observation and research, it has been found that there is a close relationship between gastric cancer and atrophic antrum inflammation. Many scholars have reported that the cancer rate in patients with atrophic gastritis is about 10%, and the risk of canceration in atrophic antrum inflammation is 20 times higher than that in normal people. In China, the survey of high and low incidence areas of gastric cancer has found that the incidence of atrophic gastritis is significantly higher in areas with a high incidence of gastric cancer. Generally speaking, when the gastric mucosa biopsy shows severe intestinal metaplasia and dysplasia, it is more likely to develop into cancer. The mechanism by which atrophic antrum inflammation evolves into gastric cancer is generally believed to be that during atrophic gastritis, the function and structure of the gastric mucosa change abnormally, the free acid in the gastric juice decreases, pH increases, the amount of bacteria in the stomach increases, especially in the presence of nitrate reductase-positive bacteria, nitrate (NO3-) is reduced to nitrite (NO2-), and the content of nitrite (NO2-) in the gastric juice increases, providing the necessary conditions for the formation of nitrosative compounds in the stomach, but it is not clear how much atrophy is needed and how long it takes to develop into cancer. Generally speaking, when the gastric mucosa biopsy shows severe intestinal metaplasia and dysplasia, it is more likely to develop into cancer.

　　1. Abdominal distension and abdominal pain Gastric antrum inflammation often occurs in males over 30 years old, with a feeling of distension in the upper abdomen, and hidden or severe pain in the upper abdomen, which often presents as periodic attacks, and may be accompanied by belching, acid regurgitation, burning sensation in the upper abdomen, nausea, vomiting, weight loss, and in a few cases, bleeding, as well as asymptomatic individuals.

　　2. Gastric antrum inflammation is a chronic inflammation occurring in the gastric antrum, which can generally be divided into superficial and atrophic types. Observational studies have found a close relationship between gastric atrophy and antrum inflammation, as well as between antrum inflammation and gastric atrophy. The risk of malignancy in atrophic antrum inflammation is 20 times higher than that in normal people, and the incidence of atrophic gastritis is significantly higher in areas with a high incidence of gastric atrophy.

　　3. Causing mental confusion Gastritis antrum is closely related to mental factors, and emotional fluctuations or fear and tension can exacerbate symptoms. It is also prone to发作 when the parasympathetic nervous system is excited.

　　There is a feeling of distension, hidden pain, or severe pain in the upper abdomen, often presenting cyclically, accompanied by belching, acid regurgitation, upper abdominal burning sensation, nausea, vomiting, weight loss, and a few may have bleeding, and some may be asymptomatic. This disease is closely related to mental factors, and emotional fluctuations, anger, mental stress, or the tension of fear of cancer can exacerbate symptoms.

　　Specific symptoms of gastritis antrum:

　　1. Stomach bloatingFeeling of stomach distension, food not digested, or bloating, feeling of food sticking in the stomach, and difficulty in swallowing. About 70% of gastritis antrum patients have this symptom.

　　2. Stomach pain:Sometimes pain before meals, sometimes after meals, and some people have pain at 3 o'clock in the morning. The feeling of stomach pain may not be severe, but dull, pressing, or oppressive pain, and the location of the pain is between the heart and the abdomen. About 85% of gastritis antrum patients have this symptom.

　　3. Heartburn:Hyperemia of the gastric mucosa and excessive stomach acid can cause heartburn, mainly a feeling of burning and fever in the stomach.

　　4. Acid regurgitation:Excessive stomach acid often causes acid regurgitation, with a feeling of acid rising from the stomach or filling up. About 50% of gastritis antrum patients have this symptom.

　　5. Lack of appetite:Lack of appetite, unable to eat, or seeing food, wanting to eat but not daring to eat.

　　6. Weight loss:Some gastritis patients feel they have a good appetite and can eat, but they lose weight and their weight decreases day by day, which indicates poor digestion. Although they eat, they do not absorb it fully.

　　7. Nausea and vomiting:Chronic gastritis patients often have symptoms such as nausea, especially in chronic atrophic gastritis, where nausea and vomiting are more prominent.

　　8. Stomach cold:Many gastritis patients are afraid to eat cold or cool foods, or when the weather changes and the temperature drops, their stomach will ache and they will have diarrhea.

　　9. Lack of energy, poor complexion, poor sleep:Gastritis patients often look unwell, lack energy during the day, have poor sleep at night, decreased work efficiency, and lose interest in many things.

　　10. Halitosis, black tongue fur:Gastritis patients often have symptoms such as halitosis, bitter taste, and black tongue fur, accompanied by stomach pain and bloating.

　　1. It is forbidden to eat hard, spicy, salty, hot, rough, and strongly刺激性 foods. The diet should be moderate and regular, with meals at fixed times and in appropriate amounts, eating less and more frequently, chewing slowly, and mixing food thoroughly with saliva to avoid overeating. Choose foods rich in nutrition and easy to digest, and eat more foods containing plant proteins and vitamins.

　　2. It is forbidden to take aspirin, acetaminophen, phenylbutazone, indole drugs, tetracycline, erythromycin, prednisone, and other drugs, especially during the active phase of chronic gastritis.

　　3. Those with insufficient stomach acid should avoid diluting stomach acid. It is advisable to add vinegar, lemon juice, and acidic seasonings to the diet, eat less difficult-to-digest and gas-producing foods, and drink less after meals.

　　4. Those with excessive stomach acid should avoid foods that can stimulate the secretion of stomach acid, such as strong spices, alcohol, acidulants, etc.

　　5. Avoid smoking and alcohol. Smoking can stimulate the gastric mucosa and increase gastric acid secretion, causing harmful irritation to the gastric mucosa. Excessive smoking can lead to dysfunction of the pyloric sphincter, causing bile reflux, damaging the gastric mucosa, and affecting the blood supply and repair and regeneration of gastric mucosal cells, so smoking should be quit. Alcohol can directly destroy the gastric mucosal barrier, allowing H+ in the gastric cavity to enter the gastric mucosa, causing congestion, edema, and erosion of the mucosa.

　　6. Mental stress is a promoting factor for chronic gastritis and should be avoided. Unrest and impatience in mood can easily cause disturbances in the gastric mucosa and gastric function. Therefore, it is advisable to avoid emotional stress responses as much as possible and relieve tension. Keep calm and composed in daily life, which is very beneficial for the recovery of gastritis.

　　7. Avoid irregular lifestyle and overwork. Pay attention to adequate rest and exercise. Physical exercise can promote peristalsis and emptying of the gastrointestinal tract, enhance gastrointestinal secretion function, improve digestion, and help the recovery of gastritis.

　　8. Chronic liver disease, diabetes, and bile duct diseases can reduce the local defensive function of the gastric mucosa and cause gastritis due to dysregulation of stomach function. In addition, the swallowing of pathogenic secretions caused by tonsillitis, sinusitis, and dental caries infections often reduces the barrier function of the gastric mucosa and induces gastritis.

　　Antral gastritis - imaging manifestations:

　　1. Irritation of the antrum is manifested by the prepyloric area often being in a semi-contracted state, unable to contract into a sac-like shape as in the normal state when the peristaltic wave is approaching, but can contract to a linear shape in the gastric cavity.

　　2. Mucosal folds become thicker and disordered, can be up to about 1 cm wide, and the mucosal folds of the antrum are mostly transverse, with the gastric wall contour showing regular sawtooth shapes, and the edges of the teeth are very smooth.

　　3. When the lesion progresses to the muscular layer thickening, it often manifests as concentric narrowing of the antrum, with a relatively fixed shape, which can generally contract to an extremely thin state but cannot dilate, and presents a gradual transition or clear boundary with the normal part. The narrowed segment can show mucosal folds, most of which are longitudinal.

　　The dietary treatment principle for antral gastritis is to adjust the various functions of the stomach and develop good eating and living habits:

　　1. Chew food slowly and thoroughly to ensure proper mixing with digestive juices.

　　2. Diet should be light and low in刺激性. Do not overeat at dinner and wait for food to digest before going to bed. Otherwise, it will increase discomfort in the stomach. In daily diet, try to keep it light, low in greasiness, and low in high-fat foods, such as fatty meat, butter, and fried foods, which can delay the emptying of the stomach and easily increase a feeling of abdominal fullness.

　　3. Reduce the intake of刺激性 foods such as chili, onions, curry, black pepper, mustard powder, and strong coffee, as these are not conducive to the recovery of gastric mucosal inflammation and should not be consumed.

　　4. For those with reduced gastric acid secretion, such as atrophic gastritis, foods with rich flavors like thick meat soup and chicken soup can be provided to stimulate gastric acid secretion and promote appetite. Meat soup and chicken soup, as well as excessive savory foods, should be avoided for those with hyperacidity gastritis (those with excessive gastric acid secretion). Meat can be cooked without the soup and then cooked again. Foods should be made thin, minced, soft, and tender. Cooking methods mostly include steaming, boiling, braising, stewing, and simmering.

　　5. Pay attention to eating nutrient-rich foods, eat more high-protein and high-vitamin foods to ensure that various nutrients in the body are sufficient, prevent anemia and malnutrition. For those with anemia and malnutrition, increase the intake of foods rich in protein and heme iron in the diet, such as lean meat, chicken, fish, liver, kidneys, and other internal organs.

　　6. High-vitamin foods include dark-colored fresh vegetables and fruits such as green leafy vegetables, tomatoes, eggplants, jujubes, etc. Pay attention to the acid-base balance in food intake. When there is excessive gastric acid secretion, drink milk, soy milk, eat mantou (steamed bun) or bread to neutralize the gastric acid. When gastric acid secretion decreases, use rich meat broth, chicken broth, sour-tasting fruits or fruit juices to stimulate the secretion of gastric juice, aid in digestion, and avoid foods that cause abdominal bloating and are rich in fiber, such as beans, bean products, sucrose, celery, chives, etc. When suffering from atrophic gastritis, it is advisable to drink yogurt, as the phospholipid substances in yogurt tightly adhere to the gastric wall, providing a protective effect on the gastric mucosa, repairing the injured gastric mucosa. The specific components of yogurt, such as lactose and glucuronic acid, produced by the metabolism of lactose, can increase the acidity in the stomach, inhibit the decomposition of proteins by harmful bacteria to produce toxins, and at the same time protect the stomach from the侵蚀 of toxins, which is beneficial to the treatment and recovery of gastritis.

　　The treatment of antral gastritis generally involves dietary control, sedation, antacids, antispasmodics, pain relief, and other symptomatic treatments. For those with emotional tension, a small dose of sedatives can be used. For belching, nausea, and gastric emptying disorders, metoclopramide 10 mg can be taken 2 to 3 times a day, or domperidone 20 mg 2 to 3 times a day, or cisapride 10 mg 2 to 3 times a day. For antral mucosal inflammatory lesions, Maizilin-S 0.67 grams can be taken 3 times a day for 6 to 8 weeks. If the patient has upper abdominal pain accompanied by heartburn, Tagamet 400 mg can be added once a day for a month. Alternatively, famotidine 20 mg can be taken once a night for a month. If the pathological diagnosis of chronic antral gastritis shows Helicobacter pylori infection, Denol 2 tablets can be taken 3 times a day for 4 to 6 weeks, or amoxicillin 500 mg can be taken 3 times a day for 4 weeks.

　　The treatment of antral gastritis generally involves dietary control, sedation, antacids, antispasmodics, pain relief, and other symptomatic treatments. For those with emotional tension, a small dose of sedatives can be used. For belching, nausea, and gastric emptying disorders, metoclopramide 10 mg can be taken 2 to 3 times a day, or domperidone 20 mg 2 to 3 times a day, or cisapride 10 mg 2 to 3 times a day. For antral mucosal inflammatory lesions, Maizilin-S 0.67 grams can be taken 3 times a day for 6 to 8 weeks. If the patient has upper abdominal pain accompanied by heartburn, Tagamet 400 mg can be added once a day for a month. Alternatively, famotidine 20 mg can be taken once a night for a month. If the pathological diagnosis of chronic antral gastritis shows Helicobacter pylori infection, Denol 2 tablets can be taken 3 times a day for 4 to 6 weeks, or amoxicillin 500 mg can be taken 3 times a day for 4 weeks.

　　1. Medical Treatment

　　General treatment includes bed rest, quitting smoking, light diet, and eating in small and frequent meals to reduce reflux.

　　1. Bile Salt Adsorbents Aluminum hydroxide can adsorb bile salts, but prospective placebo-controlled studies have proven its ineffectiveness. Sucralfate can adsorb bile salts and has a protective effect on the gastric mucosa, which can reduce gastric mucosal inflammation, but cannot improve symptoms.

　　2. Prokinetic drugs This class of drugs can reduce reflux and promote the clearance of reflux materials. Domperidone, Cisapride, and Mosapride have definite effects.

　　3. Ursodeoxycholic Acid (Ursodiol) There is only a trace amount of ursodeoxycholic acid in human bile. After taking the drug orally, the proportion of ursodeoxycholic acid, which is relatively harmless in bile, increases accordingly, while the proportion of more toxic bile acids and deoxycholic acids decreases, thereby reducing the damage of reflux to the gastric mucosa.

　　4. Anti-Hp treatment due to the fact that a considerable number of bile reflux gastritis are accompanied by Hp infection, and Hp infection also plays an important role. Anti-Hp therapy can also be used in treatment.

　　2. Surgical Treatment

　　Although the effect of the aforementioned non-surgical therapy is not ideal, it should be tried for several months before deciding on surgery or a second surgery. For those with severe reflux symptoms and ineffective medical treatment, surgical treatment can be considered. The commonly used surgical method is Roux-en-Y gastrojejunostomy, which can completely eliminate gastrointestinal reflux after the operation, and mucosal inflammation can be reduced or disappear, and early symptoms can also be significantly improved. However, long-term follow-up shows that 30% to 50% of patients have recurrent symptoms, and the reasons are still unclear.

　　3. Biological Therapy

　　The bio-enzyme Shilingshuang sugar has a good effect on the treatment of gastric antrum inflammation. Shilingshuang sugar can help patients regulate the gastrointestinal tract. Restore the normal operation of the gastrointestinal tract, repair the damaged gastrointestinal mucosa. It has a good effect on chronic gastrointestinal diseases. Patients can try it.

　　Pay attention to the following points in daily life:

　　1. Pay attention to diet and lifestyle adjustments.Avoid long-term intake of rough and irritating foods; avoid hot drinks and salty foods; maintain a regular diet, eat on time and in moderate amounts, and avoid overeating.

　　2. Avoid stimulation.Avoid or minimize the use of drugs that are strongly irritating to the stomach, such as corticosteroids, non-steroidal anti-inflammatory drugs, and potassium, iron, iodine, etc.; and quit drinking and smoking.