erosive gastritis
Introduction
Introduction to erosive gastritis Erosive gastritis is divided into acute erosive gastritis and chronic erosive gastritis. Acute erosive gastritis (acuteerosivegastritis) is an acute gastritis characterized by multiple erosion of gastric mucosa, also known as acute gastric mucosal lesions or acute erosive hemorrhagic gastritis. The disease has become one of the important causes of upper gastrointestinal bleeding, accounting for about 20% of upper gastrointestinal bleeding. The clinical symptoms are mostly dull pain or severe pain in the upper abdomen, accompanied by nausea and other symptoms. A small number of patients with heavier primary symptoms, manifested as hematemesis and (or) tar-like stools, bleeding often intermittent, some patients with acute massive bleeding, heavier conditions, hemorrhagic shock may occur. Chronic erosive gastritis, also known as verrucous gastritis or pox-like gastritis, generally only after meals, fullness, pantothenic acid, hernia, irregular abdominal pain and indigestion and other symptoms. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: atrophic gastritis, gastric cancer, gastric ulcer, gastric perforation, bile reflux gastritis
Cause
Causes of erosive gastritis
Exogenous factors (65%):
Certain drugs such as non-steroidal anti-inflammatory drugs such as aspirin, phenylbutazone, indomethacin, adrenal corticosteroids, certain antibiotics, alcohol, etc., can damage the mucosal barrier of the stomach, leading to increased mucosal permeability, hydrogen in gastric juice. The ions are oozing back into the gastric mucosa, causing erosion and bleeding of the gastric mucosa. Adrenal corticosteroids can increase the secretion of hydrochloric acid and pepsin, reduce the secretion of gastric mucus, and slow the rate of renewal of gastric epithelial cells to cause this disease.
Endogenous factors (35%):
Including serious infections, severe trauma, intracranial hypertension, severe burns, major surgery, shock, excessive stress and fatigue. Under stress, the sympathetic nerve and the vagus nerve can be excited. The former causes the vasospasm of the gastric mucosa to contract, and the blood flow is reduced. The latter causes the submucosal arteriovenous short circuit to open, which promotes the increase of mucosal ischemia and hypoxia, leading to gastric mucosal epithelial damage. Erosion and bleeding occur. Severe shock can cause release of serotonin and histamine. The former stimulates the gastric wall cells to release lysosomes and directly damages the gastric mucosa. The latter increases the secretion of pepsin and gastric acid and impairs the gastric mucosal barrier.
Pathophysiology
During stress, norepinephrine and adrenocortical hormone secretion increased, visceral vasoconstriction, gastric blood flow decreased, and reverse-dispersed H+ could not be eliminated; hypoxia and norepinephrine reduced prostaglandin synthesis, and mucus secretion was insufficient, HCO3- Secretion is also reduced; gastrointestinal motility is slow during stress, pyloric dysfunction, causing bile reflux, bile salts further damage the ischemic gastric mucosal epithelium, causing damage to the gastric mucosal barrier, eventually leading to erosion and bleeding of the mucosa. Lesions are more common in the fundus and stomach, sometimes involving the antrum, gastric mucosa with multiple erosions, with a little flaky hemorrhage, sometimes see shallow ulcers, covered with white moss or yellow moss. Histological examination showed that the epithelial cells in the surface of the erosion had focal shedding, the glands were distorted by edema and hemorrhage, and the lamina propria had infiltration of neutrophils and mononuclear cells.
Pathogenesis
The specific pathogenesis is as follows:
1. Drugs:
1 non-steroidal anti-inflammatory drugs, including aspirin, indomethacin (indomethacin) and so on. These drugs can directly damage the gastric mucosa and inhibit cyclooxygenase damage.
2 anti-tumor drugs.
2. Stress: severe trauma, major surgery, extensive burns, intracranial lesions, sepsis, severe organ damage and multiple organ failure can cause this disease.
When stressed:
1 Increased release of adrenaline and norepinephrine, leading to gastric mucosal vasoconstriction and decreased blood flow, mucosal ischemia caused by insufficient secretion of mucus and sodium bicarbonate, decreased local prostaglandin synthesis and regeneration, and decreased gastric mucosal barrier, resulting in mucosa damage;
2 increased secretion of adrenal glucocorticoids leads to hypersecretion of gastric acid and increased mucosal invasion factors;
3 gastrointestinal motility and pyloric dysfunction can lead to reflux of bile and pancreatic juice and cause damage to the gastric mucosal barrier.
3. Alcohol: The lipophilic and lipolytic properties of alcohol lead to the destruction of the gastric mucosal barrier, epithelial cell damage, intramucosal hemorrhage and edema can also lead to mucosal damage caused by hypersecretion of gastric acid.
Sudden onset of the disease, the clinical manifestations of the above gastrointestinal bleeding is the main manifestation of the disease, the incidence of which accounts for more than 1/4 of the cause of upper gastrointestinal bleeding, second only to peptic ulcer bleeding. Lighter patients only have fecal occult blood positive, while most patients have hematemesis and melena. Bleeding occurs intermittently with repeated illnesses. Usually the disease is more severe than peptic ulcer bleeding, although after a large number of blood transfusions, hemoglobin is more difficult to raise.
Prevention
Erosive gastritis prevention
1. Relaxation: Mental stress is a contributing factor to chronic gastritis and should be avoided. Emotional uneasiness and impatience can easily cause gastric mucosal disorders and gastric dysfunction. Therefore, emotional stress should be avoided as much as possible to relieve tension. Usually do not anger when you are in trouble, do not worry in the matter, do not worry, keep your mood comfortable, and it is very beneficial to the recovery of gastritis.
2, appropriate exercise: appropriate exercise is a good way to increase gastrointestinal motility, can effectively promote gastric emptying, so that gastrointestinal secretion function, digestive power, and help the recovery of gastritis.
3, avoid eating rough and irritating foods, eat too hard too spicy, too salty, overheated, too rough and irritating food. Such as fried foods, salted foods, peppers, garlic and so on. Regardless of citrus juices, tomato products, coffee, alcohol, and all foods that directly irritate the esophagus, you may not eat stomach acid.
4, avoid high-fat foods High-fat foods, wine, sugar, chocolate will relax the sphincter, causing reflux, so if you have symptoms of heartburn, you should avoid these foods.
5, a small number of meals a day more than three meals, such as six small meals, as long as you feel comfortable. Avoid eating before going to bed, diet should not be too much, so as to avoid excessive expansion of the antrum and increase the secretion of gastric acid.
6, the diet regularly pay attention to diet conditioning and maintenance, regular regular quantitative feeding, in order to maintain the rhythm of normal digestive activities. Don't be hungry for a meal or not, especially avoid overeating.
Complication
Erosive gastritis complications Complications atrophic gastritis gastric cancer gastric ulcer gastric perforation bile reflux gastritis
1, atrophic gastritis: erosive gastritis with bile reflux and gastric ulcer and gastric perforation, can further weaken the body's self-healing ability, reduce submucosal blood flow, make the submucosal gland atrophy, reduce, form atrophic gastritis ;
2, gastric cancer: erosive gastritis provides a good internal environment for HP (Helicobacter pylori) mass reproduction, stimulates HP to secrete more cytotoxins and induce cancer;
3, gastric ulcer: because of the large area of gastric mucosal damage in patients with erosive gastritis, the stomach loses a valuable protective layer, gastric acid bile can easily damage the stomach tissue, making the erosion develop into ulcers;
4, gastric perforation: due to the enlargement of erosion area, further deterioration of gastric function, excessive secretion of gastric acid, increase the corrosion of submucosal tissue, and finally penetrate the serosa to cause gastric perforation and acute gastric bleeding, and even life-threatening;
5, bile reflux: erosive gastritis damage the antrum function, pyloric closure dysfunction, leading to bile reflux into the stomach, further forming adverse symptoms of acid reflux, heartburn.
Symptom
Erosive gastritis symptoms Common symptoms Nausea upper gastrointestinal bleeding Upper abdominal discomfort Loss of appetite Stomach cramps Full left upper abdominal mass accompanied by... Vomiting
1, erosive gastritis symptoms are mostly non-specific, may include nausea, vomiting and upper abdominal discomfort. The harm of chronic erosive gastritis to human health can not be ignored. If it can not be treated in time to effectively curb the development of the disease, then peptic ulcer will occur, and even upper gastrointestinal bleeding will directly endanger the patient's life.
2, most patients often have symptoms or different degrees of dyspepsia such as abdominal pain, acid reflux, postprandial fullness, loss of appetite and so on. Patients with atrophic gastritis may have anemia, diarrhea, glossitis and water thinness. Individual patients with mucosal erosion have obvious upper abdominal pain and may have bleeding. Therefore, remind patients to have symptoms of gastrointestinal disease, they must be treated as soon as possible.
3, erosive gastritis onset more urgent, sudden upper gastrointestinal bleeding in the course of the primary disease, manifested as hematemesis and black feces, black feces alone are rare. Bleeding is often intermittent. A large amount of bleeding can cause syncope or shock, accompanied by anemia. In the bleeding, the upper abdomen is painful or uncomfortable. Endoscopy, especially in the 24- to 48-hour onset of emergency endoscopy, gastric mucosal erosion, bleeding or superficial ulcers, especially in the high stomach.
Examine
Examination of erosive gastritis
1. X-ray examination: gastrointestinal barium meal examination often can not find erosive lesions, and is not suitable for patients with acute active bleeding, because tincture can be applied to the mucosal surface, so that no endoscopic or angiographic examination can be performed in the near future; Superselective angiography of the superior mesenteric artery during acute hemorrhage can make a localized diagnosis of bleeding, which is often negative during intermittent bleeding.
2. Emergency endoscopy in emergency endoscopy within 24 to 48 hours after hemorrhage, acute gastric mucosal lesions characterized by multiple erosions and hemorrhagic foci can be diagnosed.
Diagnosis
Diagnosis and diagnosis of erosive gastritis
The main diagnosis of this disease is endoscopy
Mainly manifested as multiple warts, swollen folds or papule-like bulges in the gastric mucosa, diameter 5 ~ 10mm, visible mucosal defects or umbilical depression at the top, erosion in the center, no blush around the ridge, but often accompanied by similar size The erythema is more common in the antrum of the stomach and can be divided into continuous type and disappeared type. It is a special type of gastritis in the Sydney system classification of chronic gastritis, and the endoscopic classification is bulging erosive gastritis and flat erosive gastritis. Chronic gastritis lacks specific symptoms, and the severity of symptoms is not consistent with the degree of lesions in the gastric mucosa. Most patients often have asymptomatic or varying degrees of dyspepsia such as abdominal pain, loss of appetite, postprandial fullness, and acid reflux. Patients with atrophic gastritis may have anemia, water thinness, glossitis, diarrhea, etc. Individual patients with mucosal erosion have obvious upper abdominal pain and may have bleeding.
Endoscopic often manifest as multiple punctate or aphthous ulcers. Chronic non-erosive gastritis can be idiopathic, but also drugs (especially aspirin and non-steroidal anti-inflammatory drugs, see the treatment of peptic ulcer) Caused by Crohn's disease or viral infection. Helicobacter pylori may not play an important role.
Symptoms are mostly non-specific and can include nausea, vomiting, and upper abdominal discomfort. Endoscopically, the edge of the thickened folds is slightly erosive, with white spots or depressions in the center, and histological changes are diverse. There is no method that has a wide range of curative effects or is curable.
