Gastritis

Gastritis

Gastritis is a general term for inflammation of the stomach lining. It is a common condition that can be classified into two types based on its duration: acute gastritis and chronic gastritis. Acute gastritis often has a clear cause, while the causes and mechanisms of chronic gastritis are more complex and not fully understood. Common types of acute gastritis include acute simple gastritis and acute erosive gastritis. The former presents with upper abdominal discomfort, pain, loss of appetite, nausea, and vomiting; the latter is primarily characterized by upper gastrointestinal bleeding, with symptoms of hematemesis (vomiting blood) and melena (black, tarry stools). Chronic gastritis can be divided into superficial gastritis, atrophic gastritis, and hypertrophic gastritis. In Traditional Chinese Medicine (TCM), gastritis falls under the category of “stomach duct pain” (胃脘痛).

Causes

Causes of Acute Gastritis
It can be caused by chemical factors, physical factors, microbial infections, or bacterial toxins. In addition, neuropsychiatric dysfunction, stress, or various systemic allergic reactions can act as endogenous stimulating factors, leading to acute inflammation of the stomach lining.

Causes of Chronic Gastritis
Helicobacter pylori (H. pylori) infection is now recognized as the main cause of chronic gastritis. Experts point out that the medical causes of chronic gastritis are not yet fully understood, but it is generally believed to be related to harmful environmental factors and a susceptible constitution. Long-term, repeated exposure to physical, chemical, and biological harmful factors in susceptible individuals can lead to this condition.

• Long-term use of drugs or foods that irritate the stomach, consumption of coarse foods, or smoking.

• Improperly treated acute gastritis that persists can develop into chronic gastritis.

• Lack of stomach acid.

• The action of bacteria and their toxins.

TCM Understanding of the Causes
Gastritis is categorized as “stomach duct pain” in TCM, which refers to pain in the upper abdomen near the heart. This category includes modern medical conditions such as chronic gastritis, gastric neurosis, gastroptosis, and peptic ulcer disease. TCM believes the causes and mechanisms of stomach duct pain are as follows:

• Cold Pathogen Invading the Stomach: External cold pathogen invades the body and lodges in the stomach. Cold causes contraction, leading to disharmony of stomach Qi and pain.

• Dietary Injury to the Stomach: Irregular eating habits, or being either too hungry or too full, cause the stomach to lose its harmony and ability to descend Qi.

• Liver Qi Invading the Stomach: The Liver is an unyielding organ that prefers free flow and governs the smooth movement of Qi. If one is worried, overthinks, or is angry, Qi will stagnate and injure the Liver. When the Liver’s function of smooth flow is impaired, it can “invade” the stomach, obstructing the Qi mechanism and causing pain.

• Spleen and Stomach Deficiency: The Spleen and Stomach are internally-externally related and are responsible for the ascent of the clear and descent of the turbid. Irregular eating, overexertion, or chronic illness can injure the Spleen and Stomach, leading to insufficient Spleen Yang and cold-deficiency in the Middle Jiao, or damage to Stomach Yin, which results in a lack of nourishment and causes pain.

Prevention

Daily Prevention

1. Avoid Chemical Irritants: Oral medications like salicylates, reserpine, and corticosteroids, as well as heavy consumption of strong alcohol, strong tea, and coffee, can all irritate and damage the stomach lining, leading to acute simple gastritis.

2. Avoid Pathogenic Factors: The most common cause of acute gastritis is contaminated food, with common bacterial infections including Staphylococcus aureus exotoxins, botulinum toxins, Salmonella endotoxins, and acidophilic bacteria. H. pylori infection during the acute phase can also cause acute gastritis, which may develop into chronic active gastritis if not eradicated. Common viral factors include influenza and enteroviruses.

3. Other Factors: Neuropsychiatric dysfunction, stress, systemic allergic reactions, and certain systemic diseases like chronic cor pulmonale, respiratory failure, vitamin deficiencies, and malabsorption syndromes can also act as endogenous stimuli, causing acute inflammation of the stomach lining.

Health Education

1. Avoid Long-term Mental Stress: Chronic stress affects the autonomic nervous system via the cerebral cortex, causing vasoconstriction in the stomach lining, gastric dysfunction, and excessive secretion of stomach acid and pepsin, leading to gastritis and ulcers.

2. Avoid Overexertion: Whether it’s physical or mental labor, overexertion can lead to insufficient blood supply to the digestive organs and disordered secretion of the gastric mucosa, causing various stomach problems.

3. Avoid Irregular Eating Habits: Irregular meals are very harmful to the stomach. When hungry, the empty stomach’s acid and pepsin can easily damage the stomach wall. Binge eating overstretches the stomach wall, and food stays in the stomach for too long, which can also cause gastritis or ulcers.

4. Avoid Excessive Alcohol Consumption: Alcohol causes the stomach lining to become congested and swollen, and can even lead to erosions, bleeding, and ulcers.

5. Avoid Smoking: Smoking causes vasoconstriction in the stomach lining and reduces the synthesis of prostaglandins, which are protective factors for the gastric mucosa.

6. Avoid Strong Tea and Coffee: These are central nervous system stimulants that can cause gastric mucosal congestion and dysfunction.

7. Avoid Eating Too Quickly: Chewing food thoroughly (mastication) aids digestion. Eating too quickly increases the stomach’s burden.

8. Avoid Eating Before Bed: This can interfere with sleep and stimulate stomach acid secretion, potentially leading to ulcers.

9. Maintain Good Hygiene: H. pylori infection is a major cause of gastritis, ulcers, and stomach cancer, and it can be transmitted through shared utensils, toothbrushes, and kissing.

10. Avoid Misusing Medications: Many drugs can damage the stomach lining with long-term use. Common culprits include NSAIDs (like aspirin), corticosteroids (like prednisone), and certain antibiotics (like erythromycin).

Common Symptoms

• Acute Gastritis: Sudden onset. Mild cases may only have loss of appetite, abdominal pain, nausea, and vomiting. Severe cases can have hematemesis, melena, dehydration, and electrolyte imbalances. Bacterial infections are often accompanied by systemic toxic symptoms.

• Chronic Gastritis: Lacks specific symptoms. The severity of symptoms does not always correlate with the degree of mucosal damage. Most patients have no obvious symptoms or have varying degrees of dyspepsia, such as dull upper abdominal pain, loss of appetite, post-meal bloating, and acid reflux.

• Atrophic Gastritis: Patients may have anemia, weight loss, glossitis, and diarrhea. Some with mucosal erosions may have more pronounced upper abdominal pain and bleeding.

Clinical Examination

• Gastroscopy with biopsy is the main method for diagnosing gastritis.

• The positive rate of H. pylori infection in chronic gastritis is as high as 70-90%. This can be tested through a biopsy, a blood test for antibodies, or before and after treatment.

• Stomach acid is normal or low in superficial gastritis and significantly reduced or absent in atrophic gastritis.

• Antibodies to parietal cells, intrinsic factor, or gastrin may be detected in the blood of patients with atrophic gastritis.

Treatment

Western Medicine Treatment

Acute Gastritis:

• Etiological Treatment: Remove the cause, stop all irritating foods and drugs, and temporarily fast or consume a liquid diet.

• Symptomatic Treatment: Antispasmodics, antiemetics, acid suppressants (H2 blockers or PPIs), and correction of fluid and electrolyte imbalances.

Chronic Gastritis:

1. Eliminate or Weaken Aggressive Factors: Eradicate H. pylori, use acid-suppressing or neutralizing therapy, and address bile reflux.

2. Enhance Gastric Mucosal Defense: Use mucosal protective agents like colloidal bismuth, sucralfate, or aluminum carbonate.

3. Prokinetic Agents: For symptoms of bloating and early satiety.

4. Eliminate Pathogenic Factors: Quit smoking, correct poor dietary habits, and stop using damaging drugs.

5. Symptomatic Treatment: Digestive aids, antispasmodics, and vitamin supplements.

6. Treatment of Dysplasia: Dysplasia is a precancerous lesion and requires close monitoring and, if necessary, surgical intervention.

TCM Treatment

• Liver-Stomach Disharmony: Soothe the Liver, regulate Qi, and harmonize the stomach.

• Spleen-Stomach Deficiency: Warm the Middle Jiao and strengthen the Spleen.

• Stomach Yin Deficiency: Nourish Yin and benefit the stomach.

• Blood Stasis in the Stomach Collaterals: Invigorate blood, transform stasis, and stop pain.

• Liver-Stomach Damp-Heat: Clear and drain Liver heat, harmonize the stomach, and suppress acid.

Nursing

Professional Nursing (Acute Gastritis):

• Observe the amount, nature, frequency, and color of hematemesis or melena.

• Monitor vital signs, urine output, and peripheral circulation.

• Record 24-hour fluid intake and output.

• Establish IV access for rapid fluid resuscitation.

• Monitor hemoglobin and hematocrit levels.

Daily Nursing:

• Avoid eating within two hours of bedtime.

• Eat small, frequent meals.

• Avoid MSG, spicy, acidic, and overly salty foods.

• Abstain from coarse grains, high-fiber vegetables, irritating foods, tobacco, and alcohol.

• Avoid frozen or very hot foods.

• Do not overeat.

• Avoid fruits with high acid content if you have hyperacidity.

Dietary and Health Care

Daily Health Care:

• Remove pathogenic factors, get bed rest.

• Drink plenty of fluids, especially sugar-salt water if there is vomiting and diarrhea.

• Start with a clear liquid diet (rice soup, etc.), then progress to a bland, low-residue semi-liquid diet, and finally to a soft diet.

Food Therapy:

• Green Calyx Plum Tea: Green calyx plum and green tea. Soothes the Liver, regulates Qi, harmonizes the stomach, and stops pain.

• Kumquat Drink: Kumquat and white cardamom. Soothes the Liver, resolves depression, and harmonizes the Spleen and Stomach.

• Purple Flower Sonchus Soup: Made with purple flower sonchus. Drink warm with brown sugar.

• Clove Duck: Duck cooked with cloves, cinnamon, and cardamom. Warms the Middle Jiao, regulates Qi, and stops pain.

• Tangerine Peel Oil-drizzled Chicken: Chicken cooked with tangerine peel. Regulates Qi and opens the appetite.

• Clove Ginger Candy: Made with white sugar, ginger powder, and clove powder. Warms the Middle Jiao, descends rebellious Qi, and tonifies Qi.

• Stir-fried Shredded Carrot and Tangerine Peel with Lean Pork: Carrot, tangerine peel, and lean pork. Broadens the chest and regulates Qi.