Gastritis

Gastritis

Gastritis is a general term for inflammation of the gastric mucosa (the lining of the stomach). It is a common condition that can be classified into acute and chronic gastritis based on its course. Acute gastritis often has a clear cause, while the etiology and pathogenesis of chronic gastritis are more complex and not fully understood. Common types of acute gastritis include simple acute gastritis and acute erosive gastritis. The former presents with upper abdominal discomfort, pain, anorexia (loss of appetite), nausea, and vomiting; the latter primarily manifests as upper gastrointestinal bleeding, with hematemesis (vomiting blood) and melena (black, tarry stools). Chronic gastritis is typically categorized as superficial, atrophic, or hypertrophic gastritis. In Traditional Chinese Medicine (TCM), gastritis falls under the category of “epigastric pain” (胃脘痛, wèi wǎn tòng).

Causes

Causes of Acute Gastritis
It can be caused by chemical factors, physical factors, microbial infections, or bacterial toxins. Additionally, psycho-neurological dysfunction, stress, or allergic reactions in the body can act as endogenous stimuli, leading to acute inflammatory damage to the gastric mucosa.

Causes of Chronic Gastritis
H. pylori infection is now recognized as the primary cause of chronic gastritis. Experts note that the causes are not fully understood but are generally believed to be related to harmful environmental factors and individual susceptibility. Long-term, repeated exposure to physical, chemical, or biological harmful factors can trigger the disease in susceptible individuals.

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

2. Improperly treated acute gastritis that persists and develops into chronic gastritis.

3. Lack of gastric acid.

4. The action of bacteria and their toxins.

TCM Understanding of Causes
Gastritis is categorized as “epigastric pain” in TCM. This refers to pain in the upper abdomen near the solar plexus. Conditions like chronic gastritis, gastric neurosis, gastroptosis, and peptic ulcer disease fall within this scope. TCM identifies the following causes and mechanisms:

1. Cold Evil Invading the Stomach: External cold pathogens can invade the stomach, and since cold causes contraction, it disrupts the harmony of stomach Qi, leading to pain.

2. Injury from Diet: Irregular eating habits, such as overeating or prolonged hunger, can disrupt the stomach’s function of descending Qi.

3. Liver Qi Invading the Stomach: The Liver is responsible for the smooth flow of Qi. If emotions like worry or anger cause Qi to stagnate, the Liver’s function is impaired. This constrained Liver Qi can “invade” the stomach, obstructing its function and causing pain.

4. Spleen and Stomach Deficiency: The Spleen and Stomach are interconnected. Irregular eating, overwork, or chronic illness can injure the Spleen and Stomach, leading to a deficiency of Spleen Yang (internal cold) or a depletion of Stomach Yin (lack of nourishment), both of which can cause pain.

5. Peptic Ulcer Disease: This is often linked to excessive blood in the stomach, leading to an overproduction of gastric acid. TCM pulse diagnosis may show “fire” in the stomach meridian, indicating a need to drink more water and avoid spicy, irritating foods.

Prevention

Daily Prevention

1. Avoid Chemical Irritants: Oral medications like salicylates, reserpine, and corticosteroids, as well as heavy consumption of strong alcohol, concentrated tea, and coffee, can damage the gastric mucosa, causing inflammation, and leading to acute gastritis.

2. Avoid Pathogens: A common cause of acute gastritis is contaminated food. Common bacterial culprits include staphylococcal exotoxins, botulinum toxins, and Salmonella endotoxins. H. pylori can also cause acute gastritis during its initial infection phase, which may transition to chronic active gastritis if not eradicated. Viral infections, such as influenza and enteroviruses, are also common factors.

3. Other Factors: Psycho-neurological dysfunction, stress, allergic reactions, and certain systemic diseases can also trigger acute gastritis. Conditions like chronic pulmonary heart disease, respiratory failure, vitamin deficiencies, and advanced cancers can act as internal stimuli.

Health Education (Ten Abstentions)

1. Avoid Long-Term Mental Stress: Chronic stress affects the autonomic nervous system, causing vasoconstriction in the gastric mucosa, disrupting stomach function, and leading to excessive secretion of acid and pepsin, which can cause gastritis and ulcers.

2. Avoid Overexertion: Whether it’s physical or mental labor, overwork can lead to insufficient blood supply to digestive organs and disrupt mucosal secretions, causing various stomach ailments.

3. Avoid Irregular Eating: Skipping meals or overeating is harmful. An empty stomach is easily damaged by gastric acid, while overeating overstretches the stomach wall, both of which can lead to gastritis or ulcers.

4. Avoid Excessive Alcohol Consumption: Alcohol causes inflammation and even erosion of the gastric mucosa. Long-term drinking also damages the liver and pancreas, which in turn worsens stomach problems.

5. Avoid Smoking: Smoking causes vasoconstriction in the gastric mucosa and reduces the synthesis of prostaglandins (a protective factor for the stomach lining). It also stimulates the secretion of acid and pepsin.

6. Avoid Strong Tea and Coffee: These are central nervous system stimulants that can cause gastric mucosal congestion and disrupt its protective barrier, contributing to ulcer formation.

7. Avoid Eating Too Quickly: Chewing food thoroughly (mastication) aids digestion and increases saliva production, which helps protect the gastric mucosa from damage.

8. Avoid Eating Before Bed: Eating within two hours of sleeping can interfere with sleep and stimulate acid secretion, increasing the risk of ulcers.

9. Avoid Poor Hygiene: H. pylori, a major cause of gastritis, ulcers, and gastric cancer, can be transmitted through shared utensils, toothbrushes, and kissing. Practicing good hygiene can prevent infection.

10. Avoid Misusing Medications: Many drugs can damage the gastric mucosa. The most common culprits are NSAIDs (like aspirin), corticosteroids (like prednisone), and certain antibiotics (like erythromycin). Always use these medications under a doctor’s supervision.

Common Symptoms

• Acute Gastritis: Rapid onset. Mild cases may only involve loss of appetite, abdominal pain, nausea, and vomiting. Severe cases can include vomiting blood, black stools, dehydration, and electrolyte imbalances. Bacterial infections may be accompanied by systemic signs of toxicity.

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

• Atrophic Gastritis: Patients may experience anemia, weight loss, glossitis (tongue inflammation), and diarrhea. Those with mucosal erosion may have more significant upper abdominal pain and potential bleeding.

Clinical Examinations

• Gastroscopy combined with a direct-view biopsy is the primary method for diagnosing gastritis.

• The positive rate of H. pylori infection in chronic gastritis is as high as 70-90%. It can be detected through a biopsy of the gastric mucosa, a blood test for antibodies, or tests before and after treatment to monitor eradication.

• Gastric acid levels are normal or low in superficial gastritis and significantly reduced or absent in atrophic gastritis.

• In atrophic gastritis, antibodies against parietal cells, intrinsic factor, or gastrin may be detected in the blood.

Treatment

Western Medical Treatment

• Acute Gastritis:

  • Remove the cause: Stop all irritating foods and drugs. Rest the stomach by temporarily fasting or consuming a liquid diet.

  • Symptomatic treatment: Antispasmodics for cramps, antiemetics for vomiting, and acid suppressants (H2 blockers or PPIs).

  • Fluid replacement: Intravenous fluids for severe vomiting or diarrhea to correct dehydration and electrolyte imbalances.

  • Bleeding control: Hemostatic therapy for upper GI bleeding.

• Chronic Gastritis:

  1. Eliminate or Weaken Aggressive Factors:

     • H. pylori Eradication: Successful eradication can prevent peptic ulcers and reduce the risk of gastric cancer. Recommended for patients with mucosal erosion, atrophy, intestinal metaplasia, or a family history of gastric cancer. Triple therapy (a PPI or bismuth salt plus two antibiotics) is common.

     • Acid Suppression: For patients with mucosal erosion or symptoms like heartburn and acid reflux.

  2. Enhance Gastric Mucosal Defense:

     • Mucosal protective agents like sucralfate or bismuth compounds are used for patients with erosion, bleeding, or significant symptoms.

  3. Prokinetic Agents:

     • For symptoms like bloating and early satiety.

  4. Lifestyle Modification:

     • Quit smoking, correct poor eating habits, and stop using stomach-damaging drugs.

  5. Symptomatic and Supportive Treatment:

     • Digestive aids, antispasmodics, and vitamin supplements. Dysplasia, a precancerous condition, requires close monitoring and possibly surgical intervention.

Traditional Chinese Medicine (TCM) Treatment

• Liver-Stomach Disharmony:

  • Principle: Soothe the Liver, regulate Qi, and harmonize the stomach.

  • Formulas: Chai Hu Shu Gan San or Chen Xiang Jiang Qi San.

• Spleen-Stomach Deficiency:

  • Principle: Warm the middle burner and strengthen the Spleen.

  • Formulas: Xiang Sha Liu Jun Zi Tang or Huang Qi Jian Zhong Tang.

• Stomach Yin Deficiency:

  • Principle: Nourish Yin and benefit the Stomach.

  • Formulas: Yi Guan Jian combined with Shao Yao Gan Cao Tang.

• Blood Stasis in the Stomach Collaterals:

  • Principle: Activate blood, transform stasis, and stop pain.

  • Formulas: Shi Xiao San combined with Dan Shen Yin for heat patterns; Huang Tu Tang for deficiency-cold patterns.

• Damp-Heat in the Liver and Stomach:

  • Principle: Clear Liver heat, harmonize the Stomach, and stop pain.

  • Formulas: Wen Dan Tang combined with Zuo Jin Wan.

Dietary and Health Preservation

Daily Health Preservation

1. Remove pathogenic factors: Rest in bed during acute episodes.

2. Hydrate: Drink plenty of fluids, especially sugar-salt water, to compensate for losses from vomiting and diarrhea.

3. Dietary progression: Start with clear liquids (rice soup), then progress to bland, low-residue semi-liquids (milk, steamed eggs), and finally to soft foods as symptoms improve.

Dietary Therapy (Food Remedies)

• Two Greens Tea:

  • Ingredients: 6g Green Calyx Plum (Lu E Mei), 6g Green Tea.

  • Method: Steep in boiling water for 5 minutes.

  • Function: Soothes the Liver, regulates Qi, and relieves pain.

• Kumquat Drink:

  • Ingredients: 200g Kumquats, 20g White Cardamom (Bai Dou Kou), appropriate amount of sugar.

  • Method: Simmer kumquats in water for 5 minutes, then add cardamom and sugar and simmer briefly.

  • Function: Soothes the Liver, resolves depression, and harmonizes the Spleen and Stomach.

• Purple Flower Bitter Vegetable Soup (Zi Hua Ku Cai Tang):

  • Method: Boil 15g of the herb in 1000ml of water for 5-10 minutes. Strain and drink the warm tea (50-100ml) mixed with a few spoonfuls of brown sugar, three times a day after meals.

• Carrot and Dried Tangerine Peel with Shredded Pork:

  • Ingredients: 200g carrots, 10g dried tangerine peel (Chen Pi), 100g lean pork.

  • Method: Shred all ingredients. Sauté the carrots first. Then stir-fry the pork and tangerine peel, add the carrots back, season, and braise briefly with a small amount of water.

  • Function: Broadens the chest and regulates Qi.