Chronic atrophic gastritis is a common stomach disease. Arteriosclerosis, insufficient gastric blood flow and the hobby of tobacco, alcohol and tea are all easy to destroy the barrier function of gastric mucosa and cause chronic atrophic gastritis. In atrophic gastritis, the gastric mucosa atrophies and is replaced by intestinal epithelial cells, that is, intestinal metaplasia; If inflammation continues to develop, the cell growth is atypical, that is, anaplasia; Even cell proliferation leads to cancer. The clinical manifestations are only indigestion symptoms such as fullness in the upper abdomen, belching and loss of appetite. Sometimes, due to the destruction of stomach factors, vitamin B 12 malabsorption will cause anemia. Endoscopy and biopsy are the only means to diagnose the disease.
Atrophic gastritis can be treated with drugs, and it should be checked regularly to prevent cancer.
Atrophic gastritis can be treated with drugs, and it should be checked regularly to prevent cancer.
prescription
1. Eat fresh and nutritious food to ensure adequate intake of protein, vitamins and iron. Eat on time, don't overeat, don't eat cold or overheated food, and don't use or use less irritating condiments such as fresh and spicy powder.
2. Restrain drinking, do not smoke, and avoid the harm of nicotine to gastric mucosa; Avoid long-term use of anti-inflammatory painkillers, such as aspirin and corticosteroids, to reduce gastric mucosal damage.
3. Check regularly and do gastroscopy if necessary.
4. In case of aggravation of symptoms, emaciation, anorexia and melena, you should go to the hospital for examination in time.
How to treat chronic atrophic gastritis?
(1) General treatment: Patients with chronic atrophic gastritis, regardless of the cause, should quit smoking and drinking, and avoid using drugs that damage gastric mucosa, such as aspirin, indomethacin and erythromycin. Eat regularly, avoid overheated, salty and spicy food, and actively treat chronic oral, nasal and pharyngeal infections.
(2) weak acid treatment: patients with low or no acid can take rice vinegar in proper amount, each time 1 ~ 2 spoonfuls, three times a day; Or 10% dilute hydrochloric acid 0.5 ~ 10 ml, before or during meals, and at the same time taking pepsin mixture, each time 10 ml, 1 day three times; You can also choose multi-enzyme tablets (DPP) or pancreatin tablets to improve dyspeptic symptoms.
(3) Anti-Helicobacter pylori therapy: In chronic atrophic gastritis, gastric acid is reduced or lacking, and bacteria are born in the stomach, especially the positive rate of Helicobacter pylori is very high. The application of antibiotics can improve the symptoms of chronic atrophic gastritis. The commonly used treatment for eliminating Helicobacter pylori is bismuth (TDB, De? NOL), each time 1.20 mg, 1 4 times a day, for 4 ~ 6 weeks; Amoxicillin capsules, 0.5g each time, 1 day 4 times; Furazolidone 100mg, 3 ~ 4 times a day. These drugs can not only eliminate Helicobacter pylori, but also help to alleviate and eliminate the accompanying active gastritis. Other drugs that have therapeutic effects on Helicobacter pylori are gentamicin, berberine, metronidazole, tetracycline and norfloxacin.
(4) Inhibition of bile reflux and improvement of gastric motility: cholestyramine can complex bile salts that reflux into the stomach and prevent bile acids from damaging the gastric mucosal barrier, with the method of 3-4g 1 day, 3-4 times. Sucralfate can be combined with bile acid and lysolecithin, and can also be used to treat bile reflux. The method is 0.5- 1g, 1 day, three times. Stefaniwsky thinks that deoxycholic acid and lithocholic acid in bile are the most toxic to gastric mucosa. Bile acids in gastric juice of patients with bile reflux are mainly cholic acid and deoxycholic acid, and UDCA accounts for only 65,438+0%. After taking UDCA, the bile acid in gastric juice was mainly UDCA (accounting for 43 65,438+05%), while the concentrations of cholic acid, deoxycholic acid and lithocholic acid decreased significantly, thus reducing the damage of the latter two to gastric mucosa. Drugs such as metoprolol, Modiglin and cisapride can enhance gastric peristalsis, promote gastric emptying, assist gastric and duodenal movements, prevent bile reflux, and regulate and restore gastrointestinal movements. Specific application method: metoprolol 5 ~ 10 mg, three times a day; Modine 10mg, 1 3 times a day; Cisapride 5mg, 3 times a day.
(5) Mucosal nutrition: Albizia geranyl ester can increase gastric mucosal renewal, improve cell regeneration ability, enhance gastric mucosal resistance to gastric acid and protect gastric mucosa. The dosage is 50 ~ 60 mg, three times a day. You can also choose to promote blood circulation, and the dosage is 80 ~ 90 mg per day. Or choose sucralfate, urea capsules, gastrin, prostaglandin E, etc.
(6) Pentapeptide gastrin and hormones: Pentapeptide gastrin not only promotes the secretion of hydrochloric acid by parietal cells and increases the secretion of pepsinogen, but also has obvious proliferation effect on gastric mucosa and other upper gastrointestinal mucosa, and can be used to treat patients with chronic atrophic gastritis with low acidity or gastric atrophy. The dosage was 50μg, and intramuscular injection 1 time half an hour before breakfast, and intramuscular injection 1 time every other day in the third week.
The pathogenesis of chronic atrophic gastritis is related to autoimmunity, so we can try short-term prednisone as immunosuppressive therapy. This method is especially suitable for patients with chronic atrophic gastritis with PCA positive and pernicious anemia, but the clinical effect is not exact.
(7) Other symptomatic treatments: including spasmolysis and pain relief, anti-vomiting, digestion aid, anti-anxiety and anemia improvement. For anemia, if it is iron deficiency, it is necessary to supplement iron. According to vitamin B 12? Or folic acid deficiency. The method is vitamin B 12? 50~ 100 μ g/g/day for 20 ~ 30 days; Folic acid 5 ~ 10 mg, three times a day, until the symptoms and anemia completely disappear.
(8) Surgical treatment: For patients with chronic atrophic gastritis over middle age, if there are ulcers, polyps and bleeding during treatment or follow-up, or if there is moderate or severe atypical hyperplasia in gastroscopy pathology, partial gastrectomy can be considered in combination with the clinical situation of the patients, and early gastric cancer can be detected from the gastrectomy samples of such patients.