1. Helicobacter pylori (Hp) infection. Hp (Figure 4-2-1, see color insert at the end of the article) infection is currently considered to be the main cause of chronic gastritis. With long-term Helicobacter pylori infection, some patients may develop chronic multifocal atrophic gastritis. Hp infection itself may not be sufficient to cause chronic superficial gastritis to develop into chronic atrophic gastritis, but it increases the susceptibility of the gastric mucosa to environmental factors. Antral gastritis is common clinically.

2. Diet Epidemiological data show that long-term consumption of high-salt foods, drinking strong tea, wine, and coffee, eating too hot, too cold, and too rough foods, and lack of fresh vegetables and fruits are closely related to the occurrence of chronic gastritis.

3. Autoimmunity: There are parietal cell antibodies and intrinsic factor antibodies in the blood of patients with autoimmune gastritis. Parietal cell antibodies can destroy parietal cells and reduce or even eliminate gastric acid secretion. Intrinsic factor antibodies destroy intrinsic factor and affect the absorption of vitamin B₁₂, leading to pernicious anemia. Gastric corpus gastritis is common clinically.

4. Physical and chemical factors: Taking large amounts of NSAIDs and duodenal fluid reflux caused by various reasons will weaken the barrier function of the gastric mucosa and damage the gastric mucosa.

1. The mechanism of chronic gastritis caused by Hp infection ①Hp has a flagellum structure, which relies on its adhesion to the gastric mucosal epithelial cells to directly invade the gastric mucosa. ②Hp secretes urease, decomposes urea to produce ammonia and neutralizes gastric acid, forming a neutral environment conducive to the survival of Hp and damaging epithelial cells. ③Hp secretes vacuolating toxin proteins, which damage epithelial cells and cause a strong inflammatory response. ④The cell wall of Hp bacteria acts as an antigen to produce an immune response.

2. Others Bad eating habits, large amounts of NSAIDs, and duodenal fluid reflux will weaken the barrier function of the gastric mucosa, making it susceptible to damage by gastric acid-pepsin.

Ask the patient whether he or she drinks strong tea, spirits, or coffee for a long time, eats hot, cold, or rough foods, or eats a high-salt diet; whether he or she regularly takes nonsteroidal anti-inflammatory drugs; whether he or she has any other autoimmune diseases, such as Hashimoto’s Thyroiditis, vitiligo, etc.; whether there are chronic right heart failure, cirrhosis, portal hypertension and other diseases that cause gastric mucosal congestion and hypoxia.

1. Symptoms: The course of the disease is protracted and the progress is slow. 70% to 80% of patients have no symptoms, and some patients show non-specific indigestion symptoms, such as upper abdominal pain or discomfort, loss of appetite, fullness, belching, acid reflux, nausea, etc. Symptoms are related to eating or food types. Patients with gastric mucosal erosion may develop upper gastrointestinal bleeding; patients with autoimmune gastritis may experience obvious food fear, anemia, and weight loss; a very small number of chronic multifocal atrophic gastritis may develop into gastric cancer over a long period of time, and may experience loss of appetite, Symptoms such as weight loss and upper abdominal pain.

2. The physical signs are mostly inconspicuous, and sometimes there is mild tenderness in the upper abdomen.

Due to the protracted course of the disease, the symptoms are not obvious and persist, which can easily cause patients to have irritability, anxiety and other negative emotions; some patients have depression and fear due to obvious food fear, anemia, weight loss and fear of "cancer".

1. Gastroscopy and gastric mucosal biopsy are the most reliable methods for diagnosing chronic gastritis. In chronic superficial gastritis, erythema, rough mucosa, bleeding spots, and hemorrhagic spots can be seen under endoscopy; in chronic atrophic gastritis, the mucosa is granular, mucosal blood vessels are exposed, the color is dark, and the folds are small.

2. Helicobacter pylori detection ¹³C or ¹⁴C breath test.

3. Serological examination: In autoimmune gastritis, anti-parietal cell antibodies and anti-intrinsic factor antibodies are positive, and serum gastrin levels are significantly increased; in multifocal atrophic gastritis, serum gastrin levels are normal or low.

4. Gastric juice analysis: autoimmune gastritis, achlorhydria; multifocal atrophic gastritis, gastric acid secretion is normal or low.

The principle of treatment is to eliminate the cause, relieve symptoms, control infection, and prevent and treat precancerous lesions. The treatment plan for chronic gastritis caused by Helicobacter pylori infection is peptic ulcer; if it is caused by non-steroidal anti-inflammatory drugs, the drug should be stopped and antacids should be given; for those with bile reflux, take aluminum hydroxide gel to absorb , or take sucralfate and gastric motility drugs to neutralize bile salts and prevent reflux; for patients with autoimmune gastritis accompanied by pernicious anemia, follow the doctor's advice to apply vitamin B₁₂.

1. Rest and activity: People with an acute attack of gastritis or gastrointestinal bleeding should rest in bed. After the condition is relieved, they should perform appropriate exercises and exercises to avoid overexertion and enhance the body's resistance.

2. The principle of dietary care is a high-calorie, high-protein, high-vitamin, easy-to-digest diet, regular and quantified meals, small and frequent meals, chew slowly and slowly; avoid ingesting foods that are too salty, too sweet, too cold, too hot, and spicy. . Those with low gastric acidity can consume thick broth, chicken soup, hawthorn and vinegar as appropriate to stimulate gastric acid secretion; those with high gastric acidity can consume milk, bread, pureed vegetables, etc. to neutralize gastric acid.

Observe the location and nature of the patient's abdominal pain, the color, amount and properties of vomitus and feces, and whether the symptoms are improved before and after medication; monitor signs of upper gastrointestinal bleeding, such as vomiting blood and/or melena; monitor fecal occult blood examination, Detect changes in condition promptly.

If you have abdominal pain or discomfort, avoid mental stress and use methods such as diverting your attention and taking deep breaths to relieve pain; or use a hot water bottle to apply heat to the stomach to relieve spasm and relieve abdominal pain.

Drugs that can irritate the gastric mucosa, such as aspirin and indomethacin, are prohibited or used with caution. When using drugs to eradicate Helicobacter pylori infection, acid suppressants, and gastric mucosal protective agents as directed by your doctor, pay attention to the efficacy and adverse reactions of the drugs.

We should take the initiative to comfort patients, explain relevant knowledge about the disease and formal treatment methods, so that they can build confidence in treatment, actively cooperate with treatment, and eliminate anxiety and fear.

Introduce the cause and prognosis of the disease to patients and their families, guide patients to avoid predisposing factors and maintain a good mental state; develop a good lifestyle, dietary rules, pay attention to food hygiene and nutrition; combine work and rest, and arrange work and rest time reasonably ; Introduce the names, functions, dosages, usage, adverse reactions and precautions of commonly used drugs to patients, take the drugs as directed by the doctor, and insist on regular outpatient reviews.