Are subject to various pathogenic factors, the long-term stimulation, prolonged unhealed chronic inflammation of gastric mucosa, gastric glands have been destroyed, shrinking the number of reduced or disappeared, mucosal thinning, known as chronic atrophic gastritis. Inflammation occurs when the gastric mucosal damage and atrophy, the body will automatically be repaired, but errors may occur in the repair process, forming the so-called atypical hyperplasia. Atypical hyperplasia can be divided into mild, moderate and severe degree, and only moderate or severe dysplasia and gastric cancer was only considered to be related to the occurrence of precancerous lesions. It is noteworthy that, atrophic gastritis and dysplasia there is no specific clinical symptoms, endoscopy, while only in the gastric mucosa organizations histopathological examination, in order to do the right diagnosis.

According to scientists, projection, normal gastric mucosa through chronic inflammation, atrophic gastritis, dysplasia to cancer may take 16 to 24 years. During this long process, in which the living environment and living habits on the development of the disease have a major impact. High-salt diet, I am pleased to eat preserved and smoked foods, the Food and lack of vitamins, are unfavorable factors for patients. In fact, only a small number of patients developed chronic gastritis atrophic gastritis, and only about 1% without making the treatment of atrophic gastritis, gastric cancer may develop. Thus, excessive fear will become a chronic atrophic gastritis, gastric cancer is unnecessary, there is no scientific basis.

So how to properly deal with chronic atrophic gastritis do?

First to avoid factors that can cause gastric mucosal injury, such as spicy, salty food, eat less salted and smoked foods, eat vitamin-rich fresh vegetables and fruit.

On a case of a chronic atrophic gastritis Helicobacter pylori to change and there is (HP) of those infected, especially those with a family history of gastric cancer patients or from the high incidence of gastric cancer should be in a doctor’s guidance downward Helicobacter pylori eradication therapy, one week course of treatment it usually takes three or four drugs taken together can effectively kill H. pylori. Eradication of Helicobacter pylori, the gastric mucosa of chronic inflammation can be gradually dissipated, thereby preventing the further development of lesions, but has already shown signs of shrinkage mucosa, then the reversal less likely.

Accompanied by intestinal metaplasia and dysplasia in patients with chronic atrophic gastritis, should be under the guidance of a doctor conditions under regular endoscopy for early detection of possible early gastric cancer, early treatment.

Chronic atrophic gastritis can not make surgery help? For most patients, surgery is not necessary. Only chronic atrophic gastritis associated with severe atypical hyperplasia, and gastric cancer can not be identified only when the need for surgery.

2, atrophic gastritis, inflammation of mucous membranes in depth when the impact of the lamina propria of gastric glands to make it shrink, called atrophic gastritis. Gastric mucosal layer thinning, disappearance of mucosal folds flat or can be diffuse, but also showed limitations. Microscope, part of the disappearance of gastric glands, the individual may completely disappear, mucous layer, submucosa with lymphocytes and plasma cells infiltration. Sometimes, mucosal atrophy may be complicated by gastric pit epithelial cell proliferation, leading to local mucosal layer thickening instead, saying that the formation of atrophic gastritis with too. Such as the spread of inflammation extensive destruction of a large number of glands, so that the whole gastric body mucosa atrophy thinning, called gastric atrophy.

Atrophic gastritis can occur intestinal gland metaplasia and pseudo-pyloric gland metaplasia, in the proliferation of the gastric pits and intestinal metaplasia can occur on the basis of epithelial dysplasia (dysplasia). Dysplasia is a non-normal mucosa, with atypical cells, poorly differentiated and mucous membranes characterized by structural disorder that is most likely precancerous lesions.

The so-called air-barium double-contrast examination is to enable patients to drink barium before observation of the stomach, then a certain amount of foaming agent Zhu Huanzhe clothes, so that inflated the stomach cavity. , Once again observe the situation in the stomach cavity. After this two kinds of contrast to the situation come to a preliminary diagnosis.

Chronic superficial gastritis X-ray barium meal patterns that may be expressed as gastric mucosal thickening, and tortuous, and can be serrated, gastric antrum appears bowel syndrome. And chronic atrophic gastritis can be expressed as mucosal thinning, gastric antrum mucosa was abnormal folds, jagged edges or notches, as well as abnormal changes in the stomach cell. However, the lesions of chronic gastritis is still mucous layer, the above mentioned signs are not very specificity, so we can say, X-ray examination for the diagnosis of chronic gastritis has little significance.

The diagnosis of chronic gastritis, mainly by fiber endoscopy. However, here, to point out is: X-ray barium meal, especially the air-barium double contrast examination of the stomach is very beneficial to the continuity of observation, is the examination in gastric cancer and anti-cancer screening is an important tool.

In China, if by Strickland classification, B-type atrophic gastritis is more common, A-type atrophic gastritis is rare, and some patients with atrophic gastritis, both gastric inflammation, there are parietal cell antibodies, can not be included in the above-mentioned two types, so quite a few scholars have put forth for the specific situation in our country classification method, chronic atrophic gastritis were divided into A1-type, A2 type, B1-and B2-type. The classification based primarily on the situation of autoantibodies, serum parietal cell antibody-positive is a A-type, serum parietal cell antibody-negative is a B-type. A type medium is divided into two subtypes of gastric lesions of non-A1 type, antrum of the stomach lesions were type A2. B-type gastric body and antrum were based disease severity is divided into B1 type (gastric lesions than the stomach body weight) and the B2 type (gastric body lesions than the antrum or gastric body weight similar to gastric lesions persons) 2 subtype.

In short, the current chronic atrophic gastritis there is no complete unification of the classification, it is still used along the learning Strickland classification of chronic atrophic gastritis were divided into A-and B-type.

(1) Clinical Performance: mainly anorexia, nausea, belching, upper abdominal fullness or dull pain, a small number of patients can occur upper gastrointestinal bleeding, weight loss, anemia, brittle A, glossitis, or tongue papilla atrophy.

(2) laboratory tests

① gastric analysis: A type CAG in patients with multi-acid-free or low-acid, B-type CAG patients may be normal or low-acid.

② pepsinogen measurement: originally the main cells in pepsin secretion, chronic atrophic gastritis, the blood and urine pepsinogen content decreases.

Determination of serum gastrin ③: gastric antrum G-cells to secrete gastrin. A-CAG patients, often significantly higher serum gastrin; B-type gastric mucosal atrophy in patients with CAG, directly affect the function of G cells to secrete gastrin, serum gastrin than normal.

④ Immunological tests: Parietal cell antibodies (PCA), intrinsic factor antibodies (IFA), gastrin-secreting cell antibodies (GCA) measurement can be used as chronic atrophic gastritis and its sub-type diagnosis.

(3) X-ray: X-gastric barium meal examination in most patients with atrophic gastritis, no abnormality was found. Air-barium double contrast can show the body of stomach mucosal folds flat, thinning, greater curvature of gastric body mucosal folds of the serrated thinning or disappearance of fundus smooth, part of the gastric mucosal inflammation may be serrated or rough mucosa manifestations of disorder.

(4), endoscopy and biopsy: endoscopic examination and biopsy is the most reliable method of diagnosis. Endoscopic diagnosis should include lesions, atrophy, intestinal metaplasia and dysplasia degree. Eyes look directly observed atrophic gastritis mucosa Duocheng pale or gray, thinning, or folds flat. Mucosa can be red and white performance in serious cases, there are scattered white plaques. Submucosal blood vessels exposed to the characteristics of atrophic gastritis, can see the red mesh of small arteries or capillaries, severe atrophic gastritis, epithelial cell hyperplasia seen with the formation of fine particles or larger nodules. Also mucosal erosion, bleeding. Gastric biopsy varying degrees of gland atrophy mostly disappeared, replaced by pyloric gland metaplasia or intestinal gland metaplasia, interstitial inflammatory infiltration significantly.

(1) gastric biopsy: chronic superficial gastritis of the basic lesion is epithelial cell degeneration, epithelial hyperplasia and the inherent pit membrane infiltration of inflammatory cells, but also can be seen even pit the surface of epithelial cells and intestinal epithelial metaplasia. The disease mainly involving the gastric mucosal inflammatory lesions shallow, and sometimes also involving the deep. Domestic pathology professional group discussions provided for by the degree of inflammatory cell infiltration depth, superficial gastritis can be divided into light, medium and heavy 3. Profound part of the gastric mucosa from the surface into three equal portions, cell infiltration involving only the superficial 1 / 3 were mild, involving the 2 / 3 less than those for the moderate, more than 2 / 3 of those was severe. No matter how the severity of inflammatory lesions, superficial gastritis of the gastric glands (cardiac glands, gastric glands, pyloric glands) are always normal, there is no damage or reduction in the number. Superficial gastritis further development of the gland because of its inherent damage reduction in inflammation can be converted into atrophic gastritis.

Chronic atrophic gastritis, gastric mucosa is based on the inherent gland atrophy (decrease in the number, functional reduction) as its prominent lesions, often accompanied by intestinal metaplasia and inflammatory response. Gland by impact inherent in the extent of chronic atrophic gastritis will be divided into mild, moderate and severe three. Inherent in the stomach glands (glands in the pyloric antrum of the stomach at the bottom of gastric glands, cardiac glands in the cardia as) reducing the 1 / 3 of those for the mild, a decrease of 1 / 3 ~ 2 / 3 were moderate, a decrease of 2 / 3 or more severe.

(2) endoscopy: chronic superficial gastritis in the performance of endoscopic mainly: ① gastric mucosal hyperemia, edema, congestion zones and edema zones can intersect to form a red and white, and red with congestion-based; ② gastric mucosal surface, attached to thick patches of white or yellow mucus; ③ gastric bleeding points; ④ mucosa and sometimes can be seen a small erosion.

Chronic atrophic gastritis in endoscopic performance is: ① color fades gastric mucosa, showing pink, sallow, heavy person was gray or gray-blue. Can diffuse, but also showed the limitations of patchy distribution; ② submucosal blood vessels prominent. Shrinkage of the initial mesh can be seen a dark red mucosa of small blood vessels, severe mucous membrane shows a larger blue veins dendrite; ③ mucosal folds small or even disappear; ④ When the neck glands associated with atrophic gastritis or intestinal epithelial hyperplasia of of Health, the mucosal surface, rough, granular, or nodular; ⑤ mucosal atrophy fragility, easy bleeding, and may have erosive lesions.

The performance of chronic atrophic gastritis, gastric body mucosa atrophy, and its incidence may be related to immune factors, major clinical manifestations of anemia, an A-type atrophic gastritis.

Another way for the gastric antrum mucosal atrophy, its incidence has nothing to do with immunity, multiple chronic superficial gastritis by the evolved, so common in clinical practice of these two diseases co-exist with each other. Epigastric pain, abdominal distention, belching, etc., belong to B-type atrophic gastritis. In China, chronic atrophic gastritis are mainly B-type. B-type atrophic gastritis about 5% of patients may develop gastric cancer, this ratio is higher than normal, so on a regular basis with these patients to prevent.

Some scholars believe that: chronic gastritis, inflammation involving the stomach near the pyloric canal may cause pyloric tube dysfunction. When the food reaches the stomach pylorus peristaltic waves push, the pylorus is not in an open state, so that food passed, to reach the duodenum, but was still tightly closed, so that the stomach cavity pressure increases, reflecting the stimulus vomiting center, which makes people feel sick , and in severe, can produce vomiting. In addition, often – some patients with chronic gastritis, the merger with chronic pharyngitis, chronic esophagitis, the richer parts of the peripheral nerve susceptible to stimulation arising from nausea.

Produced by chronic gastritis, nausea, vomiting, may be oral metoclopramide 10 mg 2 times a day; or do bite Lynn 20 mg 2-3 times a day oral treatment. Patients with chronic gastritis, general nausea, vomiting, and are unlikely complications. But sicker appeared more violent retching or vomiting, but it can often lead to Mallory-Weiss, causing upper gastrointestinal bleeding. As we now know, connecting the esophagus gastric cardia is the site, Ben closed the door in a state of general. When severe nausea or vomiting, stomach pressure suddenly increased when the high-pressure air emitted from the cardia, may result in the Weiss. Laceration, mostly single, generally about 3-20 mm and a width of 2-3 mm, along the cardia mucosal folds longitudinal split.

Mallory-Weiss bleeding, accounting for upper gastrointestinal bleeding in about 10%. The amount of bleeding varies, in some cases very little bleeding, only vomit contains bloodshot eyes, or only melena without hematemesis; severe cases, there may be bleeding, shock and death. The diagnosis of this disease on medical history, and gastroscopy. . Where there is severe nausea and vomiting secondary to bleeding, should be thought of the possibility of the disease. x-ray barium meal examination, the diagnosis is negligible. Large amount of bleeding patients, selective arterial angiography in the diagnosis of a certain value. Mallory-Weiss can be healed within 24 hours, the treatment of hemorrhagic gastritis for reference.

Chronic gastritis and vomiting in some other complications include: malnutrition, water, electrolyte, acid-base balance disorders, generally after symptomatic treatment can alleviate.

Some patients often feel discomfort bloating, belching, after several hospitals and many times at endoscopy were diagnosed as “gastritis”, long-term use a variety of Chinese and Western medicine there was no significant effect, it took a lot of medical expenses . Similar patients are not uncommon. In fact, these patients have a lot of people associated with insomnia, anxiety, irritability, palpitation, suspected disease and other neuropsychiatric symptoms, some patients are always doubts about their own suffering from stomach cancer and everywhere for treatment, repeated requests to do endoscopy.

Treatment, patients should stop smoking in the proposed alcohol, to avoid irritating food and eating and drinking at the same time, more emphasis on the spirit and comfort therapy, increasing physical and exercise to improve the body’s resistance to diseases and immunity, decentralized patient’s attention and other non – drug treatment, proper use of mood stabilizers, and gastric motility drugs such as symptomatic treatment, to enable patients to be able to understand and accept your treatment plan to enhance the confidence to overcome the disease, but completely without requiring costly long-term medication and frequent endoscopy to increase unnecessary. If the symptoms of individual patients with a sustained, gradual weight, should promptly review the endoscopy to avoid misdiagnosis of malignant disease.

Mallory-Weiss bleeding, accounting for upper gastrointestinal bleeding in about 10%. The amount of bleeding varies, some patients had very little bleeding, only in the vomit contains bloodshot eyes, or only melena without hematemesis; severe cases, there may be bleeding, shock and death.

Chronic gastritis and vomiting in some other complications include: malnutrition, water, electrolyte and acid-base balance disorders, generally through the symptomatic treatment can alleviate.