Achlorhydria

Introduction Lack of stomach acid, bacteria can easily multiply in the stomach, can cause chronic gastritis. Chronic gastritis refers to various chronic gastric mucosal inflammatory lesions caused by different causes. It is a common disease and one of the most common diseases of the army. Its incidence rate ranks first among various stomach diseases. Since the wide application of fiber endoscopy, the understanding of this disease has been significantly improved. Chronic gastritis often has a certain degree of atrophy (mucosal loss of function) and metaplasia, often involving the cardia, accompanied by loss of G cells and decreased secretion of gastrin, may also involve the body of the body, accompanied by loss of acid secretion glands, leading to stomach acid, Reduction of pepsin and endogenous factors.

Cause

The etiology and pathogenesis of chronic gastritis have not been fully elucidated and may be related to the following factors:

First, the legacy of acute gastritis

After acute gastritis, gastric mucosal lesions are persistent or recurrent, and chronic gastritis can be formed.

Second, irritating foods and drugs

Long-term use of diets and drugs that are strongly irritating to the gastric mucosa, such as strong tea, spirits, spicy or salicylate drugs, or chewing when food is not enough, rough food repeatedly damages the gastric mucosa, or excessive smoking, tobacco acid directly It acts on the gastric mucosa.

Third, the reflux of duodenal juice

The study found that patients with chronic gastritis due to dysfunction of the pyloric sphincter often cause bile reflux, which may be an important cause of disease. The phospholipids in the pancreatic juice together with the bile and pancreatic digestive enzymes can dissolve the mucus and destroy the gastric mucosal barrier, causing the H+ and pepsin to diffuse into the mucosa and further cause damage. The chronic gastritis caused by this is mainly in the antrum of the stomach. Gastric inflammation is very common in patients with gastric-jejunum anastomosis due to bile reflux. Almost all patients with peptic ulcer have chronic antral sinusitis, which may be related to dysfunction of the pyloric sphincter. Nicotine in tobacco can relax the pyloric sphincter, so long-term smokers can promote bile reflux and cause antral sinusitis.

Fourth, immune factors

Changes in immune function have been widely recognized in the pathogenesis of chronic gastritis, atrophic gastritis, especially in patients with gastric gastritis, blood, gastric juice or in the atrophic mucosa can find wall cell antibodies; gastric atrophy with pernicious anemia patients found in the blood Intracellular factor antibodies indicate that autoimmune responses may be the cause of certain chronic gastritis. However, whether there are immune factors involved in the pathogenesis of gastritis is still inconclusive. In addition, the gastric mucosa of atrophic gastritis has diffuse lymphocyte infiltration, in vitro lymphoblastic transformation test and abnormal leukocyte migration inhibition test, suggesting that cellular immune response may be important in the occurrence of atrophic gastritis. Certain autoimmune diseases such as chronic thyroiditis, hypothyroidism or hyperthyroidism, insulin-dependent diabetes mellitus, and chronic adrenal insufficiency may be associated with chronic gastritis, suggesting that the disease may be associated with an immune response.

V. Infectious factors

In 1983, Warren and Marshall found that patients with chronic gastritis had a large number of campylobacter pylori on the surface of the gastric mucosa near the epithelial cells, and the positive rate was as high as 50-80%. It has been reported that this strain is not found in the normal gastric mucosa. Where the bacteria settled, the gastric mucositis cells were infiltrated, and the degree of inflammation was positively correlated with the number of bacteria. Electron microscopy also showed that the number of microprojections on the surface of epithelial cells connected to bacteria was reduced or dull. Anti-Helicobacter antibodies can also be found in the blood and gastric mucosa of patients. After treatment with antibiotics, symptoms and histological changes can be improved or even disappeared, so it is believed that this bacteria may be involved in the pathogenesis of chronic gastritis. But it is still difficult to be sure.

[Cause of chronic gastritis]

1. Mental factors. Excessive mental stimulation, depression, and other mental factors repeatedly act on the cerebral cortex, causing dysfunction of the cerebral cortex, leading to spasmodic contraction of the blood vessels in the stomach wall, inflammation or ulceration of the gastric mucosa.

2. The role of bacteria and their toxins. Since the bacteria or toxins in the nose, mouth, throat and other parts are continuously swallowed into the stomach; or the stomach lacks stomach acid, the bacteria easily multiply in the stomach and cause chronic gastritis for a long time.

3, long-term use of drugs that are irritating to the stomach, food and eating rough food or smoking. These factors repeatedly act on the gastric mucosa, making it hyperemic and edematous.

4, long-term congestion and lack of oxygen in the gastric mucosa. For patients with congestive heart failure or portal hypertension, the gastric mucosa is stagnant and hypoxic for a long time, causing malnutrition caused by nutritional disorders.

5, acute gastritis, such as improper treatment, prolonged unhealed can be converted to chronic gastritis.

6, lack of stomach acid, bacteria easily proliferate in the stomach, can also cause chronic gastritis.

7, lack of nutrition, endocrine dysfunction, immune dysfunction, can cause chronic gastritis.

8, Campylobacter infection, etc. may be the cause of chronic gastritis.

an examination

Related inspection

Basal gastric juice secretion, no gastric acid analysis, gastric ultrasound examination

Chronic gastritis is non-specific and has few signs. X-ray examination generally only helps to rule out other stomach diseases, so it is necessary to rely on gastroscopy and gastric mucosal biopsy. Helicobacter pylori can be found in the gastric mucosa in about 50-80% of patients in China. The clinical manifestations of gastritis are different in severity. There are often loss of appetite, nausea, vomiting, upper abdominal pain or colic, diarrhea, chills, headache and tendon.

1. Analysis of gastric juice

Determination of basal gastric juice secretion (BAO) and histamine test or pentagastrin gastrin after measurement of large amount of acid (MAO) and peak acid secretion (PAO) to determine gastric acid function, contribute to chronic atrophic gastritis Diagnosis and guidance of clinical treatment. Chronic superficial gastritis is more normal gastric acid, and the extensive and severe chronic atrophic gastritis is reduced in gastric acid.

2. Serological testing

Chronic atrophic gastritis serum gastrin is often moderately elevated, which is due to gastric acid deficiency can not inhibit the secretion of G cells. If the lesion is serious, not only the secretion of gastric acid and pepsin is reduced, but also the secretion of internal factors is reduced, thus affecting the decrease of vitamin B12; serum PCA is often positive (more than 75%).

3. Gastrointestinal X-ray barium meal examination

With the development of digestive endoscopy, the current diagnosis of gastritis is rarely applied to upper gastrointestinal angiography. When the fine structure of gastric mucosa is shown by double contrast of gas sputum, atrophic gastritis may have a relatively flat and reduced gastric mucosal fold.

4. Gastroscope and biopsy

Gastroscope and pathological biopsy are the main methods for diagnosing chronic gastritis. Superficial gastritis is often the most obvious in the antrum of the stomach. Most of the diffuse gastric mucosa has increased mucus on the surface. There are grayish white or yellowish white exudates. The mucosa of the lesion is red and white or plaque-like, which is like measles-like changes and sometimes erosion. The mucosa of chronic atrophic gastritis is mostly pale or grayish white, and can also be red and white, and the white area is depressed; the folds become thin or flat, and the mucosa becomes thinner and can be seen as a purple-blue submucosal blood vessel; the lesion can be diffuse or mainly In the antrum of the stomach, such as those with proliferative changes, the mucosal surface is granular or nodular.

Biopsy specimens were used for pathological examination to determine chronic superficial gastritis, chronic atrophic gastritis, intestinal metaplasia, and dysplasia. Feasible pathological biopsy tissue rapid urease test.

Differential diagnosis

First, stomach cancer

The symptoms of chronic gastritis such as loss of appetite, upper abdominal discomfort, anemia, and other X-ray signs of gastric antrum gastritis are similar to gastric cancer, and special attention should be paid to identification. The vast majority of patients with fiber gastroscopy and biopsy are helpful in identification.

Second, peptic ulcer

Both have chronic upper abdominal pain, but the abdominal regularity and periodic pain are mainly above the peptic ulcer, while the chronic stomach has little regularity and is mainly dyspepsia. Identification relies on X-ray barium meal and gastroscopy.

Third, chronic biliary diseases

Such as chronic cholecystitis, cholelithiasis often have chronic right upper abdomen, abdominal distension, hernia and other dyspepsia, easy to be misdiagnosed as chronic gastritis. However, the gastrointestinal examination of the disease was found to be abnormal, and gallbladder angiography and B-ultrasound abnormalities were finally diagnosed.

Fourth, other

For example, hepatitis, liver cancer and pancreatic diseases can also be delayed due to symptoms such as loss of appetite and indigestion, and comprehensive and detailed examinations and related examinations can prevent misdiagnosis.

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