Gastritis Gastritis is an acute or chronic inflammation of the gastric mucosa caused by various factors. It is often characterized by upper abdominal pain, bloating, belching, nausea, loss of appetite, gastrointestinal bleeding, and is one of the most common digestive system disorders. Gastritis can be broadly classified into acute, chronic, and special types of gastritis.

Gastritis is an acute or chronic inflammation of the gastric mucosa caused by various factors. It commonly presents with symptoms such as epigastric pain, abdominal distension, belching, nausea, loss of appetite, and gastrointestinal bleeding, making it one of the most common digestive system disorders. Gastritis can generally be categorized into acute, chronic, and special types of gastritis.

Based on the pathophysiological mechanisms and common clinical presentations, gastritis can be broadly classified into acute, chronic, and special types of gastritis.

Acute Gastritis

Acute gastritis refers to acute inflammation of the gastric mucosa caused by various factors, characterized by transient acute changes such as mucosal congestion, edema, exudation, erosion, and bleeding.

Chronic Gastritis

Chronic gastritis encompasses chronic inflammation or atrophic changes of the gastric mucosa caused by various factors. It can be further classified into two major categories: Helicobacter pylori (Hp) gastritis and non-Hp gastritis based on etiology. Pathologically, it can be classified into atrophic gastritis and non-atrophic gastritis. Based on the location of the lesion, it can be categorized into antral predominant gastritis, corpus predominant gastritis, and pangastritis.

Special Types of Gastritis

Special types of gastritis are caused by specific etiologies, such as infectious gastritis, chronic hypertrophic gastritis (Ménétrier's disease), and others.

Acute Gastritis

Typical symptoms include upper abdominal pain, abdominal distension, nausea, vomiting, and loss of appetite. Severe cases may involve hematemesis, melena, dehydration, acidosis, or shock.

Chronic Gastritis

Most patients are asymptomatic, but those with symptoms may experience upper abdominal discomfort, bloating, dull pain, burning sensation, loss of appetite, belching, heartburn, and other digestive discomfort.

Special Types of Gastritis

Corrosive gastritis may lead to gastrointestinal bleeding, upper gastrointestinal perforation, peritonitis, and other severe conditions.

Bacterial infectious gastritis may manifest as sudden upper abdominal pain, marked tenderness, local muscle tension, fever, nausea, vomiting, purulent vomitus containing necrotic mucosa.

Eosinophilic gastroenteritis may present with upper abdominal pain, nausea, vomiting, and may be accompanied by diarrhea, and in severe cases, pleural effusion and ascites.

Acute Gastritis

During the acute phase of gastritis, it is necessary to observe fasting, administer fluid replacement, and alleviate gastric spasms. Intramuscular metoclopramide is given to patients with vomiting, and atropine or scopolamine is administered to relieve abdominal pain. For patients with electrolyte disturbances due to frequent vomiting, intravenous fluid therapy is given to correct the imbalance.

Acute Corrosive Gastritis

For acute corrosive gastritis caused by ingestion of corrosive substances, temporary fasting is advised, and parenteral nutrition is provided with close monitoring. Nasogastric tube placement may be considered to wash or dilute the corrosive agent, drain gastric fluid, and prevent complete esophageal stenosis and obstruction. In cases of laryngeal edema and respiratory distress, tracheostomy may be considered. For patients with gastric perforation or acute peritonitis, surgical repair should be performed.

Lifestyle: Quit smoking and alcohol consumption. Maintain good psychological well-being and adequate sleep.

Diet: Eat regular meals and ensure dietary diversity to avoid selective eating.

Dietary Recommendations: During the acute phase of gastritis, temporary fasting is recommended. Once the condition improves, patients can consume liquid diets such as rice soup, fresh fruit juice, and lotus root powder. Generally, milk consumption is not recommended to avoid bloating. It is advisable to reduce sucrose intake. If the patient is comfortable, they can transition to a semi-fluid diet, including foods such as rice congee and egg drop soup. In the recovery phase, softer foods with less residue are recommended, while coarse grains and fried foods should be minimized. Tender fish, poultry, and lean meats with low fiber content are preferred, and cooking methods such as steaming, boiling, braising, and stewing are recommended.

Dietary Restrictions: Consume less smoked, pickled, and foods rich in nitrate and nitrite. Avoid consuming moldy foods and increase intake of fresh foods. Avoid consuming rough, strong, spicy foods, as well as strong tea, coffee, and other drinks. Avoid all types of alcohol and alcoholic beverages, carbonated drinks, and spicy condiments. Avoid using fibrous vegetables such as celery and unripe fruits.

In the elderly population, there is a higher risk of vitamin and micronutrient deficiencies when suffering from gastritis, and supplementation may be necessary.

For the treatment of chronic gastritis, medications can be discontinued once symptoms are relieved, and medication can be taken as needed if symptoms recur.

Use caution when using medications that may damage the gastric mucosa, such as aspirin or long-term use of corticosteroids.

Improve dietary and lifestyle habits and avoid alcohol abuse.

Discontinue unnecessary nonsteroidal anti-inflammatory drugs (NSAIDs).

For patients with severe trauma, burns, major organ failure, a history of major surgery, or long-term use of aspirin or clopidogrel, prophylactic proton pump inhibitors (PPIs) or H2 receptor antagonists may be considered.

For patients with bone and joint diseases, medications with relatively minor gastric mucosal injury, such as celecoxib, may be chosen for treatment.