Overview of Chronic Gastritis March 20, 1997

Overview of Chronic Gastritis March 20, 1997

Traditional classification methods: superficial gastritis, atrophic gastritis, and hypertrophic gastritis. In recent years, it has been recognized that these three pathological changes often coexist within the same individual, so they are now collectively referred to as atrophic gastritis, as atrophy is the most common pathological manifestation. Atrophic gastritis is further divided into two types based on whether or not the patient has parietal cell antibodies: Type A and Type B. Type A patients test positive for parietal cell antibodies, with lesions concentrated in the gastric body due to its large coverage area, resulting in reduced gastric acid secretion and impaired digestion and absorption. This particularly affects the absorption of vitamin B12, leading to anemia. In Type A, lymphocytes dominate the infiltration of gastric wall cells, and the enlarged gastric cavity dilutes allergenic substances, making localized pain less obvious and instead emphasizing upper abdominal distension. Thus, it falls under the category of deficiency syndromes in traditional Chinese medicine, with prescriptions such as Xiang Sha, Xiang Fu Liang Jiang, Da Xiao Jian Zhong, and Li Zhong being appropriate. Type B patients test negative for parietal cell antibodies, with lesions concentrated in the gastric antrum due to its smaller coverage area, resulting in relatively less reduction in gastric acid and better digestion and absorption. Patients generally enjoy better overall health, with milder anemia, but localized pain is more pronounced. In Type B, neutrophils dominate the infiltration of gastric wall cells, classifying it as a real syndrome and heat syndrome in traditional Chinese medicine, with prescriptions such as Ban Xia Xie Xin Tang, San Huang Xie Xin Tang, Huang Lian Jie Du Tang, and Qing Wei San being suitable. Additionally, there is a type of chronic gastritis where pain does not subside even after treatment with the aforementioned traditional Chinese medicines; such patients often have concurrent peptic ulcers, requiring the addition of acid-suppressing agents to the prescription. Traditional Chinese acid-suppressing agents include raw dragon bone, oyster, and cuttlefish, along with Zu Jin Wan (6 g of Huang Lian and 3 g of Wu Zhu Yu) as another acid-suppressing formulation. For persistent pain accompanied by lower back pain, consider penetrating ulcers, which are mostly located in the duodenal bulb, deeply embedded in the muscular layer, close to the serosa, and sometimes even penetrating the serosa to form adhesions. Traditional Chinese medicine refers to such pain as “long-term illness entering the meridians,” requiring highly effective treatments, hence formulations such as Shi Xiang San, Jin Ling Zi San, Shou Nian San, San Shu Wu Wu Pu Huang Rou, and Zhi Shi Dai Dang Xiao Ling Dan are all excellent choices for treating this condition. Another set of symptoms includes bitter taste in the mouth, dry throat, irritability, chest and flank pain, with greater severity on the right side—this indicates autonomic nervous system dysfunction. Mild cases can be cured with treatment, while severe cases require bile reflux treatment, best addressed by combining San Huang, Zhi Shi, and Mu Xiang.