2 Differential Diagnosis

(2) Differential Diagnosis

1. Gastric and duodenal ulcers: The upper abdominal pain experienced by most patients with chronic gastritis differs markedly from the rhythmic nature of pain in gastric and duodenal ulcers; however, some patients with chronic gastritis may also experience periodic pain similar to that of ulcers, making it easy to confuse with peptic ulcers. X-ray barium meal examination can help with diagnosis, but the most reliable method of differentiation is fiber gastroscopy.

2. Gastric neurosis: Often presents with gastrointestinal symptoms such as upper abdominal discomfort, which are clearly influenced by psychological factors, frequently accompanied by extra-gastrointestinal neurotic symptoms like insomnia, headache, and restlessness. X-ray barium meal examination usually shows no abnormalities. Palliative treatment, suggestion therapy, or sedatives often prove effective—these are key points for distinguishing it from chronic gastritis.

3. Cholecystitis and cholelithiasis: These conditions can cause recurrent upper abdominal discomfort or chronic pain, sometimes misdiagnosed as chronic gastritis. However, upon closer observation, the pain tends to be localized in the right upper quadrant and often radiates to the right shoulder and back, frequently associated with consumption of fatty and greasy foods. X-ray cholecystography or ultrasound examination can usually differentiate them.

4. Gastric mucosal prolapse: This condition also causes upper abdominal pain, but since the prolapse occurs intermittently, the pain and other symptoms are likewise intermittent. Sometimes, turning to the left side can relieve the pain; these characteristics can be used for differentiation. Diagnosis mainly relies on X-ray barium meal or contrast imaging, which reveals an "umbrella-shaped" or "mushroom-shaped" shadow in the duodenal bulb.

5. Gastric ptosis: Patients experience upper abdominal discomfort, dull pain, fullness, heaviness, belching, nausea, and constipation, and may even exhibit the sound of fluid sloshing in the abdomen. If the sensation of abdominal distension lessens when lying down, it suggests the possibility of this condition. X-ray gastrointestinal barium meal examination can be used for differentiation.

Section 3 Integrated Traditional Chinese and Western Medicine Treatment

Treatment for chronic gastritis tends to focus on symptomatic relief in Western medicine, while Traditional Chinese Medicine emphasizes regulating the spleen and stomach. However, overall, the therapeutic effects are still not ideal, and further exploration is needed to find treatments that can not only eliminate symptoms but also improve pathological changes.