Chronic gastritis refers to various chronic inflammatory lesions of the gastric mucosa caused by different factors. It is a common condition that predominantly affects middle-aged and elderly individuals, with its incidence increasing with age.
In Traditional Chinese Medicine, this condition falls under the categories of “epigastric pain” and “fullness.”
I. Etiology and Pathogenesis of Chronic Gastritis
1. Etiology and Pathogenesis in Traditional Chinese Medicine
The onset of this condition results from damage caused by diet and emotional factors, which in turn influence one another, leading to epigastric pain. When dietary factors damage the spleen and stomach and are compounded by emotional distress, liver qi becomes stagnant and rebellious, invading the stomach and overpowering the spleen, thereby causing disharmony between the liver and stomach. Alternatively, liver qi stagnation may transform into fire, leading to stagnant heat in the liver and stomach; this accumulated heat and fire can further deplete stomach yin. When stomach yin is deficient, it loses its ability to moisten and descend; Initially, the disorder manifests as a qi-related condition; however, prolonged pain affects the collaterals, damaging the meridians and causing disharmony between qi and blood, which results in pain due to blood stasis. If the pain persists without resolution, spleen and stomach deficiency and deficiency of central qi may develop—or, in cases of pre-existing spleen and stomach deficiency, excessive consumption of raw, cold, or spicy foods may further impair central yang, transforming the condition into a pattern of spleen and stomach deficiency-cold.
Clinically, the condition is often classified into four types: Stagnation of Qi with Loss of Appetite, Liver Qi Invading the Stomach, Stomach Heat with Yin Deficiency, and Spleen and Stomach Deficiency-Cold.
2. Modern Medical Etiology
(1) Residual effects of acute gastritis: After a patient suffers from acute gastritis, if the gastric mucosal lesions persist or recur, they may evolve into chronic gastritis.
(2) Irritating foods and medications: Long-term consumption of foods or medications that strongly irritate the gastric mucosa—such as strong tea, hard liquor, coffee, spicy and coarse foods, and salicylate-containing drugs—as well as inadequate chewing, excessive smoking, and overeating.
(3) Bile reflux: In patients with dysfunction of the pyloric sphincter or those who have undergone gastric surgery, bile may reflux into the stomach, damaging the gastric mucosal barrier and leading to chronic gastritis.
(4) Immunological factors: Patients with compromised immune function are more susceptible to this condition.
(5) Other factors: Patients with chronic infection foci in the nasal cavity, oral cavity, or pharynx may experience involvement of the gastric mucosa and develop chronic gastritis.
Clinically, chronic gastritis is classified into three types: superficial, atrophic, and hypertrophic.
II. Manifestations of Chronic Gastritis
Patients primarily present with chronic upper and middle abdominal pain, bloating and discomfort, belching, and acid reflux, which are more pronounced after eating. Symptoms vary depending on the type and location of the inflammation.
Patients with corpus gastritis may experience marked loss of appetite and weight loss, sometimes accompanied by anemia—though this is typically iron-deficiency anemia—while gastrointestinal symptoms are less common. In antral gastritis, gastrointestinal symptoms are more pronounced and may sometimes resemble those of peptic ulcers, potentially including minor, recurrent bleeding.
Gastroscopy reveals distinct surface features of the gastric mucosa for each of the three types; a biopsy can confirm the diagnosis. On barium meal X-ray examinations, most cases of chronic gastritis show no significant abnormalities.
III. Treatment of Chronic Gastritis
1. TCM Differential Diagnosis and Treatment
(1) Stagnation of Qi and Indigestion Type: Patients present with a sensation of fullness, distension, and oppression in the epigastric region, possibly accompanied by pain. They experience poor appetite, indigestion, loose stools, a white tongue coating, and a slippery pulse. The treatment principle is to harmonize the stomach and eliminate fullness; Banxia Xiexin Decoction may be used. For patients with severe stomach pain, Bai Shao and Yuan Hu may be added.
(2) Liver Qi Invading the Stomach Type: Patients primarily present with distending pain in the epigastric region, a sensation of fullness and discomfort that worsens after eating, frequent belching, and symptoms that are often exacerbated by emotional stress. They exhibit a thin white tongue coating and a deep, taut pulse. The treatment principle is to regulate the liver and harmonize the stomach; Chaihu Shugan San with appropriate modifications may be used.
(3) Stomach Heat with Yin Deficiency Pattern: Patients in this pattern present with stomach pain accompanied by a burning sensation. The pain occurs irregularly but is more severe in the afternoon or on an empty stomach; it may be relieved after eating. They also experience thirst and dry stools. The tongue is red with a thin yellow coating and little saliva; the pulse is string-like, fine, and rapid. The treatment principle is to clear stomach heat and nourish yin. Treatment may involve the Yangwei Decoction with appropriate modifications.
(4) Spleen-Stomach Deficiency-Cold Pattern: Patients present with dull, persistent stomach pain; regurgitation of clear fluid; a preference for warmth and pressure on the abdomen; worsening pain when exposed to cold; mental fatigue and weakness; loose stools; a pale tongue with a white coating; and a deep, fine, and weak pulse. The treatment principle is to warm the middle and dispel cold; treatment may involve the Huangqi Jianzhong Decoction with appropriate modifications.
2. Symptomatic Treatment in Modern Medicine
Currently, there are no specific treatment methods; only symptomatic treatment is provided.
For atrophic gastritis, patients with reduced appetite should be given digestive aids, while those with low gastric acid should be given 1% dilute hydrochloric acid or gastric enzyme compounds; For superficial gastritis, medications that protect the gastric mucosa and antacids such as aluminum hydroxide gel may be administered; for patients with pain, analgesics and antispasmodics such as atropine or propantheline may be prescribed; and for patients with anemia, ferrous sulfate preparations should be administered. Regarding the use of antibiotics: since low or absent gastric acidity in gastritis allows bacteria to proliferate in the stomach, which can exacerbate the condition or trigger gastritis, antibiotics should be administered for only a short period. Because they are poorly absorbed, antibiotics with no gastrointestinal side effects, such as neomycin and gentamicin, may be used.
3. Surgical Treatment
Medication can completely resolve the symptoms of superficial gastritis. However, if the condition progresses to chronic atrophic gastritis, drug therapy is less effective. In particular, gastritis of the gastric antrum accompanied by severe dysplasia requires close monitoring and regular endoscopic examinations to prevent malignant transformation, or timely surgical intervention such as a total gastrectomy.
IV. Prevention of Chronic Gastritis
1. Quit smoking and drinking alcohol;
2. Avoid taking medications that irritate the stomach;
3. Avoid eating foods that irritate the stomach;
4. Avoid eating foods that are too cold or coarse;
5. Maintain emotional well-being and avoid intense anger;
6. Treat superficial gastritis promptly to prevent it from progressing to chronic atrophic gastritis, as a small percentage of atrophic gastritis cases may develop into gastric cancer, with a cancerous transformation rate of 2.55%;
7. Actively treat chronic infectious diseases of the mouth, nose, and throat;
8. Take traditional Chinese medicines that boost the body’s immune function;
9. Avoid overeating. As the old saying goes, “To stay healthy, never eat until you’re too full.” This wisdom is invaluable.