There are a wide variety of other causes of gastritis. Atrophic gastritis is characterized by a variable loss of g&stric glands accompa-nied by varying degrees d intestinal metaplasia. Multifocal gastric atrophy is associated with chrome H. pylori infection and is espe-cially common in populations at increased risk for adenocarcinoma of the stomach. Atrophy of the oxyntic mucosa may also be encoun-tered in the elderly and is accompanied by achlorhydria or hypochlorhydria. Gastric atrophy may also be encountered in pa-tients with pernicious anemia, which is characterized by malabsorp-tion d vitamin B12, absolute achlorhydria, and megaloblastic ane-mia. Atrophy in these patients is autoimmune in etiology, with an-tib0dies to intrinsic factor.
A variety of uncommon digorders may cause gastritis. Lymphocytic gastritis is characterized by a mononu-clear infiltration of T cells. Often in association with celiac disuse, collagenous/lymphocytic colitis, and Mfinfitrier' s disease. Eosinophilic gastritis is characterized by an eosinophilic infiltration d any of the layers of the stomach. Especially in the antrum. M¡§trier's disease is characterized by glant gastric folds in the fun-dus and the body of the stomach, with a histologic appearance of increased mucosal thickness, glandular atrophy, and an increase in the size of the gastric pits. A variety of infections may involve the stomach in addition to H. pylori. These are typically seen in irn-munocompmmised patients in the setting of human immunoddi-ciency virus infection, chemotherapy, or organ transplantation. Some of the more important infections include tuberculosis, syphilis, and cytomegalovirus infection, although many other fungi and parasitic infections are possible. Systemic diseases such as sar-coid and Crohn' s disease may also involve the stomach. Both will have characteristic granulomas histologically.
Diagnosis in Traditional Chinese Medicine
Gastritis in traditional Chinese medicine pertains to the categories of "pi" (feeling of fullness in the upper abdomen ), "wei wan tong" (stomachache), etc.
1. The chief symptoms are chronic upper abdominal pain, fullness and discomfort, belching and acid regurgitation which often occur after meals. Mild hemorrhage of upper digestive tract may be induced by some precipitating factors in a few cases. Severe atrophic gastritis may be accompanied with ane-mia and pathologic leanness.
2. Physical examination reveals mild but diffuse tender-ness in the upper abdominal region.
Differentiation and Treatment of Common Syndromes in Traditional Chinese Medicine
1. Stagnation of the Stomach-q/:
Clinical manifestations: Epigastric distension and fullness or pain, loss of appetite, indigestion, or diarrhea, white coat-ing of the tongue, and slippery pulse.
Therapeutic method: Regulating the stomach-q/ to re-lieve distension and fullness.
Recipe: Pinellia Decoction for Purging Stomach-fire.
Ingredients:
Rhizoma Pinelliae 9g
Rhizoma Zingiberis 9g
Radix Scutellariae 6g
Rhizoma Coptididis 12g
Radix Codonopsis Pilosulae 9g
Rhizoma Glycyrrhizae 12 pieces
Fructus Ziziphi Jujubae 9g
Administration: The decoction of a dose is 200-300ml. Take equal shares in the morning and in the evening.
Modification: For the case of a more severe stomachache, Rhizoma Paeoniae Albe 15g and Rhizoma Corydalis 9g may be employed.
