A Deep Dive into the Pathology of Chronic Gastritis and Myths about Gastric Acid: Classification Characteristics, Helicobacter pylori Inducing Factors, and Mechanisms of Pantothenic Acid Formation [i]

Chronic gastritis can be classified according to its etiology, such as drug-induced gastritis, alcoholic gastritis, and reflux gastritis; according to the morphology of the lesions, such as erosive gastritis and verrucous gastritis; according to the location of the lesions, such as antral gastritis and bodily gastritis; according to the function of gastric secretion, such as hyperacidity gastritis and hypoacidity gastritis; and according to pathology, such as superficial gastritis and atrophic gastritis [i]. The causes of chronic gastritis include: 1. Sequelae of acute gastritis [i]. 2. Irritating foods and drugs [i]. Long-term consumption of foods and drugs that strongly irritate the gastric mucosa, such as strong tea, strong alcohol, spicy foods or salicylates, or insufficient chewing of food, repeated damage to the gastric mucosa by rough foods, or excessive smoking [i]. 3. Reflux of duodenal fluid: Studies have found that patients with chronic gastritis often experience bile reflux due to pyloric sphincter dysfunction [i]. Phospholipids in pancreatic juice, along with bile and pancreatic digestive enzymes, can dissolve mucus and damage the gastric mucosal barrier [i]. 4. Immune factors [i]. 5. Infectious factors: Studies have found that a large number of Helicobacter pylori (HP) are present in the gastric antrum mucus layer near the surface of epithelial cells in patients with chronic gastritis, with a positive rate as high as 50% to 80% [i]. Characteristics of various chronic gastritis: slow onset, often with upper abdominal discomfort or pain after eating, often irregular paroxysmal or persistent pain [i]. May be accompanied by loss of appetite or anorexia, nausea, vomiting, abdominal distension and belching [i]. May present with weight loss, fatigue, diarrhea, glossitis, brittle nails and anemia, mostly iron deficiency anemia [i]. Superficial gastritis: decreased appetite, upper abdominal fullness and discomfort after meals, or a feeling of pressure, feeling better after belching [i]. Atrophic gastritis: loss of appetite, postprandial fullness, dull pain in the upper abdomen, as well as weight loss, anemia, and diarrhea [i]. Hypertrophic gastritis: upper abdominal pain similar to peptic ulcer disease, which can be temporarily relieved by eating or taking alkaline drugs [i]. Atrophic gastritis is the most difficult type of gastritis to treat, and its incidence is related to age [i]. Atrophic gastritis is difficult to cure, and most people live with the disease for life, with very few developing into gastric cancer [i]. Many people know that chronic gastritis can cause abdominal pain, so they assume that they have chronic gastritis as soon as they experience abdominal pain [i]. However, this is not always the case [i]. If a patient has chronic upper abdominal pain, the location of which is not large, and it is pre-meal pain, i.e., hunger pain, which often occurs in the cold season, accompanied by acid reflux and heartburn, duodenal ulcer or gastric ulcer should be considered [i]. If a patient frequently experiences significant upper abdominal pain during the course of their illness, sometimes even severe colic, accompanied by fever and jaundice, and the abdominal pain is usually related to eating fatty foods, cholecystitis or gallstones can be considered [i]. Some patients with functional dyspepsia have gastric motility disorders [i]. Chronic gastritis and gastric ulcers are two different diseases, and it cannot be assumed that chronic gastritis can cause gastric ulcers [i]. In normal individuals, there is a valve-like structure at the junction of the stomach and esophagus, which allows food to pass through the esophagus into the stomach and prevents stomach contents, gastric acid, pepsin, and bile from flowing back into the esophagus [i]. Once the "valve" malfunctions, stomach contents can easily flow back into the esophagus and even the mouth [i]. Gastric acid and pepsin in the body "attack" various foods, digesting and absorbing them [i]. However, they are a "strong corrosive agent" for the esophageal mucosa, and frequent acid reflux can lead to reflux esophagitis [i]. Common symptoms of acid reflux include: heartburn, which is especially noticeable after meals when lying down or when abdominal pressure increases; and reflux of food, acidic, and bitter liquids into the mouth [i]. There are many causes of excessive stomach acid and acid reflux, mainly two types: 1. Physiological: When under stress, excessively fatigued, or in a bad mood, the cerebral cortex becomes dysfunctional and cannot properly control the nerves that regulate stomach acid secretion, leading to increased secretion [i]. Improper diet, such as consuming excessively sweet, salty, spicy, sour, cold, or hot foods, can stimulate increased stomach acid secretion [i]. Certain whole grains, sweet potatoes, and potatoes contain abundant starch, sugar, and acid, which can stimulate the stomach to produce large amounts of stomach acid [i]. 2. Pathological: Chronic gastritis, gastric and duodenal ulcers, etc., can promote increased stomach acid, often resulting in acid reflux [i].