Cause Analysis Of The Proximal Stomach Gastritis

Objective:Chronic gastritis is a common disease of digestive diseases, which common causes are: Helicobacter pylori(H.pylori) infection, food environment, autoimmune, drinking, NSAID drugs, some excitant food, etc. Chronic gastritis gives priority to the distal stomach gastritis but we also find proximal stomach gastritis patients in the clinical work. The case of the proximal stomach gastritis is still not very clear. This study aims to explore the cause of the proximal stomach gastritis so as to provide reasonable and effective reference for clinical treatment of the proximal stomach gastritis.Methods:1 Patient selection: 60 patients with the proximal stomach gastritis and 40 patients with the distal stomach gastritis were chosen from January 2015 to January 2016 in the Third Hospital of Hebei Medical University, Department of Gastroenterology.1.1 Inclusion Critera :(1) All patients needed to accept gastroscopy and rapidurease test(RUT);(2) Patients with the proximal stomach gastritis: Fundus+1/3upper corpus were mucous erythema, petechiae, rough mucosa with/without edema and hyperemia under gastroscope. Histologic examination showed neutrophils or lymphocytes cells,plasma cells;(3)Patients with the distal stomach gastritis: Autrum+2/3 lower corpus were mucous erythema, petechiae, rough mucosa with/without edema and hyperemia under gastroscope. Histologic examination showed neutrophils or lymphocytes cells, plasma cells. Gastritis diagnostic criteria were based on ? China,Chronic Gastritis Consensus Opinion(2012,Shanghai)?.1.2 Exclusion Critera:(1)Patients with liver cirrhosis portal hypertension gastropathy;(2) Patients who had accepted H.pylori eradication therapy;(3)Patients who were treating by anti-anxiety and depression medication;(4)Patients who didn,t not agree to participate in the research.2 Methods2.1 Grouping:All patients who met the inclusion criteria were divided into Group A and Group B:Group A: the proximal stomach gastritis group(60 cases)Group B: the distal stomach gastritis group(40 cases)2.2 Clinical method:We took two pieces mucosal biopsy expectively in the greater curvature of the proximal stomach and the distal stomach where was 4-6cm far from pylorus for testing H.pylori, while we took two pieces mucosal biopsy respectively in the greater curvature of the proximal stomach where inflammation was heavier and the distal stomach where was 4-6cm far from pylorus for pathologic examination in the proximal stomach gastritis group. We took two pieces mucosal biopsy respectively in the greater curvature of the proximal stomach and the distal stomach where was 4-6cm far from pylorus for testing H.pylori, while we took two pieces mucosal biopsy respectively in the greater curvature of the proximal stomach and the distal stomach where inflammation was heavier for pathologic examination in the distal stomach gastritis group. We recorded the data of all the patients, such as: gender, age, occupation, smoking, drinking, education, life events, life regulation, the application of NASID drugs recently, the application of acid suppression drugs, endoscopy results, pathology results, H.pylori infection, anxiety score, deression score and clinical characteristics.2.3 Statistical Analysis: Application SPSS21.0 statistical software for analysis. Counting data were expressed as Percentage. The comparison of the rate was analyzed by?2 test. P<0.05 was considered statistically significant. Measurement data were expressed as Median+Quartile Range deviation. Non-heterogeneity of variance and non-normal distribution of the data between the two groups was used approximate noamal U test. P<0.05 was considered statistically significant. The analysis of risk factors was used binary logistic regression analysis, B>0, OR>1for risk factors, P<0.05 was considered statistically significant.Results:1 Sigle factor analysis of the two groups: The patients of the two groups both distributed in 16-31, 31-46, 46-61, 61-. There were no statistical difference in the age distribution between the two groups(P=0.205). There were more female patients in the proximal stomach gastritis group. There were statistical difference in the gender distribution between the two groups(P=0.017). There were more brain workers in the proximal stomach gastritis. There were statistical difference in the occupation distribution between the two groups(P=0.000). There were less patients with drinking in the proximal atomach gastritis. There were statistical difference in drinking between the two groups(P=0.020). There were more patients who were highly educated in the proximal atomach gastritis. There were statistical difference in the degree of education between the two groups(P=0.037). There were more patients who were infected by H.pylori in the proximal stomach in the proximal stomach gastritis group. There were statistical difference in the H.pylori infection between the two groups(P=0.000). There were more patients who underwent life events in the proximal stomach gastritis. There were statistical difference in life events between the two groups(P=0.000)(Table1).2 Multiple factors analysis of the two groups:The infection of H.pylori and life events were risk factors of the proximal stomach gastritis(P<0.050,B>0,OR>1)(Table2).3 The comparison of anxiety depression between two groups: The patients of the proximal stomach gastritis group had higher scores than patients of the distal stomach gastritis group. There were statistical difference in anxiety depression between the two groups(P=0.000). The score of patients with distal stomach gastritis were distributed among 0-3.The score of patients with proximal stomach gastritis were aslo distributed among 4-9. There were no statistical difference in the comparison of the composition of life events between the two groups(P=1.000)(Table3-4,Fig.5-8).4 The comparison of the H.pylori infection between two groups: There were 26cases(46.7%) patients infected by H.pylori in the distal stomach of the proximal stomach gastritis group while 11 cases(27.5%) patients infected by H.pylori in the distal stomach gastritis group. There were no significant difference between two groups(P=0.108)(Table5); There were 21cases(35%) patients infected by H.pylori in the whole stomach of the proximal stomach gastritis group while only 3 cases(7.5%) patients infected by H.pylori in the distal stomach gastritis group. H.pylori infection rate of the whole stomach in the proximal stomach gastritis group was higher than the distal stomach gastritis group. There were significant difference between two groups(P=0.002)(Table6).5 The comparison of clinical features between the two groups: The clinical characteristics of patients in the proximal stomach gastritis group were epigastric pain 58 cases(96.7%), epigastric distention 47 cases(78.3%), early satiety 51 cases(85%),nausea 29 cases(48.3%) and little appetite 34 cases(56.7%). In the distal stomach gastritis group were epigastric pain 6 cases(15%), epigastric distention 12 cases(30%), early satiety 6 cases(15%), nausea 12 cases(30%), little appetite 10 cases(25%). There were significant difference between two groups(P=0.416). Under gastroscope, the proximal stomach gastritis mainly presented as hyperemia 28 cases(46.7%), edema 32 cases(53.3%), erythema 23 cases(38.3%) and purpura 24 cases(40%) and eroaion 13 cases(21.7%) was rare. The distal stomach gastritis mainly presented as erosion 16 cases(40%) and hyperemia 5 cases(12.5%), edema 5 cases(12.5%), erythema 6 cases(15%) and purpura 6 cases(15%) were rare. There were significant difference between two groups(P=0.001). Pathologically, the proximal stomach gastritis mainly presented as chronic non-atrophic gastritis 53 cases(88.3%) and chronic atrophic gastritis 7 cases(11.7%), intestinal metaplasia 5 cases(8.3%) and hyperplasia 2 cases(3.3%) were rare.The distal stomach gastritis mainly presented as chronic atrophic gastritis 28 cases(70%), intestinal metaplasia 20 cases(50%) and hyperplasia 12 cases(30%). Chronic non-atrophic gastritis 13 cases(32.5%) was rare. There were significant difference between two groups(P=0.000)( Table7-9, Fig.1-4).Conclusions:1 life events and the infection of H.pylori were risk factors of the proximal stomach gastritis.2 The clinical characteristics were mainly epigastric pain, epigastric distention, early satiety, nausea and little appetite. Main performance under gastroscope were hyperemia, edema, erythema, eroaion and purpura. Main performance in pathology was chronic non-atrophic gastritis.