Discomfort and fullness under the xiphoid process

Although the symptom of stuffiness and discomfort under the xiphoid process occurs in the xiphoid process, it is not necessarily caused by a lesion in this area. It is more consistent with the characteristics of chronic superficial gastritis and is very likely caused by this disease. We need to have a comprehensive understanding of the situation of chronic superficial gastritis and make a comprehensive judgment based on other symptoms of the patient, so that we can draw a preliminary conclusion.

Clinical manifestations

1. Upper abdominal pain

The most common symptom is epigastric pain, which occurs in most patients with chronic superficial gastritis. Most upper abdominal pain is irregular and has nothing to do with diet. The pain is generally diffuse upper abdominal burning pain, dull pain, bloating, etc. Symptoms are often aggravated by eating cold, hard, spicy or other irritating foods, and in a few cases are related to climate change.

2. Abdominal bloating

Patients with chronic superficial gastritis often have abdominal distension. It is often caused by food retention in the stomach, delayed emptying, and indigestion.

3. Belching

The patient has belching. It indicates that the gas in the stomach increases and is discharged through the esophagus, temporarily relieving the upper abdominal fullness.

4. Recurrent bleeding

It is a common symptom. The cause of bleeding is an acute inflammatory change of the gastric mucosa occurring on the basis of chronic superficial gastritis.

5. Others

Loss of appetite, acid reflux, nausea, vomiting, fatigue, constipation or diarrhea, etc.

6. Physical signs

There is upper abdominal tenderness during examination, and a few patients may have weight loss and anemia.

Causes

The pathogenic factors of superficial gastritis have not yet been fully understood, among which the more clear causes are:

1. Bacteria, viruses and toxins

It is more common after acute gastritis, when gastric mucosal lesions do not heal for a long time or recur repeatedly, gradually evolving into superficial gastritis. Chronic infection lesions in the nasal cavity, oral cavity, pharynx, etc., such as alveolar abscesses, tonsillitis, sinusitis, etc., and long-term ingestion of bacteria or their toxins can repeatedly irritate the gastric mucosa and cause superficial gastritis. It has been found that 90% of patients with chronic tonsillitis have chronic inflammatory changes in the stomach.

2. Smoking

The main harmful ingredient in tobacco is nicotine. Long-term and heavy smoking can cause relaxation of the pyloric sphincter, reflux of duodenal fluid, contraction of gastric blood vessels, and increased gastric acid secretion, thereby destroying the gastric mucosal barrier and leading to chronic inflammatory lesions.

3. Medication

Certain drugs such as salicylic acid preparations, corticosteroids, digitalis, indomethacin, and phenylbutazone can cause chronic gastric mucosal damage.

4. Spicy food

Long-term consumption of strong liquor, strong tea, coffee, spicy and rough food, as well as irregular eating habits such as being too hungry or too full can damage the protective barrier of the gastric mucosa and cause gastritis.

5. Circulatory and metabolic dysfunction

In case of congestive heart failure or portal hypertension, the stomach is in a state of congestion and hypoxia for a long time, which leads to weakened gastric mucosal barrier function, reduced gastric acid secretion, and massive bacterial reproduction, which can easily cause inflammatory damage to the gastric mucosa. In chronic renal failure, the excretion of urea from the gastrointestinal tract increases, and through the action of bacteria or intestinal hydrolases, ammonium carbonate and ammonia are produced, which irritate and damage the gastric mucosa, causing congestion, edema, and even erosion of the gastric mucosa.

6. Bile or duodenal fluid reflux

Bile reflux discovered or confirmed by gastroscopy is an important cause of superficial gastritis. Due to pyloric sphincter dysfunction or gastric surgery, duodenal fluid or bile can reflux into the stomach and destroy the gastric mucosal barrier, prompting H+ and pepsin to diffuse back into the mucosa, causing a series of pathological reactions and leading to superficial gastritis.

7. Helicobacter pylori (Hp) infection

In 1986, the 8th meeting of the World Society of Gastroenterology proposed that Hp infection is one of the important causes of superficial gastritis. The pathogenic mechanism of Hp may be mainly through destroying the gastric mucosal barrier, causing H+ to diffuse in the opposite direction, and ultimately causing inflammation of the gastric mucosa.

8. Psychological factors

Due to unhealthy mental hygiene and long-term state of mental tension, anxiety or depression, it can cause imbalance in the sympathetic and parasympathetic nervous functions throughout the body. It leads to gastric mucosal vasomotor dysfunction, resulting in reduced gastric mucosal blood flow, destroying the gastric mucosal barrier function and forming a chronic inflammatory response of the gastric mucosa.