Frequent nausea and vomiting of bile? Be careful of bile reflux gastritis!

We seldom hear of the disease of bile reflux gastritis. In fact, it is a comprehensive motility disorder of the biliary system and gastrointestinal system. The symptoms are similar to those of other gastritis and there is no big difference. They are usually manifested as: abdominal pain, indigestion or no digestion, vomiting (mostly vomiting bile), etc. In fact, normal people have all had this disease due to gastrointestinal acid-base imbalance and other reasons. However, some severe patients will feel pain behind the sternum and a feeling of indigestion in the stomach. Some patients still cannot relieve this pain and feeling of indigestion after taking alkaline drugs. In addition, due to the temporary inability of the stomach to digest food, patients often vomit at night, and there may be some blood in the vomit. This stomach torture causes some people to reduce their food intake or not eat at all, for fear of vomiting and discomfort, which can lead to short-term weight loss, thin body, and malnutrition.

1. Diagnosis

1. Endoscopic examination The endoscopic diagnostic criteria for bile reflux gastritis are: endoscopy shows yellow or yellow-green bile-like mucus pools, bile clots can be seen on the gastric mucosa, and the mucosa is congested, edematous, brittle or eroded, and is beef red. Gastroscopy is intuitive, but since most patients experience obvious nausea, false positive results are prone to occur. Generally speaking, if the above situation occurs during painless gastroscopy, or the bile attached to the stomach wall is thick and difficult to wash away, and the gastric mucosa is rough and uneven, then the patient may have long-term chronic bile reflux. In addition, according to the suggestions of Kellosalo et al., reflux is divided into grades 0, 1, 2, and 3 according to the color of the gastric mucus lake, ranging from clear, light, medium to dark yellow or yellow-green. This can rule out bile reflux caused by endoscope insertion stimulation in some cases and significantly improve the accuracy of gastroscopy diagnosis.

2. Pathological examination

Bile reflux gastritis has special pathological changes in the gastric antral mucosal tissue, manifested as hyperplasia of gastric pits, congestion of the lamina propria, vascular dilation and hyperplasia of the mucosal muscle, while the infiltration of inflammatory cells is relatively mild.

2. Treatment

In the treatment of bile reflux gastritis, on the one hand, bile acid should be combined to reduce the harmful effects of refluxed materials; on the other hand, gastrointestinal motility should be improved and coordinated movement of the stomach and duodenum should be promoted to reduce the occurrence of duodenogastric reflux. Current treatments include gastrokinetic agents (mosapride or itopride) + bile adsorption mucosal protective agents (smectite and aluminum magnesium carbonate) + acid inhibitors (rabeprazole, omeprazole, pantoprazole, esomeprazole, etc.), psychotherapy, surgical treatment, etc.

Eating habits are also crucial:

(1) Food selection: Low-fat, easily digestible foods should be consumed to avoid stimulating increased bile secretion.

(2) Form good eating habits: Patients should pay attention to regular diet and eat three meals on time. Because meals can easily lead to reflux, it is not advisable to lie down and rest immediately after eating or interact vigorously.

(3) Avoid eating too much before going to bed.

(4) Lose weight (being overweight will increase abdominal pressure and promote reflux, so people should avoid consuming high-fat foods that promote reflux and lose weight).

(5) Raise the head of the bed by 10-15 cm (this is very important for reflux when lying flat at night, using gravity to clear harmful substances in the esophagus).

(6) Avoid various movements and postures that increase abdominal pressure for a long time in daily life (including wearing tight clothes and tightening belts).

(7) Quit smoking and drinking.

(8) Relax your mind.