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When it comes to atrophic gastritis, many people will change their faces because they hear that they may become cancerous. Is atrophic gastritis really that terrible? What is the probability of getting cancer? How can we treat and prevent atrophic gastritis?

Atrophic gastritis is a kind of chronic gastritis. Its pathological manifestation is repeated damage of gastric mucosa epithelium, which leads to the decrease of proper glands, with or without intestinal metaplasia. The incidence of the disease increases with age, which is more common in middle-aged and elderly people. Gastroscopy and gastric mucosal biopsy are the most accurate diagnostic methods, and pepsinogen detection and X-ray barium meal commonly used in general physical examination also have certain indications.

Helicobacter pylori infection

autoimmunization

The parietal cell antibody or endogenous factor antibody can be detected in patients with atrophic gastritis, which is related to the patient's autoimmune reaction.

environmental factor

Other environmental factors, such as excessive intake of nitrite, imbalance of trace elements, smoking, drinking, lack of fresh vegetables and fruits, frequent consumption of moldy, pickled, smoked and fried foods, can increase the risk of gastric cancer. Bile or duodenal juice reflux, genetic factors, radiation and heavy metals are also closely related to atrophic gastritis.

At present, it is considered that trace element selenium has a certain effect on the prevention of gastric cancer, but excessive application has hepatorenal toxicity, and its appropriate dosage and course of treatment need to be studied. It is not recommended to supplement selenium blindly.

The vast majority of atrophic gastritis has a good prognosis, and only a few will become cancerous. Statistics show that the canceration rate of atrophic gastritis is about 0.5% ~ 1.0%. Data from Europe (such as the Netherlands) show that the annual incidence of gastric cancer in patients with atrophic gastritis and intestinal metaplasia is 0. 10% and 0.25% respectively.

The canceration of atrophic gastritis is a chronic process, so there is no need to be afraid of suffering from atrophic gastritis. Check it regularly and deal with it if there are signs of cancer.

Eradication of Hp is helpful to reduce the occurrence of atrophic gastritis associated with Hp infection.

Work and rest regularly, pay attention to diet. Eating stale, hard and indigestible food and irregular food will cause physical and chemical damage to gastric mucosa; Foods high in fat, sugar, salt and oil, fried, salted and spicy foods will increase the burden on the stomach.

Folic acid supplementation can prevent gastric mucosal atrophy to some extent.

Develop good living habits. Do not smoke, drink alcohol in moderation to avoid the harm of nicotine and alcohol to gastric mucosa; Avoid taking irritating drugs such as aspirin for a long time.

Check regularly. Even if there is no discomfort such as abdominal distension and abdominal pain, people over 45 years old are advised to have regular gastroscopy. For those who have a history of Hp infection and a family history of gastric cancer, it is recommended to screen in advance.

The therapeutic goal of atrophic gastritis is to delay or block the progress of the lesion, reduce the risk of canceration and improve the uncomfortable symptoms. Mainly includes the following processing contents:

general treatment

Improve living habits, regular diet, light and low-salt diet, and eat less salty, smoked and fried food. It is suggested that patients with atrophic gastritis eat more fresh and light food, less hard or cooked food, and less cold, overheated, expired, fried and irritating food (such as spicy and greasy). At the same time, we should quit smoking and drinking, drink less strong tea and coffee, and some fruits with high acidity, such as pineapples and oranges, are recommended to be eaten as much as possible after meals. In particular, people with poor stomach should avoid eating hawthorn, persimmon and black dates on an empty stomach, because tannic acid in these fruits meets stomach acid and has the risk of stomach stones.

Strengthen monitoring

Correctly understand the risk of atrophic gastritis and improve the compliance of monitoring and follow-up. It is suggested that patients with atrophic gastritis should undergo endoscopic examination and biopsy every 1 ~ 2 years. Patients with moderate or severe atrophy or intestinal metaplasia in biopsy need to be followed up once a year, and patients with dysplasia need to be followed up and treated more closely according to the degree of dysplasia. Moderate patients are recommended to be followed up once every six months. Patients with severe dysplasia can undergo endoscopic treatment or surgical resection according to the scope and size of the lesion.

Eradication of helicobacter pylori (Hp) treatment

To eradicate Hp, eliminate or improve gastric mucosal inflammation, and prevent atrophy and intestinal progress, at present, the quadruple scheme consisting of acid inhibitor, bismuth and two antibiotics is generally adopted.

Symptomatic treatment

Patients with upper abdominal distension, nausea and vomiting can take oral prokinetic drugs, such as domperidone, trimebutine maleate, mosapride and itopride. However, the elderly or heart patients should be alert to its side effects, and it is recommended to take it under the guidance of a professional doctor.

The damage of gastric mucosa is obvious. Patients with gastric mucosal erosion and bleeding can apply gastric mucosal protective agents, such as sucralfate, rebamipide, teprenone, gefarnate, icarbet, etc., which can improve the gastric mucosal barrier and reduce the damage of bile reflux.

Patients with gastric mucosal erosion, acid regurgitation, abdominal pain and other symptoms can choose acid inhibitors, such as H2 receptor antagonists or proton pump inhibitors. The possibility of gastric acid secretion in patients with local atrophy of gastric antrum is still too great. Even in patients with low gastric acid secretion, a small amount of gastric acid stimulation can cause obvious discomfort due to mucosal injury. At this time, it is necessary to use acid inhibitors or drugs to neutralize gastric acid, and the course of treatment and dosage should be well measured. It is recommended to follow the doctor's advice.

Such as atrophy of gastric mucosa glands, weakened secretion of gastric acid and digestive enzymes, delayed gastric emptying and abdominal distension, digestive enzyme drugs can be used to improve dyspepsia.

For chronic gastritis patients with dyspeptic symptoms with obvious mental factors, antidepressants or anxiolytics can be used, and patient education and psychotherapy are needed.

Autoimmune gastritis with pernicious anemia needs folic acid and vitamin B 12.

Syndrome differentiation and treatment of TCM

In recent years, traditional Chinese medicine combined with endoscopy and pathological manifestations has deepened the understanding of atrophic gastritis and treated it according to syndrome differentiation, which has certain curative effect on patients with local atrophy and mild intestinal metaplasia.

Du, MD, chief physician, associate professor, tutor for master students, and deputy director of the Department of Gastroenterology, China-Japan Friendship Hospital. Standing Committee member of Middle-aged and Elderly Health Branch of China Health Care Association for the Promotion of International Exchange, member of Comprehensive Oncology Branch of China Anti-cancer Association, member of Esophagogastric Varicose Group of Beijing Gastroenteroscopy Society, member of Beijing Society of Liver Diseases with Integrated Traditional Chinese and Western Medicine, and winner of the first Xin Fertility Age Award of China-Japan Friendship Hospital. He has been engaged in clinical, teaching and scientific research work in gastroenterology all the year round, and has rich experience in the diagnosis and treatment of common diseases, difficult diseases and critical diseases of digestive system. Proficient in various diagnosis and treatment techniques of digestive endoscopy, especially in endoscopic minimally invasive treatment of pancreaticobiliary diseases and critical gastrointestinal bleeding. Participated in the establishment of the comprehensive minimally invasive professional treatment group for cholelithiasis in the International Department of China-Japan Friendship Hospital and the emergency endoscopic treatment group in the Department of Gastroenterology, devoted to the multidisciplinary and teamwork treatment of critical diseases in the digestive system, including cholelithiasis and gastrointestinal bleeding, and achieved good clinical results. In recent years, he has presided over and participated in many scientific research projects and published more than 20 papers, including 7 SCI papers published by the first author or correspondent.

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