Overview
Lesions that occur in the cardia and its surrounding tissues are classified as benign and malignant
Predisposed to gastroesophageal reflux disease (GERD), immune disorders, etc.
Often caused by immune disorders, infections, malnutrition, chemicals, etc.
Treatment is a combination of medication and surgery
Definition
Cardia lesions are generally a microscopic diagnosis of gastroscopy and are lesions of the cardia and its surrounding tissues. However, histopathologic findings have not been obtained for various reasons, so the nature of the lesion cannot be determined.
The cardia is the area where the lower esophageal extension meets the stomach, and the cardia opens when food enters the lower esophagus under the push of the esophageal smooth muscle, and food passes through the cardia into the stomach.
There are benign and malignant lesions of the cardia, which can be diagnosed by further examination, such as histopathologic examination, ultrasonic endoscopy, chest and abdominal CT examination, etc. Commonly, there are cardia dystrophy, carditis, cardia cancer and so on.
Classification
It can be divided into primary cardia lesion and secondary cardia lesion. Primary cardia lesion is mainly caused by pathological changes in the cardia and its surrounding tissues, while secondary cardia lesion is caused by other diseases, such as chronic gastritis, esophagitis, tumors and so on.
Cardia lesions can also be divided into benign lesions and malignant lesions according to their benign and malignant nature. Benign lesions commonly include pancreatic achalasia, carditis, etc.; malignant lesions are mainly cardia cancer.
Incidence
The incidence of cardia lesions depends on the etiology and the individual condition of the patient. According to research reports, about 6.7%-18.2% of patients with chronic gastritis suffer from cardia lesions.
Bulk statistical analysis shows that the incidence of cardia cancer is about half that of esophageal cancer, accounting for 16.1%-41.5% of gastric cancers.
Causes
Causes
Cardia lesions are diseases of the cardia area of the digestive tract, which are mainly manifested as inflammation, polyps, ulcers, stenosis, cancer or other abnormalities in the cardia area. There are many causes of cardia lesions, mainly including the following:
Immunologic diseases
Cardia lesions may be caused by some kind of immune disease, such as systemic lupus erythematosus and rheumatoid arthritis.
Infection
Common infectious diseases, such as enteritis and syphilis, may also lead to cardia lesions.
Malnutrition
Malnutrition is a common cause of cardia lesions. Common malnutrition includes vitamin A, vitamin C and vitamin E deficiency.
Chemical substances
Certain chemicals, such as alcohol and drugs, may also lead to cardia lesions.
Foods
Hot, hard, coarse and spicy foods, alcohol consumption, smoking and nutritional deficiencies are associated with morbidity.
Frequent consumption of moldy food can induce pancreatic cancer, and mold and nitrosamines have cancer-promoting effects.
Others
Pancreatic lesions may also be caused by trauma, tumor, radiation therapy, hormone therapy and other reasons.
Pathogenesis
The pathogenesis of carditis is unclear and may be associated with chronic reflux of gastric contents into the esophagus, decreased acidity values, and chronic inflammation of the cardia mucosa.
Common pathological types of cardia polyps include hyperplastic polyps and adenomatous polyps. The former are polypoid elevations formed by inflammatory mucosal hyperplasia with a cancer rate of no more than 1-2%. The latter are benign tumors originating from the mucosal epithelium with a cancer rate of more than 30%.
Chronic inflammation of the cardia leads to destruction and degeneration of the gastric mucosa, which results in narrowing and bleeding of the cardia. In addition, chronic inflammation may lead to hypertrophy of the gastric wall, which further aggravates cardia stenosis.
The mechanism of cardia ulcers is the same as that of peptic ulcers, part of which are benign lesions caused by gastroesophageal reflux and Helicobacter pylori infection, while some cardia ulcers are caused by malignant diseases such as cardia cancer.
The development of pancreatic cancer is related to heredity, gastroesophageal reflux disease, esophageal hiatal hernia, intestinal epithelial hyperplasia, and Helicobacter pylori infection, and the underlying pathogenesis needs to be further studied.
Symptoms
Main Symptoms
Heartburn and acid reflux
Heartburn and acid reflux often appear one hour after a meal, and are aggravated by lying down, bending over, or increased abdominal pressure (e.g., pregnancy, ascites), or at night when sleeping. Some patients may have no symptoms of heartburn and reflux.
Dyspepsia
Patients present with loss of appetite, nausea, vomiting, abdominal distension and abdominal pain, especially nausea and vomiting are more pronounced.
Dysphagia
In severe cases, there may be pain in swallowing, and a few patients have choking sensation in swallowing, or accompanied by shortness of breath and wheezing, especially after eating, the symptoms will be aggravated.
Chest pain
Patients may have chest pain, the pain is in the chest, and the pain is accompanied by coughing, which may be accompanied by bloody sputum.
Gastrointestinal bleeding
The patient may vomit blood, mostly bright red, and the amount of blood varies.
Weight loss
Patients may lose weight due to indigestion and bleeding, which may lead to malnutrition in severe cases.
Complications
Gastric perforation
Cardia lesions can lead to gastric perforation, which can present with fever, abdominal pressure, muscle tension, and rebound pain.
Gastroesophageal reflux
Cardia lesions can lead to gastroesophageal reflux, which can cause heartburn, sore throat, cough, vomiting, chest tightness, and hiccups.
Consultation
Department of Medicine
Gastroenterology
If you have acid reflux, heartburn, difficulty in swallowing, abdominal distension, or gastrointestinal bleeding, you should consult a gastroenterologist as soon as possible to determine the cause of pancreatic lesions and take effective treatment measures according to the actual situation.
General Surgery
If the cardia lesion is malignant and cancerous, it may be necessary to consult general surgery or oncology.
Preparation for medical treatment
Consultation: Registration, Preparation of Documents, Frequently Asked Questions
Tips for your visit
Take a medical history, including symptoms, onset, duration and frequency of attacks.
Prepare the reports of previous checkups.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Any nausea, vomiting, diarrhea, bloating?
Fever, chills, malaise, weakness?
Cough, phlegm, difficulty breathing?
How long have these symptoms lasted?
Under what circumstances do these symptoms resolve or worsen?
List of medical history
Has there been any tearing of the cardia mucosa? Has there been any effective treatment?
Any immune system disorders such as SLE?
Is there a history of a heavy alcohol diet?
Is there a history of chronic gastritis?
Are there any medications such as aspirin, indomethacin, etc.?
Has an Hp test been performed? What are the test results?
Checklist
Test results in the last six months, which can be brought to the doctor’s office
Routine blood test, biochemistry, glycated hemoglobin, etc.
Abdominal ultrasound, CT, etc.
Electronic gastroscopy.
Medication List
Medication in the last 3 months, if available in boxes or packages, you may bring them to the doctor’s office
Antibiotics: clarithromycin, amoxicillin, tinidazole, metronidazole, etc.
Bismuth: bismuth potassium citrate, bismuth pectin, etc.
Antacids: magnesium aluminum carbonate, aluminum thiosulfate, aluminum hydroxide, etc.
Proton pump inhibitors (PPI): omeprazole, lansoprazole, pantoprazole, rabeprazole, etc.
H2 receptor antagonists: cimetidine, ranitidine, famotidine, etc.
Non-steroidal anti-inflammatory drugs: aspirin, indomethacin, etc.
Diagnosis
Diagnostic basis
The diagnosis of cardia lesions is based on the patient’s history, clinical manifestations, gastroscopy, pathologic examination, laboratory tests and imaging findings.
Medical history
History of chronic gastritis.
History of medication use with non-steroidal anti-inflammatory drugs such as aspirin and indomethacin.
Possible Helicobacter pylori (Hp) infection.
Clinical manifestations
Symptoms
Patients may have epigastric pain, loss of appetite, postprandial fullness, belching, acid reflux, and nausea.
Physical signs
Patients may have atypical epigastric tenderness.
Laboratory Tests
Helicobacter pylori (Hp) test
Hp testing can identify the cause of the disease, guide the use of clinical medication, and evaluate the results of Hp eradication therapy.
H. pylori testing methods are categorized into two main types: invasive and non-invasive.
Invasive tests include rapid urease test, histologic examination, and H. pylori culture.
Non-invasive tests include serum antibody test, 13C or 14C urea breath test, and fecal H. pylori antigen test.
Gastroscopy
Endoscopy and biopsy histopathology are the main tools for the diagnosis and differential diagnosis of cardia lesions.
Pathological histologic examination
Pathological histologic examination can determine the nature and extent of lesions.
Imaging
Imaging tests can help doctors diagnose cardia lesions, including digestive tract barium contrast and abdominal CT examination.
Differential Diagnosis
Cardia lesions mainly need to further identify the nature of benign and malignant lesions. All of them can be manifested as non-specific gastrointestinal symptoms, such as dyspepsia, stomach pain, loss of appetite, etc. Pathological examination of cardia cancer can find the proliferation of tumor cells and the alteration of tumor tissues. Benign cardia lesions such as cardia inflammation, stenosis, obstruction, etc. have no tumor cells.
Treatment
Aim of treatment: to improve patients’ symptoms, prevent and treat the complications caused by cardia lesions at an early stage.
Treatment principle: mainly control the disease first, then treat the original disease.
General treatment
Patients with cardia lesions should choose low-fat, low-sugar and low-salt nutritional diet to reduce the burden of digestion and improve the symptoms of dyspepsia.
Do eat regularly and quantitatively, do not eat too much and avoid overeating.
Quit smoking and drinking.
Exercise more and maintain a good psychological state to alleviate the condition.
Symptomatic treatment
According to the different conditions, choose appropriate drugs to effectively control the symptoms and improve the condition.
Acid-suppressing drugs, such as omeprazole and rabeprazole, can effectively inhibit the secretion of gastric acid and improve the symptoms of acid reflux and heartburn.
Gastric stimulants Mosapride and Domperidone promote gastrointestinal peristalsis and help relieve symptoms such as acid reflux and hiccups.
Antiemetic drugs metoclopramide and vitamin B6 can effectively relieve nausea and vomiting symptoms.
Treatment of the cause
Pancreatic dystrophy: it can be treated with nifedipine, botulinum toxin injection, endoscopic minimally invasive surgery (POEM), and transcaval modified Heller surgery.
Pancreatitis: It is mainly treated by choosing different drugs mentioned above according to the symptoms.
Cardia polyps: they can be completely removed by endoscopic minimally invasive surgery (EMR, ESD), and the interval of review will be decided according to the pathological results.
Pancreatic ulcer: standardized acid-suppressing drug treatment, with a course of 6-8 weeks, can be added with mucosal protective drug teprenone, magnesium aluminum carbonate, and so on.
Cardia cancer: endoscopic minimally invasive surgery, surgery, chemotherapy, radiotherapy, biotargeting, immunotherapy and other methods are chosen according to the clinical stage and the patient’s physical condition.
Prognosis
Cure situation
The cure of cardia lesions depends on the extent of the lesion and the type of lesion.
Mild cardia lesions can be controlled by medication.
Severe cardia lesions require surgery, such as cardioplasty or cardiotomy.
Most benign cardia lesions can be cured by medication.
Malignant cardia lesions can be removed completely by endoscopic minimally invasive surgery in the early stages, with regular follow-up after surgery.
Most malignant cardia lesions in the progressive stage require a combination of surgery, radiotherapy and biologics, and have a relatively poor prognosis.
Daily
Daily management
Dietary management
Eat more fresh vegetables and fruits.
Try to eat less high-salt and high-oil food, such as fried food and high-salt pickled food, so as not to aggravate the burden on the stomach and intestines.
Eat a light diet and keep spicy and stimulating foods to a minimum so as not to irritate the gastrointestinal tract and affect digestion.
Drink plenty of water to keep your body well hydrated to aid digestion.
Life Management
Avoid intense exercise to avoid excessive secretion of stomach acid.
To ensure sufficient sleep and avoid staying up late so as not to aggravate the condition.
Psychological support
Provide correct psychological cognition so that the patient understands the importance of the condition and treatment.
Give comfort to patients to eliminate their anxiety so that they can accept treatment better.
Actively guide the patient to participate in social activities, so that the patient can positively face the condition and actively participate in life.
Prevention
Quit smoking and drinking, exercise in moderation, get enough sleep, and maintain a good lifestyle.
Avoid using drugs that damage the gastric mucosa as much as possible.
Avoid using smoked, barbecued, high-salt, moldy food.
Eat more fresh fruits and vegetables to supplement vitamins.