I. What is chronic atrophic gastritis (CAG)?
Chronic atrophic gastritis (CAG) is a common and difficult disease of the digestive system characterized by thinning of the gastric mucosa, atrophy of the intrinsic glands or with intestinal epithelial metaplasia and heterogeneous hyperplasia, with an incidence of 13.8% of the examined population. The incidence is 13.8% of the examined population. There are two main types of autoimmune gastritis (type A) and multifocal atrophic gastritis (type B). The former lesion is mainly in the gastric body and develops from autoimmune gastritis; the latter lesion is mainly in the gastric sinus and shows multifocal atrophy in the stomach and develops from chronic non-atrophic gastritis caused by H. pylori infection. In 1978, the World Health Organization classified chronic atrophy as precancerous state of gastric cancer, and the incomplete intestinal epithelial metaplasia or moderate or severe heterogeneous hyperplasia on this basis is regarded as precancerous lesion, and the cancer rate is about 5.4%.
2.What are the examinations needed.
1.X-ray examination
Dual gas-barium imaging can show the mucosal folds of gastric body.
2.Gastroscopy and biopsy
The most reliable diagnostic method.
3.Gastric fluid analysis
Patients with type A CAG mostly have no acid or low acid, while patients with type B CAG may have normal or low acid.
4.Pepsinogen determination
In chronic atrophic gastritis, the level of pepsinogen in blood and urine is reduced.
5.Serum gastrin measurement
In type A CAG patients, serum gastrin is often significantly increased; in type B CAG patients with atrophy of the gastric sinus mucosa, serum gastrin is lower than normal.
6.Immunological examination
Mural cell antibody (PCA), internal factor antibody (IFA), and gastrin-secreting cell antibody (GCA) measurement can be used as an auxiliary diagnosis of chronic atrophic gastritis and its typing.
III. What are the clinical symptoms?
Most patients with chronic atrophic gastritis have no obvious conscious symptoms, and those who have symptoms also lack specificity, but patients may complain of burning pain, distension, dull pain in the upper abdomen or stomach fullness, stuffiness, especially after eating, poor appetite, early satiety, nausea, belching, indigestion, fatigue, constipation or diarrhea, and other symptoms. In severe cases, there may be emaciation, anemia, brittle nail, tongue inflammation or tongue papilla atrophy, and a few cases of gastric mucosal erosion may be accompanied by upper gastrointestinal bleeding. In general, it is summarized as the following main manifestations.
1, distention and fullness in the stomach and epigastric region.
2, pain in the stomach and epigastric region.
3. heartburn and indigestion symptoms.
4, abnormal stools and symptoms of weakness.
5, anemia.
IV. Prognosis of the disease?
According to epidemiology, the incidence of gastric cancer in patients with chronic atrophic gastritis is significantly higher than that in the general population. Among them, chronic atrophic gastritis caused by H. pylori can develop into gastric ulcer and duodenal ulcer.
V. Do I need surgery?
The number of patients undergoing surgical prophylactic surgery is gradually decreasing. The main thing is to perform gastroscopic follow-up with at least one gastroscopy every 3 months, 6 months or 1 year.
Sixth, how to treat western medicine.
1.Treatment of indigestion
Give acid-suppressing and anti-acid, gastrointestinal motility drugs, gastric mucosa-protecting drugs such as aluminum thioglycollate and bismuth potassium citrate.
2, eradication of Helicobacter pylori treatment
Use proton pump inhibitors plus two antibiotics, such as omeprazole combined with clarithromycin and metronidazole to eradicate H. pylori.
3, the treatment of autoimmune gastritis
There is no specific treatment, and vitamin B12 injection is given when accompanied by pernicious anemia.
4.Treatment of heterogeneous hyperplasia
Heterogeneous hyperplasia is a precancerous lesion of gastric cancer. For severe heterogeneous hyperplasia, preventive surgery should be performed, and at present, endoscopic mucosal resection is mostly used in China.