Ms. Xu, the owner of a foreign trade company in Shanghai, has been suffering from recurrent epigastric pain for nearly a year, and she is afraid to eat more than she should. Gastroscopy diagnosed “chronic atrophic gastritis with mild intestinal metaplasia”. The doctor told her that atrophic gastritis with intestinal metaplasia is prone to cancer, and that she needs to review the gastroscopy regularly.
Accordingly, over the past year, Ms. Xu was extremely upset and had her gastroscopy reviewed four times, all of which were diagnosed as “chronic atrophic gastritis with mild intestinal metaplasia”. When I first met Ms. Xu, the doctor felt that she was nervous and was just about to prescribe medication, but Ms. Xu insisted on another gastroscopy before taking medication, and repeatedly emphasized that other doctors said that atrophic gastritis is prone to cancer, so she should review the gastroscopy regularly. The diagnosis of gastroscopy is still “chronic atrophic gastritis with mild intestinal metaplasia”.
Ms. Xu was confused: how far is atrophic gastritis from cancer? How long is the so-called “period” of regular gastroscopy?
The cause of atrophy
As we all know, the stomach wall is covered with a thick layer of gastric mucosa. The surface of the gastric mucosa is covered with a variety of glandular cells. Different glandular cells have different functions: some play a lubricating role by secreting mucus so that food can pass easily; some secrete pepsin to promote protein digestion; some secrete hydrochloric acid to provide a suitable environment for pepsin, and have bactericidal and antibacterial functions.
In atrophic gastritis, the normal glands atrophy or even disappear after repeated damage to the surface of the gastric mucosa, and the glandular function decreases. Thus, the main clinical manifestations of atrophic gastritis are loss of appetite, nausea, belching, epigastric fullness or dull pain, and upper gastrointestinal bleeding, wasting, anemia, brittle nails, tongue inflammation or tongue papillae atrophy can occur in a few patients. In fact, the majority of patients can be cured with treatment. However, some patients think that atrophic gastritis is a pre-cancerous disease of gastric cancer as considered by medical science, so they are worried about cancer and have a heavy mental burden, which affects the recovery of the disease.
Moderate or above is more dangerous
In recent years, a lot of research has been conducted at home and abroad on the relationship between atrophic gastritis and gastric cancer. At present, it is believed that atrophic gastritis, especially those with moderate or above intestinal metaplasia and heterogeneous hyperplasia, are more likely to become cancerous, while mild atrophic gastritis is less likely to become cancerous.
The so-called heterogeneous hyperplasia of gastric mucosal epithelium refers to the deviation of gastric mucosal epithelium and glands from normal differentiation and heterogeneous expression in morphology and function.
It is generally believed that almost all malignant tumors are preceded by heterogeneous hyperplasia, and rarely transform from normal to malignant without going through several stages. Therefore, when performing gastroscopy, doctors pay special attention to the pathological examination results. Meanwhile, according to scientific estimation, it takes 16-24 years for normal gastric mucosa to develop into cancer, so there is plenty of time for early detection and early treatment.
Agreement with the stomach for examination period
Therefore, those who suffer from atrophic gastritis need not be overly nervous, but they should be taken seriously. It is generally believed that the annual cancer rate of atrophic gastritis is about 0.5%-1%. Strengthening regular follow-up monitoring and making biopsy under gastroscopy to pay attention to the dynamic evolution of its precancerous changes is one of the important means of current gastric cancer prevention and treatment.
In order to reduce the occurrence of gastric cancer, facilitate patients and meet the requirements of medical economics, patients with atrophic gastritis without intestinal hyperplasia and heterogeneous hyperplasia can be followed up by endoscopy and pathology once every 1-2 years; patients with moderate or severe atrophy or atrophic gastritis with intestinal biopsy should be followed up once every year or so; patients with atrophic gastritis with polyps, heterogeneous hyperplasia, or focal depression or bulge are recommended to be reviewed once every 3-6 months; patients with moderate or severe atrophy or atrophic gastritis with intestinal hyperplasia are recommended to be followed up once every 3-6 months. For atrophic gastritis with polyps, heterogeneous hyperplasia, or focal depressions or bulges, a review once every 3-6 months is recommended; for moderate atypical hyperplasia, a review once every 3 months is recommended; for severe atypical hyperplasia (cancer rate of 10% or more), surgery or endoscopic local treatment is required.
The good and bad of gastroscopy
Gastroscopy can visually detect small lesions and achieve the purpose of early detection, early diagnosis and early treatment. So, is the more gastroscopy done the better, the more diligent and the more at ease? Actually, it is not. The frequency of gastroscopy should be based on the different conditions of each patient as recommended by the professional physician. Multiple unnecessary examinations not only bring physical discomfort and economic waste to the patient, but also repeated clamping of the mucosa for pathological examination, each time accompanied by the risk of bleeding or even haemorrhage, which also increases the risk of medical transmission.
Appendix: Classification of atrophic gastritis
Atrophic gastritis can be classified as mild, moderate, or severe depending on the extent of glandular atrophy or the amount of reduction.
Mild: The superficial glands of the gastric sinus are focally atrophied and reduced, while the small and large curved glands are normal.
Moderate: Atrophy and reduction of both sinus and small curvature glands, with more extensive lesions than mild.
Severe: most of the glands in the gastric sinus are atrophied and reduced, only a few normal glands remain, and the large and small curved glands are atrophied; or the mucosa is significantly thinner, and the original glands are completely atrophied and disappeared, and replaced by septic glands.
What is intestinal metaplasia
Intestinal metaplasia, i.e. intestinal epithelial metaplasia, refers to the replacement of gastric mucosal epithelial cells by intestinal-type epithelial cells, i.e. the appearance of epithelial cells in the gastric mucosa that resemble the mucosa of the small or large intestine. Intestinal metaplasia is a common lesion of the gastric mucosa and is seen in many chronic gastric diseases.