Gastric disease has always been a major problem for us, and with the improvement of living standards, people are paying more and more attention to their health. However, many people do not know enough about gastric disease, there are still great misunderstandings in diagnosis, treatment, conditioning and prognosis, especially chronic atrophic gastritis “talk about the tiger” to produce unnecessary anxiety, fear and other emotions.
There are many causes, mainly caused by Helicobacter pylori infection, long-term stomach-damaging drugs, chronic foci of infection in the oropharynx, spilling, bile reflux, etc. Gastric body atrophic gastritis is associated with autoimmune damage. Persistent inflammation can cause glandular atrophy and intestinal metaplasia. With the widespread availability of gastroscopy, the detection rate of atrophic gastritis has greatly increased and increases with age. Atrophic gastritis is considered a precancerous lesion of gastric cancer. How to treat atrophic gastritis, chronic atrophic gastritis such patients will have upper abdominal fullness, discomfort or pain, more pronounced after meals, along with other dyspeptic symptoms such as belching, acid reflux, nausea, vomiting and loss of appetite. Gastroscopy and pathological examination can confirm the diagnosis, and pathological findings are the gold standard for diagnosis. There is no specific treatment for this disease in Western medicine, and symptomatic treatment is mostly used, but it cannot improve the atrophic lesions. Chinese medicine is currently the most effective treatment for atrophic gastritis, and generally uses a combination of evidence and disease identification to reverse some of the effects of atrophic gastritis. Atrophic gastritis is one of the characteristic TCM treatment diseases in our department.
A. Proper understanding of chronic atrophic gastritis
Chronic atrophic gastritis can be classified pathologically into three conditions: glandular atrophy, intestinal epithelial hyperplasia and atypical hyperplasia (abnormal hyperplasia). The degree of lesions can be classified as mild, moderate or severe. Most data indicate that mild and moderate atrophy is reversible, while severe atrophy has little reversibility. What is intestinal epithelial metaplasia? Under normal circumstances, there is no intestinal epithelium in the gastric mucosal glands, and the more severe the atrophy is, the more intestinal hyperplasia appears. Some scholars have investigated patients with enterocolitis of gastric mucosa for 10 years, and the cancer rate is only 1.9%.
Pathologically, cancerous cells evolve from normal – aging – hyperplasia – atypical hyperplasia – cancerous cells in the gastric mucosa, but this process is long, not a year or two, so if you have chronic atrophic gastritis, you should not be overly afraid that you will develop into gastric cancer soon. Mild atrophic gastritis is common among elderly people and does not require daily medication, just like the wrinkles on your face, it is an ageing phenomenon and the chance of becoming cancer is also small.
Gastric precancerous lesions are not terrible, and it takes a long way to develop into gastric cancer from intestinalization and heterogeneous hyperplasia. Therefore, it is reasonable to think that as long as they are handled properly, intestinalization and heterogeneous hyperplasia are safe and unnecessary to cause too much anxiety and worry. Patients with atypical hyperplasia should pay attention to this. First of all, we should ask the doctor to analyze again whether it is possible that there is a lesion but not biopsied to (which is very common in clinical practice and is not an error of the doctor), and if so, it needs to be checked again for gastroscopy to take a biopsy. If a lesion is found, but it is difficult to see the lesion, staining + magnification endoscopy is needed. If cancer is suspected, ultrasound endoscopy is needed first to determine the depth of the lesion to see if it can be treated under endoscopy.
II. Problems that should be noted
For patients with chronic atrophic gastritis, gastroscopy should be reviewed regularly in order to monitor the dynamic changes of the lesions. It is recommended that those with intestinalization and heterogeneous hyperplasia should choose to review the gastroscopy for the first time at 3 months, 6 months, or a year, depending on the specific situation, and thereafter for follow-up and clinical observation. In younger patients, some of the intestinal and heterogeneous hyperplasia can disappear and be reversed. This, of course, requires aggressive treatment. For those with moderate atypical hyperplasia once in about 3 months (endoscopic debridement should be done if there is a clear lesion), and for severe atypical hyperplasia, if the lesion is found to be located in the mucosal layer after performing ultrasound endoscopy, endoscopic debridement should also be performed.
Related tests
1. Gastroscopy is the main means of diagnosing this disease. The gastric mucosa is congested with edema, red and white, erosion and bleeding spots, increased mucus secretion and enhanced reflection. In heavier cases, the gastric mucosa becomes pale or even grayish white in color. The mucosa becomes thin and brittle, the folds are thin, the submucosal vessels are revealed, or the mucosa is rough and granular, and in severe cases the amount of mucus lake is minimal or absent (dry stomach).
2, gastric mucosal biopsy pathological examination, can understand the inflammation, activity, atrophy, degree of enterization, the presence of heterogeneous hyperplasia and Helicobacter infection. Biopsy should indicate the site of sampling.
3, H. pylori examination, there are a variety of methods, such as 14C-UBT, rapid urease test, histological examination, pathological examination, etc. The principle of 14C-UBT: HP produces a large number of urease in the human stomach, which can decompose urea and then generate ammonia and CO2, to patients infected with HP oral urea capsules containing isotopically labeled C (14C-urea), urea is decomposed to produce isotopic The labeled CO2 is exhaled from the lungs, and the exhaled breath sample is collected at regular intervals, and the amount of isotopically labeled C is detected by gas isotope mass spectrometry, which can determine whether there is currently HP infection.
4, gastric fluid analysis, determination of gastric fluid secretion function, commonly used pentagastrin secretion stimulation test, determination of basal gastric acid secretion (BAO), maximum gastric acid secretion (MAO), peak gastric acid secretion (PAO) and gastric fluid PH. sinus gastritis is normal or low acid. Obviously low acid or no acid suggests atrophic gastritis of the gastric body.
5, barium X-ray examination, the diagnostic value is limited, mainly used to exclude peptic ulcer and gastric cancer and other upper gastrointestinal tract diseases.
6, in case of atrophic gastritis, blood routine, gastric fluid analysis, serum gastrin concentration, serum vitamin B12 concentration, retrieval vitamin B12 absorption test, serum mural cell antibodies, antibodies to factors in serum or gastric fluid, bone marrow aspiration smear and other tests can be performed.
IV. Treatment
Some atrophic gastritis may become the prelude of gastric cancer, but the transformation into gastric cancer is only very rare. Therefore, there is no need to be alarmed, and even if you have severe atrophic gastritis, there is no need to be nervous and pessimistic. Even if you have severe atrophic gastritis, you do not need to be nervous and pessimistic. As long as you treat it seriously and adopt comprehensive therapy, you can get better or cured. It should be reminded that while treating, various causative factors should be removed, such as quitting smoking and drinking, eating less pickled foods, avoiding overeating and eating spicy and moldy foods, paying attention to dietary hygiene, eating less and more meals, actively treating chronic diseases of the mouth and pharynx, etc. If such patients have H. pylori infection must be treated and eradicated.
Chinese medicine treatment.
According to the characteristics of the disease for a long time, as well as the causative factors, clinical manifestations, especially the microscopic morphological changes of gastric mucosa intestinal hyperplasia and heterogeneous hyperplasia, Chinese medicine believes that the disease is mostly on the basis of positive deficiency and weakness of the spleen and stomach, qi stagnation, dampness, stasis and toxicity, or poisonous decay into ulcers, or stasis into accumulation, or qi stagnation, dampness and phlegm, if lost or mismanaged, the disease is prolonged or aggravated, and finally can form malignant tumors.
In the treatment of chronic atrophic gastritis with intestinal chemosis and cellular heterotypic hyperplasia, the aim should be to actively prevent carcinogenesis or reverse the process of carcinogenesis, and the treatment should be based on evidence-based treatment, combined with gastroscopic mucosal images, and appropriate use of herbs that activate blood circulation, resolve blood stasis, detoxify and disperse nodules, and increase acidity and anti-cancer.