Gastric precancerous lesions and their prevention and treatment measures
I. What is precancerous lesion of stomach
According to the World Health Organization, precancerous gastric cancer can be divided into precancerous state and precancerous lesion. Precancerous state of the stomach is a clinical concept, which refers to some diseases with higher possibility of gastric cancer, such as atrophic gastritis, chronic gastric ulcer, gastric polyp, remnant stomach, giant hypertrophic gastritis, etc.; precancerous lesion of the stomach is a histopathological concept, which refers to some pathological changes of gastric mucosa that can be easily transformed into gastric cancer, mainly referring to atypical hyperplasia, intestinal epithelial metaplasia.
Clinical symptoms are non-specific. In the case of gastric antral lesions, there are no specific clinical manifestations. The more common symptom is only upper abdominal discomfort and the duration of the disease is already long. Patients with atrophic gastritis with intestinal metaplasia and/or atypical hyperplasia have more frequent upper abdominal distention, and those with pernicious anemia are pale and anemic; those with gastric ulcer with intestinal metaplasia and/or atypical hyperplasia often have more pronounced acid reflux and discomfort in the empty stomach; those with residual gastritis with intestinal metaplasia and/or atypical hyperplasia have a history of major gastric incision, and most have symptoms of bile reflux such as regurgitation of yellow-green bitter water. Therefore, clinical biopsies must be taken by gastroscopy and confirmed by pathological examination.
II. Preventive measures
Gastric precancerous lesion has a gradual process, generally speaking, it is developed when acute superficial gastritis is not treated effectively and thoroughly in time.
Chronic superficial gastritis → superficial atrophic gastritis → atrophic gastritis → atrophic gastritis with intestinal epithelial hyperplasia → atrophic gastritis with atypical hyperplasia → gastric cancer
Chronic superficial gastritis → verrucous gastritis → verrucous gastritis with intestinal epithelial hyperplasia → verrucous gastritis with atypical hyperplasia → gastric cancer.
Chronic superficial gastritis → gastric ulcer → gastric ulcer with intestinal epithelial hyperplasia → gastric ulcer with atypical hyperplasia → gastric cancer
Pylorus loss after gastric biopsy → residual gastritis → residual gastritis with intestinal epithelial hyperplasia → residual gastritis with atypical hyperplasia → gastric cancer
Therefore, we should pay attention to gastric health care in general to prevent gastric diseases, and after the disease, timely and thorough treatment is the key to prevent further aggravation. Specific health care measures can be divided into the following aspects.
1.Diet should be avoided in general to avoid taking diet with strong stimulation to gastric mucosa. Such as strong tea, strong alcohol, spicy diet. When eating to fully chew, slow chewing and fine glass le hook plant banter engraved pelican Song just lining is not gray urination beach le scraping cup stepping member acenaphthene light at the end of the day roach ben uranium pelican Song just lining
2, contraindicated drugs life in the world, may suffer from a variety of diseases at the same time, pay attention to the choice of drugs to treat other diseases, chronic gastritis patients to avoid taking the following drugs, so as not to aggravate the disease.
① salicylic acid such as aspirin, sodium salicylate ;
②Anilines such as paracetamol, finasteride;
③Bizodone, such as pautazone, aminopyrine;
④Other anti-inflammatory organic acids such as anti-inflammatory pain, ibuprofen, etc;
⑤ Antibiotics such as tetracycline, etc;
(6) glucocorticoids such as prednisone, dexamethasone, cortisone, etc.
3, adjust the mood, try to reduce stress because all organs of the human body are governed by the central nervous system. Regularize your life and develop good habits. Prevent sleep deprivation, relax your mind and avoid excessive worry about the appearance of anxiety to enhance immunity. Of course, if full of care, delayed treatment is also wrong.
4, timely detection and kill H. pylori recommended that every gastroscopy check the pathology and H. pylori, because it is one of the important causes of chronic gastritis, gastric ulcers and other diseases occurring and repeatedly difficult to heal. If the endoscopist does not mention H. pylori test results on the gastroscopy report form, it is possible that this test was not done and should be referred for H. pylori examination. When combined with H. pylori infection, it is usually killed with triple or quadruple dosing for two weeks. Depending on the condition, gastroscopy and pathology should be checked once every three months to six months.
C. Current status of Chinese medicine in the treatment of gastric precancerous lesions
The therapeutic effect of Chinese medicine on gastric precancerous lesions is becoming more and more obvious and has better efficacy. According to Chinese medicine, deficiency of qi and blood stasis is the pathological basis of gastric precancerous lesions, deficiency of qi in the spleen and stomach is its root cause, and blood stasis and toxicity in the stomach ligament are its symptoms. It advocates the combination of macroscopic identification and microscopic identification, and the combination of dialectical treatment and pathological treatment. The treatment is always based on the combination of strengthening the spleen and qi, activating blood circulation and eliminating blood stasis, regulating qi and dispersing nodules, clearing heat and dampness, detoxifying and anti-cancer, etc.
Active treatment of underlying gastric diseases leading to gastric precancerous lesions often varies greatly due to their underlying diseases (e.g. atrophic gastritis, warty gastritis, gastric ulcer, residual gastritis) and individual differences of patients. The principle is to support the positive and eliminate the evil, and treat both the symptoms and the root cause. The most intuitive way is to improve and eliminate the carcinogenic environment in the stomach, such as reduced gastric acid in atrophic gastritis, increased gastric acid secretion in gastric ulcer, bile reflux in residual gastritis, Helicobacter pylori infection, reduced gastric motility, delayed emptying, etc.; to reduce or eliminate the emergence of gastric mucosal intestinal hyperplasia and atypical hyperplasia. It can also reduce or eliminate intestinal hyperplasia and atypical hyperplasia of gastric mucosa, so that they do not develop into gastric cancer, inhibit cell differentiation and proliferation, and prevent cell mutation, etc.
Commonly used drugs to benefit qi and strengthen spleen include Radix et Rhizoma Ginseng, Radix Astragali, Atractylodes Macrocephala, Ganoderma Lucidum, Rhodiola Rosea, Poria, Yam, Lentil, Job’s Tear, etc;
Commonly used drugs for promoting blood circulation and resolving blood stasis include Dan Shen, Tao Ren, Hong Hua, Radix Angelicae Sinensis, Chuan Xiong, San Li, Curcuma longa, Panax notoginseng, etc;
Commonly used drugs to regulate Qi and disperse knots include: Chai Hu, Citrus aurantium, Fructus Foetida, Aromatic Herb, Citrus aurantium, Radix et Rhizoma, Cyperus rotundus, and Zha Bei Mu;
Commonly used drugs for clearing heat and resolving dampness include: Huang Lian, Scutellaria, Dandelion, Yin Chen, Mao Gen;
Commonly used detoxifying and anticancer drugs include: Baihua snake tongue herb, half-root, vine root, Baiying, snake six grain, etc.
Four months is a course of treatment. Re-examine gastroscopy and pathology.
Fourth, severe intestinal metaplasia and heterogeneous hyperplasia should be promptly treated by surgery
Severe intestinal metaplasia and severe heterogeneous hyperplasia are more dangerous precancerous lesions and should be given high priority. For mild to moderate intestinal metaplasia and heterogeneous hyperplasia, traditional Chinese medicine has better efficacy and should be treated in time. Whenever severe intestinal metaplasia or heterogeneous hyperplasia is found, for the sake of caution, it is advisable to perform prophylactic surgery after another biopsy or confirmation by another pathologist.