Several questions of concern to patients with gastric diseases have been noted in the work of the gastroenterology clinic.
1. When is a gastroscopy necessary
The symptoms of the upper gastrointestinal tract (including those of esophageal, gastric and duodenal origin) lack specificity, and according to the severity and type of symptoms, they cannot be clearly distinguished as gastroesophageal reflux, gastritis, gastric ulcer, duodenal ulcer, upper gastrointestinal tumor, or simple dyspepsia, so they need further examination or therapeutic observation. According to clinical epidemiological studies, endoscopy is needed for our Han population with upper gastrointestinal symptoms, older than 45 years old, or (although they may be younger than 45 years old) with so-called alarm symptoms such as vomiting blood, black feces, wasting, and severe pain.
2. How to treat H. pylori infection
The prevalence of H. pylori infection in our adults is about 50%, and increases with age. Not all individuals with H. pylori infection need H. pylori eradication. Those for whom eradication treatment is recommended include those with established upper gastrointestinal symptoms, a family history of gastric cancer in first-degree relatives (parents, siblings, children), a history of existing or former ulcers, and established more severe chronic or malformed gastritis.
3. Whether H. pylori eradication is needed in small children
Adolescents under 13 years of age generally do not require H. pylori eradication therapy unless they have an established disease related to H. pylori infection. The reasons are as follows.
(1) Recurrence rate after eradication in children.
(2) Antibiotics interfere with the intestinal microecology and are detrimental to the establishment of normal developmental immune function in the child’s GI tract.
(3) antibiotics have other safety risks.
4, atrophic gastritis is not far from gastric cancer?
Atrophic gastritis is an inflammation of the gastric mucosa accompanied by atrophy. The degree of harm does not lie in the atrophy, but mainly in the accompanying inflammation and atrophy accompanied by intestinal metaplasia and atypical hyperplasia. It is the unstable intestinal chemosis and atypical hyperplasia that raises the chances of malignancy.
5.Can gastric mucosal atrophy be good?
Age increase, gastric mucosa glandular decrease (is atrophy) is a normal physiological phenomenon. Therefore, a certain range of gastric sinus mucosa and a certain degree of atrophy is inevitable. Age-related mild to moderate atrophy is a normal accompaniment of aging, like wrinkles on the skin, and will not be completely reversed, nor does it need to be completely reversed. For excessive (beyond age-related) atrophic changes, some degree of recovery will accompany the reduction of inflammation as long as the etiology is removed.
6.What is intestinal metaplasia and can it become cancer?
In a sense, intestinal metaplasia is an adaptation phenomenon in the local environment (bile acid, inflammatory activity), i.e. mild small intestine type metaplasia is not harmful. If the etiology (H. pylori, bile acids, inflammation, etc.) persists, damage occurs continuously, and intestinal metaplasia worsens or presents unstable large intestine type metaplasia, there is a risk of further malignant transformation.
7.What are atypical hyperplasia, endothelial neoplasia, and heterogeneous hyperplasia, and are they scary?
Atypical hyperplasia, endothelial neoplasia, and heterogeneous hyperplasia are all concepts with the same meaning. It is the phenomenon of unstable hyperplasia with the risk of malignant transformation. Mild atypical hyperplasia, low-grade intraepithelial neoplasia, and mild heterogeneous hyperplasia require aggressive treatment and endoscopic follow-up (generally requiring review within 1 year). Severe atypical hyperplasia, severe heterogeneous hyperplasia and high-grade intraepithelial neoplasia require immediate endoscopic review, and endoscopic minimally invasive treatment is generally recommended if there are restrictive changes.
8.Are acid inhibitors safe for long-term use
Proton pump inhibitors have a good safety profile. No evidence of promoting carcinoid tumor or gastric cancer has been found for long-term use. There are concerns that long-term use may increase the chance of infection and increase the risk of osteoporosis. There is no evidence of adverse reactions in pregnant women or adverse effects on the fetus.