A. Definition of atrophic gastritis Chronic atrophic gastritis (CAG) is a type of chronic gastritis, which is a common, frequent and difficult to treat disease of the digestive system characterized by limited or extensive atrophy (reduced number and function) of the intrinsic mucosal glands after repeated damage to the epithelium of the gastric mucosa. It is often accompanied by intestinal epithelial metaplasia, heterogeneous hyperplasia (intraepithelial neoplasia) and inflammatory reaction, and its diagnosis mainly relies on pathological findings from gastroscopy and gastric mucosal biopsy. Lu Weimin, Department of Splenic and Gastrointestinal Diseases, Jiangsu Provincial Hospital of Traditional Chinese Medicine Modern medicine believes that the disease can be partly developed from superficial gastritis, so the causes of superficial gastritis can be the causative and aggravating factors of CAG, such as Helicobacter pylori (H. pylori) infection, long-term poor dietary habits, smoking, duodenal fluid reflux, immune factors, genetic factors, chronic inflammation of the upper respiratory tract, abuse of non-steroidal drugs, etc. The incidence of CAG is related to the stimulation of some heavy metal elements, iron deficiency anemia, chronic liver disease, and age factors. At present, the incidence of this disease is gradually increasing, and it is often recurrent and not easy to cure clinically, and is closely related to the occurrence of gastric cancer, so it is getting more and more attention. (Note: Do not pay too much attention to it, otherwise the most dangerous thing is not to think about food in the day and sleep at night! Atrophic gastritis is also not a shrinking stomach, it is a reduction in the intrinsic glands of the gastric mucosa, which can affect the secretory function of the gastric glands and therefore lead to changes in digestive function.) The incidence of the disease increases with age, and the degree of the lesion becomes heavier, so it is believed that CAG is a degenerative degeneration of the gastric mucosa in middle and old age, a “semi-physiological” phenomenon. At present, there is a lack of complete large-scale national epidemiological survey data of this disease in China. According to epidemiological surveys in some regions, the incidence of chronic gastritis reaches 30% in people over 50 years old, and CAG accounts for about 30% of chronic gastritis. The incidence of CAG accounts for 13.8% of patients examined by gastroscopy and up to 28.1% in areas with high incidence of gastric cancer, and more than 50% of gastric cancer cases have a history of CAG. Foreign literature reports that the incidence of gastric cancer is as high as 9-10% in CAG, especially in those with intestinal epithelial hyperplasia and heterotypic hyperplasia, and 7% in China. Wang Xingxiang et al. investigated 1285 cases of CAG patients in Bazhou, Xinjiang, and found that the incidence ratio of men to women was 2.2:1, and the incidence rate of men was significantly higher than that of women. The age of onset was 18 to 79 years old, with a mean age of 50.7 years, and there was a correlation between the incidence and age. The incidence of CAG carcinoma was in the range of 2 to 8%. (Press: the epidemiological findings vary among families, and the data of our consensus opinion on chronic gastritis is more recognized. It is generally believed that the annual cancer rate of atrophic gastritis is about 0.5% to 1%, and regular checkups are most important) III. Clinical features The clinical manifestations of CAG not only lack specificity, but also are not completely consistent with the degree of lesion (so it is still necessary to review regularly). Clinically, some patients with CAG may have no obvious symptoms. However, most patients may have burning pain, distension, dull pain or fullness, stuffiness in the upper abdomen, especially after eating, loss of appetite, nausea, belching, constipation or diarrhea. In severe cases, there may be wasting, anemia, brittle nails, tongue inflammation or tongue papilla atrophy, and in a few cases of gastric mucosal erosion, there may be upper gastrointestinal bleeding. Among them, type A CAG complicated by pernicious anemia is rare in China. The disease has no specific signs, and there may be mild pressure pain in the upper abdomen. CAG is known as the background disease of gastric cancer, but according to the analysis of domestic follow-up data for many years, most of them have good prognosis, and a few of them can become cancerous. Simple CAG, especially mild and moderate CAG, has a low cancer rate, but severe CAG with moderate and severe intestinal epithelial hyperplasia and severe heterogeneous hyperplasia, or patients with positive carcinoembryonic antigen, has a high cancer rate, so it should be paid great attention to regular follow-up, gastroscopy every 3 to 6 months, and cellular deoxyribonucleic acid (DNA) content and tumor-associated antigens can be checked if available. The cancer rate is also higher in post-operative atrophic residual gastritis because of the long-term stimulation of bile reflux, so active measures should be taken to reduce the stimulation of alkaline reflux fluid to prevent the occurrence of cancer.