1.When is gastroscopy needed? Symptoms of the upper gastrointestinal tract (including those of esophageal, gastric and duodenal origin) lack specificity, and depending on the severity and type of symptoms, they cannot be clearly distinguished from gastroesophageal reflux, gastritis, gastric ulcer, duodenal ulcer, tumors of the upper gastrointestinal tract, or simple dyspepsia, and therefore require further examination or therapeutic observation. According to clinical epidemiological studies, endoscopy is needed for the Han Chinese population with upper gastrointestinal symptoms who are older than 45 years old or (although they may be less than 45 years old,) have the so-called alarm symptoms such as vomiting blood, black feces, lethargy, severe pain, and so on. 2.How to treat H. pylori infection? The rate of H. pylori infection in adults in China is about 50%, and the rate of H. pylori infection increases with age. Not all H. pylori infected individuals need H. pylori eradication. Eradication is recommended for those with established upper gastrointestinal symptoms, a family history of gastric cancer in first-degree relatives (parents, siblings, children), existing ulcers or a history of previous ulcers, and established severe chronic or deformed gastritis. 3. Do small children need H. pylori eradication? Adolescents under 13 years of age generally do not need H. pylori eradication therapy unless they have an established disease associated with H. pylori infection. The reasons are as follows: (1) the recurrence rate after eradication is high in children, (2) antibiotics interfere with intestinal microecology, which is not conducive to the normal development of children’s digestive tract and the establishment of immune function, and (3) antibiotics have other safety hazards. 4, atrophic gastritis is not far from stomach 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. Unstable intestinal metaplasia and atypical hyperplasia is only the chance of malignant changes will be elevated. 5, gastric mucosal atrophy can be good? With the increase of age, gastric mucosa glands decrease (is atrophy) is a normal physiological phenomenon. Therefore, a certain range and a certain degree of atrophy of the gastric mucosa is inevitable. Age-related mild-to-moderate atrophy, like wrinkles on the skin, is an accompanying phenomenon of normal aging and will not be completely reversed, nor does it need to be completely reversed. For excessive (beyond age-related) atrophic changes, there is some degree of recovery along with a reduction in inflammation once the cause is removed. 6.What is intestinal metaplasia? Can it become cancerous? Intestinal metaplasia is a feature of gastric mucosa that is repaired after gastric mucosal injury, and in a sense, intestinal metaplasia is a kind of adaptive phenomenon under local environment (bile acid, inflammatory activity), i.e., mild small intestinal type of metaplasia is not harmful. If the etiology (Helicobacter pylori, bile acids, inflammation, etc.) persists, damage continues to occur, intestinal chemosis worsens, or an unstable large bowel-type chemosis is present, there is a risk of further malignant changes. 7. What are atypical hyperplasia, endothelial neoplasia, and heterogeneous hyperplasia? Are they scary? Atypical hyperplasia, endothelial neoplasia, heterogeneous hyperplasia are all concepts of the same meaning. It is the phenomenon of unstable hyperplasia that carries the risk of malignant transformation. Mild atypical hyperplasia, low-grade intraepithelial neoplasia, and mild heterogeneous hyperplasia require aggressive treatment and endoscopic follow-up (usually requiring review within 1 year). Severe atypical hyperplasia, severe heterotopic hyperplasia and high-grade intraepithelial neoplasia require immediate endoscopic review, and endoscopic minimally invasive treatment is generally recommended if there are limited changes. 8. Are acid inhibitors safe for long-term use? Proton pump inhibitors have a favorable safety profile. No evidence has been found that long-term use promotes carcinoid or gastric cancer. However, there are concerns that long-term use may increase the chance of infection and the risk of osteoporosis. There is no evidence of adverse reactions in pregnant women or adverse effects on the fetus.