The evolution of the mucosa during gastric carcinogenesis is: normal gastric mucosa → inflammation → atrophy → intestinal metaplasia → heterogeneous hyperplasia → gastric cancer. It is evident that chronic atrophic gastritis is one of the most important precancerous lesions of gastric cancer, and timely treatment of chronic atrophic gastritis, or stopping its occurrence, has become one of the main measures to prevent gastric cancer nowadays. Folic acid can regulate the occurrence of colorectal cancer, which has been confirmed in animal tests and population-based clinical trials. So, does folic acid also prevent gastric cancer?
Folate deficiency leads to increased risk of gastric cancer
Abnormal DNA methylation is one of the important mechanisms of gastric carcinogenesis, in which the DNA of cells in the stomach deviates from its normal development, leading to heterogeneous proliferation of normal cells and cancer.
Folic acid, also known as vitamin B9, is a water-soluble vitamin and is the only substance that can first synthesize the one-carbon moiety, which is required for DNA methylation, and therefore DNA methylation is dependent on the presence of folic acid. It has been found that folic acid deficiency can lead to disruption of DNA methylation, making DNA repair less efficient, which means that mutations are more likely to occur and cannot be corrected in a timely manner, leading to an increased risk of stomach cancer.
Folic acid supplementation may reduce the risk of progression to gastric cancer
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As seen in the evolution of gastric cancer, atrophy of the gastric mucosa, intestinal epithelial metaplasia, and heterogeneous hyperplasia in patients with chronic gastritis are precancerous changes in the stomach that may transform into gastric cancer, and folic acid has been shown to improve these lesions. The use of folic acid in patients with chronic atrophic gastritis can effectively reduce the incidence of gastric cancer by truncating the evolutionary pathway of normal gastric mucosa progression to gastric cancer.
How is folic acid taken?
The use of folic acid for the treatment of chronic atrophic gastritis and the prevention of gastric cancer requires long-term adherence under medical supervision. However, it is important to note that if you have been diagnosed with gastric cancer, you should not take folic acid at will. The folic acid is a very important part of the diet, but it is also a very important part of the diet.
Summary
For patients with chronic atrophic gastritis but undiagnosed gastric cancer, folic acid is both a treatment for gastritis and a way to prevent gastric cancer. In addition, Helicobacter pylori (Hp) infection is an important factor in the development of gastric cancer, and the combination of H. pylori eradication with folic acid in patients with H. pylori infection can be effective in improving the degree of atrophy in chronic atrophic gastritis. Doctors will make recommendations on a case-by-case basis. (Coauthored by Siwei Pan, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)