Case sharing: Since last year, 50-year-old Wang has often experienced symptoms such as bloating, belching, acid reflux and decreased appetite, and his meals have little taste, and he often takes some “stomach care” medicine at home, and his symptoms are relieved. The doctor suggested a gastroscopy, and the diagnosis after the gastroscopy was chronic atrophic gastritis. When you see the test report, Wang did not care too much, and then his own “Baidu” a little, really took him a jump. Baidu said anything, especially that chronic atrophic gastritis will sooner or later turn into gastric cancer. This scared him, but is this fear justified?
Definition of atrophic gastritis
Atrophic gastritis is also known as chronic atrophic gastritis. It is a pathological change in which the mucosal intrinsic glands atrophy or even disappear and the mucosal muscle layer commonly thickens after repeated damage to the gastric mucosal surface. Due to the atrophy or disappearance of the glands, the gastric mucosa has varying degrees of thinning and is often accompanied by intestinal epithelial metaplasia, inflammatory reaction and atypical hyperplasia. The disease is one of the common diseases of the digestive system. Atrophy of the intrinsic glands of the gastric mucosa is a lesion that accounts for 10% to 20% of chronic gastritis, which is most commonly seen in middle-aged and elderly people, with the incidence rising with age. Gastroscopy and gastric mucosal biopsy are the most reliable diagnostic methods.
Chronic atrophic gastritis refers to chronic gastritis in which atrophic changes in the gastric mucosa have occurred and can be divided into two categories: multifocal atrophic gastritis and autoimmune gastritis. The former atrophic changes are multifocal atrophy in the stomach, mainly in the gastric sinus, and mostly develop from chronic non-atrophic gastritis caused by Helicobacter pylori infection, while the latter atrophic changes are mainly in the gastric body, and mostly develop from autoimmune gastritis caused by the gastric body.
The figure below shows the manifestation of atrophic gastritis with white light, indigo carmine staining and pathology. Normal gastric mucosal surface is smooth, covered with mucus, and rich in folds generally appearing talk pink. In contrast, endoscopy of patients with typical atrophic gastritis reveals that the gastric mucosa is lighter in color, thinner, with fewer or absent mucosal folds, with permeable submucosal vessels, with a rough and uneven surface, granular or nodular, and with disorganized or even absent indigo carmine staining of small concave structures.
Atrophic gastritis ≠ cancer
Atrophic gastritis is a precancerous disease of gastric cancer, while atrophic gastritis with intestinal epithelial hyperplasia or heterogeneous hyperplasia is a precancerous lesion, and the two concepts are different. Although atrophic lesions are common in the mucosa surrounding gastric cancer, there is no conclusion that chronic atrophic gastritis will necessarily develop into gastric cancer.
Whether chronic atrophic gastritis will develop into precancerous or cancerous lesions in the future should be analyzed on a case-by-case basis according to the degree of atrophy of the lesions, and cannot be generalized. The current medical consensus is that although chronic atrophic gastritis can become cancerous, the cancer rate is very low (most studies have found that the cancer rate does not exceed 3%), so it cannot be said in general that chronic atrophic gastritis is the precursor and prologue of gastric cancer, and the two cannot be equated.
In recent years, scholars at home and abroad have done a lot of research on the relationship between chronic atrophic gastritis, H. pylori and gastric cancer, and found that the incidence of atrophic gastritis is high among people in areas with a high incidence of gastric cancer, but it is also related to the high incidence of H. pylori, whether it is H. pylori or atrophic gastritis that predisposes people to gastric cancer does not need to be strictly distinguished, the two often coexist and together lead to heterogeneous hyperplasia of the gastric mucosa, treatment of H. pylori It is also an aspect of the treatment of atrophic gastritis itself.
Atrophic gastritis must be reviewed
Although the cancer rate of chronic atrophic gastritis is very low, it is not unrelated to each other. In order to minimize the possibility of cancer, standardized treatment and review are needed, so active prevention and treatment is still necessary and desirable.
Chronic atrophic gastritis with incomplete colonic intestinal epithelial hyperplasia should be taken seriously and followed regularly for prevention. In order to monitor the dynamic changes of the lesion, gastroscopy should be reviewed regularly. In general, chronic atrophic gastritis (without significant intestinal epithelial hyperplasia and atypical hyperplasia) should be reviewed once every 3 years; incomplete colonic intestinal epithelial hyperplasia with mild atypical hyperplasia once a year; with moderate atypical hyperplasia once every 3 months; with severe atypical hyperplasia should be considered as cancerous and local lesions can be considered for excision or surgical removal to eliminate future problems.
Treatment of atrophic gastritis
1.General treatment
The general treatment of atrophic gastritis: quit smoking, avoid alcohol, avoid too salty, spicy, too hot, strong tea, coffee, eat more fresh vegetables and fruits. Prevention and treatment of H. pylori infection, standardized antibacterial therapy, and review. Establish good hygienic habits, meal sharing system, disinfection of tableware, treating family members together, etc.
2.Anti-Hp treatment
3.Weak acid treatment
Patients with low acidity or no acidity confirmed by pentagastrin test can take rice vinegar in appropriate amount, 1~2 spoons each time, 3 times a day; or 10% dilute hydrochloric acid 0.5~1.0ml, before or during meals, and pepsin combination, 10 ml each time, 3 times a day; also choose multi-enzyme tablets or pancreatic enzyme tablets to improve the symptoms of indigestion.
4.Inhibit bile reflux and improve gastric power
Biliary amines can complex the bile salts that reflux into the stomach to prevent bile acids from destroying the gastric mucosal barrier. Aluminum thioglycollate can combine with bile acid and lysolecithin, which can also be used to treat bile reflux. Ursodeoxycholic acid may also be given. Gastrodia, morpholine and cisapride can enhance gastric motility, promote gastric emptying, assist gastric and duodenal motility, prevent bile reflux, regulate and restore gastrointestinal motility.
5.Increase mucosal nutrition
Acacia leaf ester can increase the renewal of gastric mucosa, improve cell regeneration, enhance the resistance of gastric mucosa to gastric acid, and achieve the role of protecting gastric mucosa. It can also be used live blood; or choose thioglycollate, teprenone, allantoin capsules, raw gastrone, prostaglandin E, etc.
6.Chinese herbal medicine, dialectical treatment
Some people feel that atrophic gastritis is more stubborn and difficult to cure, in fact, the efficacy of poor treatment should also consider whether the treatment is standardized. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. The actual fact is that you will be able to get a lot more than just a few of the most popular and most popular ones.
The earlier the better: the sooner you find out about atrophic gastritis the better the treatment effect, if you do not adhere to the treatment or review, you have to wait until the appearance of intestinal epithelial hyperplasia and atypical hyperplasia to pay attention to is not self-deception, to know that mild, moderate atrophic gastritis by the treatment of most or reversible, and severe atrophic gastritis reversible very little. The probability of atrophic gastritis developing into gastric cancer is very low when adhering to standard treatment and review. The best way to avoid the chagrin of not even knowing about the cancer is to have regular review and treatment and review.