Helicobacter pylori, the only bacterium found to date in the human stomach. The prevalence of H. pylori infection in Chinese people is very high, over 56%. It has been proven that there is a correlation between H. pylori and gastric cancer, but it is not a certainty that you will get gastric cancer if you are infected with hp.
China is a large country with H. pylori, and more than half of the population are carriers of the bacteria. When some people find out they are carrying H. pylori, they will be worried and any small detail will be magnified infinitely, wondering if they have become a high-risk patient of stomach cancer.
So, what factors are associated with gastric cancer? Will one definitely get gastric cancer if infected with H. pylori? How to check and prevent the infection of hp?
We will explain this tumor with “Chinese characteristics” – gastric cancer.
The association between H. pylori and stomach cancer
There is a correlation between H. pylori and the occurrence of gastric cancer. In patients with early gastric cancer, the rate of H. pylori infection is high. People infected with H. pylori are almost four times more likely to develop gastric cancer than those who are not infected with H. pylori.
However, it does not mean that infection with H. pylori will definitely lead to gastric cancer because there are many strains of H. pylori, and patients may develop gastric cancer only if they are infected with a very virulent strain of the bacterium that has a high chance of causing cancer. H. pylori infection is also related to the immunity of the individual.
The occurrence of gastric cancer is the result of a combination of multiple factors and goes through a long process, generally speaking, it takes chronic superficial gastritis – atrophic gastritis – intestinal epithelial metaplasia – In general, it takes a slow process of chronic superficial gastritis – atrophic gastritis – intestinal epithelial hyperplasia – heterogeneous hyperplasia (atypical hyperplasia, intraepithelial neoplasia) – gastric cancer. Various pathogenic factors in the body of patients with the disease can act individually or synergistically in the above-mentioned stages, and H. pylori infection is not the only pathogenic factor of gastric cancer.
H. pylori mainly acts in the initiation stage of carcinogenesis, and it is the basis for the development of gastric cancer.
However, H. pylori infection does not directly cause mutation of cellular DNA and transformation of cellular phenotype in a person’s body, that is, H. pylori cannot directly cause cancer, but is only an accomplice of cancer. Some toxic substances secreted by H. pylori, such as ammonia and phospholipase, can damage the gastric mucosa, making it easier for various carcinogenic factors to act directly on the epithelial cells of the gastric mucosa. At the same time, the chemicals secreted by H. pylori can also directly promote cell division and increase the chance of cellular DNA mutation.
In clinical practice, a large number of people are infected with H. pylori, but few of these people develop gastric cancer. This is related to the above-mentioned reasons, but also to the individual patient’s resistance and susceptibility to H. pylori, as well as to the different infection outcomes that occur in the organism after H. pylori infection.
In addition, genetic factors, dietary habits, nutritional status, age, tobacco and alcohol stimulation, and other environmental factors may play a very important role in the complex pathophysiological process of H. pylori infection.
It is important to note that people infected with H. pylori should neither be nervous about it nor ignore it and let it develop. When a patient is found to have H. pylori infection and has symptoms such as stomach pain, bloating, acid reflux, belching, bad breath, burping, or a combination of superficial gastritis, erosive gastritis, gastric ulcer or gastric polyp, or when inflammatory infiltration of the gastric mucosa is detected, or when epithelial hyperplasia of the gastric mucosa, atrophy of the intrinsic glands, intestinal epithelial hyperplasia, or abnormal hyperplasia of the gastric mucosa glands are detected, they should be actively treated and regularly reviewed . Especially, patients with family history of gastric cancer should pay attention to avoid cancer.
High-risk groups of gastric cancer
1.People in regions with high incidence of gastric cancer in China, such as southeast coast and northwest region.
2.People who suffer from long-term gastric diseases, these people include: people with H. pylori infection, chronic atrophic gastritis, gastric ulcer patients, patients who have undergone partial gastrectomy in the past, patients with chronic hypertrophic gastritis, etc.
3.People with family history of gastric cancer, such as those who have gastric cancer in their immediate family, have a much higher probability of developing gastric cancer.
4.People with long-term bad habits: smoking, drinking alcohol, high salt diet, and like to eat pickled food.
Epidemiological findings show that patients infected with H. pylori have a higher risk of gastric cancer than those who are not infected with H. pylori, so for those who are positive for H. pylori, if they are accompanied by some high-risk pathogenic factors, such as chronic atrophic gastritis and other chronic gastric diseases, then they should undergo H. pylori eradication treatment.
A study showed that HP eradication can reduce the chance of developing gastric cancer by 39%.
【 To prevent gastric cancer, the first line of defense is timely removal of risk factors for gastric cancer. A study conducted in Linqu, Shandong Province for 15 years showed that Hp eradication could reduce the incidence of gastric cancer by 39%. Therefore, eradication of Hp is the most effective measure to reduce the occurrence of gastric cancer].
Since patients with gastric cancer do not have specific symptoms in the early stage, most of them are already in the middle and late stage when they visit the clinic. Early symptoms of gastric cancer are very similar to those of some benign diseases of the stomach: such as vague pain in the stomach, upper abdominal discomfort, constant feeling of fullness and indigestion, etc. These symptoms are easily ignored by patients and treated as chronic gastritis and other diseases. And once the more obvious symptoms appear, they often have already entered the middle and advanced stages of gastric cancer. Japan and Korea have conducted screening for nationals over 45 years of age, and the screening is conducted by means of annual gastroscopy. This makes it easier to detect and treat the disease at an early stage. However, such an approach is not suitable for widespread in China, and it is only recommended that high-risk people should undergo gastroscopy every 1 to 2 years to detect stomach tumors as early as possible.
TNM staging of gastric cancer
For tumor patients, we often use “early stage” or “middle to late stage” to describe the degree of malignant tumor lesions, but in fact, the staging is not so simple. Currently, the internationally accepted staging method for gastric cancer is to use TNM staging, which is to assess the extent of tumor lesions based on the primary lesion (T), lymph node metastasis (N) and the presence of distant metastasis (M); T refers to the size and depth of primary tumor invasion, N refers to the extent of lymph node dissemination, and M refers to the metastasis or spread of tumor to other tissues or organs in the body. . This staging method can make a more comprehensive assessment of the extent of tumor development, and at the same time can formulate corresponding treatment plans according to the staging and predict the prognosis of patients.
In the middle and late stages of gastric cancer, multidisciplinary comprehensive treatment is the key
In the treatment of gastric cancer, multidisciplinary and integrated treatment by surgery, internal medicine and radiotherapy is the key. In China, most of the patients are in the middle and late stages when they are diagnosed, so they need to work together through multidisciplinary teams to develop treatment plans to achieve the best outcome for patients. There are three main treatment modalities for gastric cancer: surgery, chemotherapy and radiotherapy. For early stage patients, surgery is the main treatment, while for progressive and advanced gastric cancer, surgery can be performed first, followed by adjuvant chemotherapy and radiotherapy, or radiotherapy can be used before surgery to further improve the curative effect of surgery and the prognosis of patients.
For patients who have metastasis, chemotherapy or radiotherapy can further shrink the tumor, and then they can be further evaluated to see whether the tumor has the possibility of resection, and if it can be resected, we will classify this part of patients as transformed surgical treatment, which can also achieve more satisfactory results. For patients with advanced disease, general surgical treatment does not benefit the patient, so generally we focus on chemotherapy. For this part of patients, the main purpose of treatment is to relieve symptoms, improve patients’ quality of life and prolong patients’ survival as much as possible.
After gastric cancer surgery: eat less and eat more and follow up regularly
After gastric cancer surgery, the stomach capacity is reduced, especially for patients who have received total gastrectomy, and the digestion and absorption ability is obviously weakened. For these patients, we suggest that patients should have small and many meals, avoid overeating, and at the same time, they should mainly have a fine and soft diet, 5-6 meals per day, which can make the food fully digested and absorbed. Within 2 years of gastric cancer surgery, patients need to visit the hospital once every 3 months for follow-up; within 3 to 5 years after surgery, they should visit the hospital once every 6 months; after 5 years after surgery, they should visit the hospital once a year for follow-up. The examination items mainly include clinical physical examination, hematological examination (including tumor index examination), chest X-ray and abdominal CT examination, etc. A follow-up endoscopy will be performed 1 to 2 years after surgery.
Detection of H. pylori
There are three types of diagnostic methods for H. pylori.
1, whistle detector test: this is one of the most advanced equipment for H. pylori detection, without intubation, only a gentle blow, you can find out the case of H. pylori (HP) infection, the “culprit” of gastric disease. It is simple, fast, highly accurate, non-invasive and non-cross-infecting. The former is relatively safe, while the latter is not suitable for children under 12 years old and pregnant women.
2.Immunological testing: H. pylori infection is detected by measuring H. pylori antibodies in serum, including complement binding test, agglutination test, passive hemagglutination assay, immunoblotting technique and enzyme co-adsorption assay.
3, direct examination of bacteria: the gastric mucosa is taken by gastroscopy forceps for direct smear, staining, tissue section staining and bacterial culture to detect H. pylori.
Once tested positive, eradication treatment should be under the guidance of physicians, generally commonly used quadruple therapy, 10-14 days to eradicate the bacteria.
How to effectively avoid infection with H. pylori?
1, avoid clustered infection with H. pylori
Prevention of H. pylori, should avoid family cluster infection of H. pylori. It is understood that the infection of H. pylori has the tendency to family aggregation characteristics. In addition, the probability of parents infecting their children is higher, and it is expected that H. pylori-infected people actively do a good job of preventing their families from being infected.
2, oral health must be maintained
Daily how to prevent H. pylori good? It is learned that H. pylori infection generally has bad breath and other oral problems, so for negative H. pylori infection, maintain oral health can not wait. This is how to prevent H. pylori in the future, padded with the appropriate prevention of the foundation.
3, prevention of H. pylori should not eat raw
Studies have confirmed that H. pylori can survive in tap water for 4-10 days and in river water for up to 3 years. Therefore, one of the main points of how to prevent H. pylori is not to drink raw water, should not eat raw, etc.
4, tableware should be disinfected regularly
In addition to regular disinfection of dishes and utensils, scratching serious tableware, but also to regularly eliminate the replacement. Especially weak children and the elderly, should try to use stainless steel dishes that can be sterilized at high temperatures to avoid the health effects of disease from the mouth.
5, try to implement meal sharing, avoid mouth-to-mouth feeding.