Gastroscopy is the most intuitive way to diagnose stomach diseases. Gastroscopy is the most visual inspection method for stomach diseases, especially the most ideal medical instrument for diagnosing early tumors of esophagus and stomach. However, since gastroscopy is an invasive examination, the gastroscope has to enter the patient’s body cavity, which can cause mild discomfort during operation. What kind of examination instrument is gastroscopy? In layman’s terms, gastroscopy is a small camera installed at the head end of a hose, which can project the internal mucosa of the upper gastrointestinal tract on the monitor for the doctor’s diagnosis, and the hose can also be extended to a small biopsy forceps to sample suspicious lesions for pathological examination and analysis. Many patients and friends think that stomach pain is a minor disease, take some medicine to reduce the symptoms as the standard of cure, gastroscopy is delayed again and again, while the disease is repeatedly attacked, more and more aggressive, often until the emergence of complications when the determination to check, when the stomach disease has often progressed to advanced malignant lesions, regret too late. The reason for this is that people “demonize” the discomfort of doing gastroscopy, making patients afraid of gastroscopy. In fact, with the rapid development of medical technology, gastroscopy, like blood and urine routine has been a universal routine examination, gastroscopy tube diameter gradually reduced, more soft, the examination to the patient brought less and less pain, is a convenient, reliable and effective means of clinical examination. The 5mm diameter nasogastroscope and intravenous anesthesia gastroscope have made gastroscopy painless. Therefore, patients with stomach, esophagus and back discomfort must undergo gastroscopy in a timely manner according to their condition and doctor’s recommendations, and should not wait until their condition deteriorates before considering gastroscopy. 2, why to review the gastroscopy “gastric disease”, including chronic superficial gastritis, chronic atrophic gastritis, gastric ulcer, duodenal ulcer, etc.. These “old gastric diseases” may have been clearly diagnosed with gastroscopy, but why after a period of time, gastroscopy, which is mainly based on the following aspects of the reasons. (1) Gastroscopy is intuitive and accurate. The gastroscopy operator can directly observe the changes in the patient’s gastric mucosa through the gastroscope, including mucosal congestion, edema, the extent and nature of the lesion. In general, a clear diagnosis can be made directly through gastroscopy. In addition, pathological sampling and histological examination can be accurately performed under direct vision for lesions that cannot be clearly diagnosed. Therefore, the accuracy of gastroscopy in the diagnosis of gastric disease is not replaced by any other examination methods. (2) Observe the progress of gastric disease or the efficacy of treatment. After the diagnosis of chronic gastric disease has been determined after a period of treatment, it is necessary to understand the changes in the condition, whether it is aggravation or improvement, in addition to the conscious symptoms, the most reliable basis is the gastroscopy review. (3) Observe the complications. Patients with “old stomach disease” may have this or that complication. For example, ulcer disease may present with pyloric obstruction, upper gastrointestinal bleeding or cancer. Gastroscopy should be performed if a patient is clinically suspected of having a complication to clarify the diagnosis, and sometimes endoscopic treatment is available. (4) Tracking precancerous diseases and precancerous lesions. Gastric ulcer, atrophic gastritis, remnant stomach (after major gastrectomy), gastric polyp and intestinal hyperplasia, and atypical hyperplasia are called precancerous diseases and precancerous lesions because of the possibility of gastric cancer. Regular gastroscopic review is necessary for these diseases. Especially for patients with moderate or severe gastric mucosal atypical hyperplasia, regular gastroscopy review is clinically necessary. Endoscopic follow-up, biopsy and cytological examination of precancerous gastric diseases and pre-cancerous lesions to detect asymptomatic early gastric cancer are of great significance for cancer prevention. From the above discussion, it is easy to understand the reason why gastroscopy is needed for old stomach diseases. 3. How to treat H. pylori infection? The prevalence of H. pylori infection among adults in China is about 50-60%, and increases with age. Not all people with H. pylori infection need H. pylori eradication. People for whom eradication treatment is recommended are those with chronic gastritis with established upper gastrointestinal symptoms, family history of gastric cancer in first-degree relatives (parents, siblings, children), peptic ulcer (gastric ulcer or duodenal ulcer) or previous history of peptic ulcer, and those with established more severe chronic gastritis such as chronic atrophic gastritis, especially with enterocolitis or atypical hyperplasia. It is recommended that if no treatment is needed, do not test for H. pylori, so as not to find out instead of the normal psychological burden. 4, whether children need to eradicate H. pylori? Adolescents under 13 years of age generally do not need H. pylori eradication treatment unless there is a definite disease associated with H. pylori infection. The reasons are as follows: 1) high recurrence rate after eradication in children, 2) antibiotics interfere with the intestinal microecology and are not conducive to the establishment of immune function for normal development of the digestive tract in children, and 3) antibiotics have other safety risks. 5. Is atrophic gastritis close to gastric 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 inflammation and atrophy accompanied by intestinal hyperplasia and atypical hyperplasia. Only those patients with atrophic gastritis accompanied by high-level intestinal chemosis and atypical hyperplasia have a higher chance of developing gastric cancer. 6. Can gastric mucosal atrophy be treated well? With the increase of age, the decrease of gastric mucosal glands (that is, atrophy) is a normal physiological phenomenon. Therefore, a certain range and degree of atrophy of gastric sinus mucosa is inevitable. Age-related mild to moderate atrophy is a normal accompaniment of aging, like wrinkles on the skin, and will not be completely reversed, nor does it need to be completely reversed. For excessive (beyond age-related) atrophic changes, some degree of recovery will occur with the reduction of inflammation as long as the cause, such as H. pylori, is removed. 7.What is intestinal metaplasia? Can it become cancerous? In a sense, intestinal metaplasia is a phenomenon of adaptation to the local environment (bile acid, inflammatory activity), i.e. mild small intestine type metaplasia is not harmful. The risk of further malignancy exists only if the etiology (e.g. H. pylori, bile acids, inflammation, etc.) persists, damage occurs continuously, and intestinal metaplasia worsens or presents unstable large intestine type metaplasia. 8.What are atypical hyperplasia, endothelial endomatosis, and heterogeneous hyperplasia? Is it scary? Atypical hyperplasia, intraepithelial neoplasia, and heterogeneous hyperplasia are all concepts of the same meaning. It is the phenomenon of unstable hyperplasia with the risk of malignant transformation. Mild atypical hyperplasia, low-grade intraepithelial neoplasia, and mild heterogeneous hyperplasia require aggressive treatment and endoscopic follow-up (generally requiring review within 1 year). For patients with severe atypical hyperplasia, severe heterogeneous hyperplasia or high-grade intraepithelial neoplasia, minimally invasive endoscopic treatment (e.g. ESD) is generally recommended. 9. Are acid inhibitors safe for long-term use? Proton pump inhibitors have a good safety profile. No evidence of promoting carcinoid or gastric cancer has been found with long-term use. However, long-term use can increase the chance of lung infection and increase the risk of osteoporosis, among other concerns.