Chronic atrophic gastritis is also known as atrophic gastritis. It is a pathological change in which the intrinsic mucosal glands atrophy or even disappear after repeated damage to the gastric mucosal surface, and thickening of the mucosal muscle layer is common. The disease is one of the common diseases of the digestive system, and the incidence of chronic gastritis is very high in the general population in China, with atrophic gastritis accounting for 13.8% of the number of people examined. Chronic atrophic gastritis is mostly caused by the failure or mismanagement of chronic superficial gastritis. The World Health Organization classifies it as a precancerous state of the stomach, especially if it is accompanied by intestinal epithelial hyperplasia or atypical hyperplasia, which is more likely to become cancerous. The name of atrophic gastritis does not exist in the literature of Chinese medicine, but belongs to the category of “stomach pain” and “abdominal distension” in Chinese medicine, because chronic atrophic gastritis is characterized by painful fullness of the spleen in the stomach and epigastric region, or fullness of the spleen without pain, and there are still a few patients without obvious symptoms, so The National Chinese Medicine Association’s Third Academic Conference on Spleen and Stomach believes that chronic atrophic gastritis can be classified as “gastric bloating”, as far as atrophic gastritis is concerned.
I. The degree of atrophy, which can be divided into three levels.
Mild: the superficial glands of the gastric sinus are focally atrophied and reduced, while the size of the curved glands are normal.
Moderate: the gastric sinus and small curved glands are atrophied, reduced, and cut a wider range than mild.
Severe: most of the atrophy of the gastric sinus p reduced, only a few of the original glands remain, large p small curved and curved glands atrophy; or significant thinning of the mucosa, the original glands completely atrophied p disappeared, and replaced by chemotaxis glands.
Second, chemosis: refers to the intrinsic glands of various parts of the gastric mucosa, into other types of gastric glands or intestinal glands, such as intestinal epithelial metaplasia pyloric gland metaplasia.
1, intestinal epithelial metaplasia: refers to any kind of gland of the gastric mucosa becomes a gland of the small intestine, most commonly in the pylorus, gastric sinus, followed by expansion to the small bend p large bend p gastric body part, intestinal epithelial metaplasia is divided into small intestinal gland metaplasia and large intestinal gland metaplasia, the difference between them lies in the large intestinal gland metaplasia has Pan’s cells.
2, pseudopyloric gland metaplasia: is a change that occurs when the gastric body and fundic glands atrophy, if the biopsy is taken from the gastric body, the pyloric gland is seen in the mucosa, it can be considered as metaplasia, especially from the mucosa of the greater curvature, if the pyloric gland is seen, it can definitely be metaplasia.
3.Atypical hyperplasia: It refers to the abnormal tissue structure of the gland on the basis of hyperplasia, i.e. the heterogeneity of tissue structure. The atypical hyperplastic glands are often focally distributed and generally have a clear demarcation with the surrounding glands, sometimes, only a few glands have atypical hyperplastic changes.
Carcinoma
Etiology: The etiology of chronic atrophic gastritis has not been understood so far and may be related to the following factors.
1, the continuation of chronic superficial gastritis: chronic atrophic gastritis can develop from chronic superficial gastritis. The PLA General Hospital and six other hospitals reported 164 cases of superficial gastritis after 5 to 8 years of follow-up observation, of which 34 cases turned into chronic atrophic gastritis (20 .7%). The causes of chronic superficial gastritis can be the causative and aggravating factors of chronic atrophic gastritis.
2, genetic factors: chronic atrophic gastritis patients among the first generation of relatives, the incidence of chronic atrophic gastritis significantly higher, the incidence is 20 times greater than the control group, indicating that chronic atrophic gastritis may be related to genetic factors.
Polmer called it excretory gastritis. In addition to lead, many heavy metals such as mercury, tellurium, copper and zinc have certain damaging effects on the gastric mucosa.
4, radiation: radiation therapy ulcer disease or other tumors, can make the gastric mucosa damage or even atrophy.
5, iron deficiency anemia: some scholars believe that gastritis is the primary cause, because gastritis gastric acid low iron can not be absorbed or due to gastric bleeding so that the formation of anemia; another opinion that the first anemia, because the body iron deficiency in the gastric mucosa renewal rate is affected and prone to inflammation.
6, biological factors: such as chronic hepatitis, tuberculosis, etc.
7, physical factors: the occurrence of the disease is positively correlated with age.
8, bile or duodenal fluid reflux: due to pyloric sphincter dysfunction or after gastrojejunostomy, bile or duodenal fluid can reflux into the stomach and destroy the gastric mucosal barrier, prompting H?+ and pepsin to backscatter into the mucosa causing a series of pathological changes, leading to chronic superficial gastritis, and can develop into chronic atrophic gastritis.
9, immune factors: in patients with atrophic gastritis within the blood, gastric juice is often detected within the wall cell antibodies or antibodies to internal factors.
The most important factor is that the patient’s blood and gastric juices are often infected with H. pylori, which is an important cause of chronic gastritis.
In addition, such as improper diet, long-term addiction to alcohol and tobacco, drug abuse to damage the gastric mucosa, as well as after major gastrectomy, gastric secretion of the gastric sinus region removed, resulting in gastric mucosa nutritional disorders, etc., are likely to lead to damage to the gastric mucosa and atrophy, inflammatory changes.
Fourth, general treatment
1, eradicate H. pylori: as long as the atrophic gastritis must first eradicate H. pylori, eradication of H. pylori must be standardized treatment, note: triple therapy for a week program has been eliminated, to follow the latest Wellspring consensus program to sterilize, can be better with Chinese medicine.
2, folic acid: is currently the only Western medicine that certainly has a role in the treatment of atrophic gastritis, telomerase is a common marker of many tumors (including gastric cancer). Folic acid reverses CAG blocking the occurrence of gastric cancer because it can inhibit the activity of telomerase.
In recent years, the medical community has found folic acid to be effective in the treatment of atrophic gastritis, and many patients have benefited from it to avoid cancer. However, there are some misconceptions about the relationship between folic acid and atrophic gastritis.
Myth 1: Folic acid can be taken whenever there is atrophic gastritis
Folic acid has a therapeutic effect on patients with atrophic gastritis and is also available for those with mild heterogeneous hyperplasia. However, those with moderate heterogeneous hyperplasia should be cautious, and endoscopy and pathology should be reviewed in a timely manner; once severe heterogeneous hyperplasia is detected, the mucosal tissue should be removed under gastroscopy or surgical treatment should be performed as soon as possible to avoid further deterioration into gastric cancer. In addition, the efficacy of folic acid is poorer in those with warty changes (a kind of chronic elevated erosive changes).
Myth 2: Atrophic gastritis can be treated with folic acid only
Chronic atrophic gastritis often occurs with symptoms such as bloating, early satiety, belching, epigastric pain or heartburn, etc. Folic acid is clearly not enough to solve these problems and should be combined with the application of prokinetic, acid-inhibiting or neutralizing drugs. When there is H. pylori infection, it should be eradicated promptly, not only to facilitate the relief of symptoms, but also to remove one of the triggers for the development of gastric cancer. That said, folic acid alone does not resolve the many symptoms of atrophic gastritis. High doses of folic acid alone may also lead to vitamin B12 deficiency, so it is usually used in conjunction with vitamin B12 in clinical practice.
Myth 3: Folic acid can be taken in high doses without restriction
Although folic acid is a water-soluble vitamin with few side effects, the safety of long-term high doses remains to be further observed. For example, it can affect the absorption of zinc and cause loss of appetite.
Myth 4: Folic acid can cure stomach cancer
This is absolutely wrong. Folic acid only has a preventive effect on some gastric cancers that develop from atrophic gastritis, but it is definitely not a “cure” for gastric cancer. Moreover, once a tumor is detected in any organ in the body, no matter benign or malignant, folic acid should not be taken because it may promote the growth of tumor cells. Here, we especially emphasize that if you experience unexplained wasting, do not take folic acid orally for the treatment of atrophic gastritis without ruling out malignant tumors. Be sure to use the medicine under the guidance of a doctor.
V. Symptomatic treatment.
Some power drugs can be used for abdominal distension, some mucosal protective agents can be used for erosion, and some neutralizing or acid inhibiting drugs can be used for excessive gastric acid as appropriate.
Six, special treatment
1, Chinese medicine characteristic treatment: At present, Western medicine has no effective way to atrophic gastritis, Chinese medicine treatment has become a powerful weapon for the treatment of atrophic gastritis. The concept of Chinese medicine in treating atrophic gastritis is to invigorate blood circulation, eliminate swelling and disperse nodules. The blood-activating and stasis-removing drugs are divided into the following categories.
2, endoscopic characteristic treatment: for Chinese medicine treatment after 3 to 6 months atrophic gastritis or intestinal epithelial hyperplasia, mild heterogeneous hyperplasia did not disappear can be considered endoscopic treatment, for atrophic gastritis without obvious augmentation should be based on clinical experience to determine the atrophy site for endoscopic treatment, if there are warty augmentation is easy to determine the site, treatment methods are microwave, thermal probe electrocoagulation, argon knife, The specific choice is based on the extent and scope of the lesion, such as a larger scope or heterogeneous hyperplasia can be considered endoscopic mucosal resection, if the scope is not large and only atrophic gastritis or intestinal epithelial hyperplasia can be treated with microwave, thermal probe electrocoagulation or argon knife.
The majority of atrophic gastritis can be cured through the above mentioned features of comprehensive treatment.