Atrophic gastritis, what to do?

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I recently met a friend who came for consultation with a pathology report of gastroscope and gastroscope biopsy in the outpatient clinic, and asked:

What medicine do I need for atrophic gastritis? Will it cause cancer?

Atrophic gastritis is a common digestive system disease and a type of chronic gastritis. Because of there is a certain probability of cancerous transformation, once diagnosed, patients are generally More worried, go to the doctor or believe in home remedies, secret recipes, etc.

So, can all atrophic gastritis be cancerous?

How should atrophic gastritis be treated and followed up?

What should I pay attention to in my daily diet?

Let’s learn together.

I. The relationship between atrophic gastritis and gastric cancer

Chronic atrophic gastritis, although a benign disease, can progress to intestinal metaplasia, dysplasia, and gastric cancer.

Atrophic gastritis is mostly stable, and the risk of canceration needs to be comprehensively judged according to the scope and degree of atrophy, Helicobacter pylori infection, age, and family history of gastric cancer. In short, the greater the extent of atrophy, the higher the degree of intestinal metaplasia, and the family history of gastric cancer, the higher the risk of developing gastric cancer.

The occurrence of gastric cancer is the result of multi-step and multi-factor evolution. The development of chronic atrophic gastritis to gastric cancer requires a long process of change.

Figure 3 Progression of atrophic gastritis to gastric cancer

Second, how to reduce atrophy or intestinal metaplasia

1. Antibacterial treatment of Helicobacter pylori

The occurrence of atrophic gastritis is closely related to Helicobacter pylori infection. For those who are positive for Helicobacter pylori, radical treatment of Helicobacter pylori is the most basic treatment for atrophic gastritis and intestinal metaplasia. Bacteria can reduce the degree of partial atrophy.

The lighter the atrophy, the greater the chance of the atrophic gastric mucosa returning to normal mucosa. Radical treatment of Helicobacter pylori cannot reduce the degree of intestinal metaplasia, but can delay the progress of intestinal metaplasia.

The current domestic anti-Helicobacter pylori treatment recommends a quadruple drug regimen: an acid-suppressing drug (such as omeprazole, lansoprazole, pantoprazole, rabe prazole, esomeprazole, ilaprazole) + two antibacterials (eg, amoxicillin, tetracycline, furazolidone, clarithromycin, metronidazole, levofloxacin) + one bismuth (commonly citrate Potassium bismuth citrate, colloidal bismuth pectin), the recommended antibacterial course of treatment is 14 days. After the course of treatment, all drugs are stopped for more than 1 month, and then the carbon 13 or carbon 14 breath test is repeated on an empty stomach to determine whether Helicobacter pylori is cleared.

2. Symptomatic treatment other than anti-Helicobacter pylori

Atrophic gastritis has no obvious symptoms in some people, and some people have symptoms such as epigastric discomfort, fullness, pain, loss of appetite, belching, acid regurgitation, nausea, and bitter mouth. Those with symptoms can Choose acid-suppressing drugs and/or prokinetic drugs (such as domperidone, mosapride or itopride, etc.) and/or digestive aids (such as compound digestive enzyme capsules, pancreatic enzyme enteric-coated capsules, etc.) according to the corresponding symptoms. Compound azinamide enteric-coated tablets, etc.) and (or) antacid and antibile drugs such as aluminum magnesium carbonate tablets and (or) anti-anxiety and sleep-promoting drugs, etc.

3. Other drug therapy

Drugs specifically for the treatment of atrophy or intestinal metaplasia currently have no evidence-based support. Common folic acid (if folic acid is low, supplementation can be considered), vitamin C or E, trace element selenium , Weifuchun, Morodan and other drugs have clinical applications, but they are controversial, and they still need sufficient evidence-based medical evidence to support them for better application.

4. Lifestyle adjustment

Atrophic gastritis and gastric cancer are the result of multiple factors. In addition to the above factors, lifestyles also need to be improved in coordination, such as diet, increasing the intake of fresh vegetables and fruits, protein It is recommended to focus on high-quality protein such as chicken, duck, fish, shrimp, etc., eat a light diet, low-salt diet, eat less or no pickled, smoked or fried food, avoid excessive coffee, heavy drinking, smoking, work and rest law.

5. Follow-up gastroscopy

For those who have developed atrophy and/or intestinal metaplasia, gastroscopic follow-up is also a very important part.

For patients with atrophic gastritis without intestinal metaplasia or dysplasia, gastroscopy and pathological examination can be done once every 1-2 years;

Patients with moderate or severe atrophy or atrophic gastritis with intestinal metaplasia were followed up with endoscopy and pathology every 1 year;

With low-grade cancer (intraepithelial neoplasia), but no visible lesions, 6-12 months follow-up gastroscopy and pathology;< /p>

If there are visible lesions, the gastroscope and pathology should be followed up once every 6 months according to the gastroscope and clinical conditions; high-grade cancer needs to be identified as soon as possible, and surgery or endoscopic resection should be performed after the diagnosis is made. .


In summary, the occurrence and development of atrophic gastritis are related to many factors such as lifestyle, Helicobacter pylori infection, age, heredity and other factors. Drug treatment and lifestyle improvement, removal of unhealthy factors, and attention to gastroscope and pathological follow-up to avoid the progression of atrophic gastritis to malignant lesions.

(Contributed by Pharmacist Zhang Xiaogang from the “Ask the Pharmacist” team)

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