Clinic story: Lao Zhang suffers from chronic gastritis. He thinks about “ten people and nine stomachs”, but he doesn’t pay much attention to it, and he doesn’t regularly return to the clinic. Recently, Lao Zhang always felt upper abdominal pain and belching. He went to the gastroenterology department of the hospital for treatment. The doctor suggested that Lao Zhang check the gastroscope. Lao Zhang got his own gastroscope report and found that the above diagnosis was “chronic atrophic gastritis”. Lao Zhang couldn’t help but feel nervous, and many questions came to his mind, “I heard that atrophic gastritis is easy to get stomach cancer? Is it really serious for me? What should I do?”
Term Explanation
Chronic atrophic gastritis
Chronic atrophic gastritis is a type of chronic gastritis, which refers to the reduction of intrinsic glands caused by repeated damage to the gastric mucosal epithelium, often accompanied by intestinal metaplasia and A chronic gastric disorder with/or dysplasia.
Some people have no obvious symptoms, while others may experience symptoms of indigestion, weight loss, and anemia such as abdominal pain, acid regurgitation, and abdominal distension.
In fact, atrophy does not mean that the entire stomach becomes smaller, but the mucosal layer of the stomach becomes thinner.
Helicobacter pylori infection is the main cause
With the acceleration of social life, continuous high pressure, frequent social activities and irregular work and rest have led to the occurrence of many digestive system diseases, among which Chronic atrophic gastritis is one of the “regulars”. The causes of chronic atrophic gastritis include:
■Helicobacter pylori infection: The most important factor in chronic gastritis is Helicobacter pylori infection. The World Health Organization has classified Helicobacter pylori infection as a carcinogenic factor.
■Bile reflux: Bile reflux can damage the gastric mucosal barrier and weaken the mucosal repair function, leading to the occurrence of chronic atrophic gastritis. Old age, weakened gastric motility, smoking, etc. may be the causes of bile reflux.
■Vitamin deficiency: Studies have shown that vitamin B12, folic acid deficiency, and long-term Helicobacter pylori infection in patients with atrophic gastritis can inhibit the secretion of vitamin C from the gastric mucosa, and make vitamin C effective against oxygen free radicals and nitrite. Decreased clearance, thereby aggravating the severity of chronic atrophic gastritis.
■Immune factors: Atrophic gastritis of gastric body is related to autoimmunity.
■Lifestyle: Long-term overheating, high-salt diet, and low intake of fruits and vegetables are associated with the occurrence of chronic atrophic gastritis, and the relationship with alcoholism is unclear.
Atrophic gastritis is not necessarily cancerous
This is the most common misunderstanding. With the popularity of the Internet, many patients diagnosed with atrophic gastritis will equate it with gastric cancer , so anxious.
Generally speaking, the development of most gastric cancers follows the following rules: non-atrophic gastritis → atrophic gastritis → intestinal metaplasia → dysplasia → carcinoma.
It can be seen that the development of chronic atrophic gastritis to gastric cancer requires two stages of intestinal metaplasia and dysplasia. It often takes several years or even decades to develop to gastric cancer. In fact, only a very small percentage of atrophic gastritis may develop into gastric cancer (about 1%). Only those with moderate to severe atrophic gastritis with moderate to severe intestinal metaplasia or dysplasia have a significantly increased risk of gastric cancer.
Atrophic gastritis should be checked regularly by gastroscope
Considering the condition, convenience and economy of the patient, the following follow-up time should be followed according to different situations:
■Atrophic gastritis Patients with gastritis without intestinal metaplasia and dysplasia can undergo endoscopy and pathological follow-up every 1 to 2 years;
■Patients with mild to moderate dysplasia should undergo gastroscopy every 6 months;
■Patients with severe dysplasia should undergo immediate surgery or endoscopic treatment to remove the lesions after diagnosis;
■Asymptomatic does not mean that the disease has not progressed, and the above principles should also be followed.
There is currently no specific drug that can definitively reverse atrophic gastritis or prevent it from developing into gastric cancer. It is more certain that the elimination of Helicobacter pylori can reduce the proportion of atrophic gastritis that develops into gastric cancer.
Reminder
■Irrespective of the cause, all patients should quit smoking and drinking;
■Avoid the use of drugs that damage the gastric mucosa Irritant food and drink, such as too sour, too sweet, too salty, spicy, hot, too cold food, as well as strong tea, coffee, etc., should eat a regular diet, eat less fried, smoked, pickled food, do not eat Eat rotten and spoiled food, and eat more fresh vegetables and fruits;
■ Regularly eat three meals a day, avoid too fast and too full; Work and live under stressful conditions;
■Exercise properly. (Liu Ziyu, Xuanwu Hospital, Capital Medical University)