Hello everyone, I am Dr. Hu from the Department of Gastroenterology of ** Hospital. Today I would like to talk to you casually about chronic gastritis . Because I am in a hurry, I have not prepared any courseware. I will tell you what comes to mind. Please Forgive me!
Atrophic gastritis is very common among people of over 10 years old; almost one in every three people has it.
But some people are scared to death when they see "atrophic gastritis with intestinal metaplasia", thinking that once intestinal metastasis occurs, they are not far away from gastric cancer .
Today, I can tell you responsibly and clearly, it is far away. , don’t be afraid of , some don’t even need treatment!
Although the incidence rate of gastric cancer is relatively high, its progress does not happen overnight. It takes a long time and a variety of factors work together. The so-called "three feet of ice does not freeze in a day."
Only a very small number of general chronic gastritis and atrophic gastritis may develop into gastric cancer.
The relationship between gastritis and gastric cancer is very complicated. Time is tight today, so I will just talk about it briefly. Although
is simple and popular, the ins and outs are still explained clearly.
Let’s first talk about where gastric cancer comes from?
Today we will not talk about specific gastric cancer. After all, the probability of that is very low. Let’s focus on the most common gastric cancer, which accounts for 90% of gastric cancers, called “intestinal gastric cancer”.
It is generally believed that the development process of this kind of gastric cancer is:
chronic superficial gastritis → chronic atrophic gastritis → intestinal metaplasia → atypical hyperplasia → gastric cancer → metastatic cancer .
is also commonly known as [The Four Steps of Gastric Cancer].
There is nothing wrong with the process mentioned above, but each link requires the participation of many factors and will take a long time. It cannot be achieved overnight, and it is not necessary to follow this path.
From chronic gastritis to intestinal metaplasia is not an inevitable process.
From intestinal metaplasia to dysplasia is not an inevitable process.
From atypical hyperplasia to gastric cancer, it is not an inevitable process either.
In this development chain, we can block it as long as we actively check , actively standardize treatment, and improve our living and eating habits.
What is atrophic gastritis?
Atrophic gastritis is a chronic digestive system disease in which the ruffled walls of the gastric mucosa become smoother, the mucosal layer becomes thinner, and the glands that secrete digestive juices decrease.
Under gastroscopy, you can see that the gastric mucosa turns white and blood vessels are exposed. Pathological examination may see the disappearance or reduction of glands, or the occurrence of intestinal metaplasia, dysplasia, etc.
Atrophy can be focal or whole stomach.
Because the reduction of glands affects the digestive function, it often manifests as upper abdominal pain, fullness, belching, loss of appetite, weight loss, anemia, etc. It is not easy to distinguish it from superficial gastritis. Some patients have no obvious symptoms.
The diagnosis of atrophic gastritis is mainly based on the pathology report.
There are many reasons for atrophy, such as age, Helicobacter pylori infection, drug stimulation, bad living habits, autoimmune factors, genetics, etc.
Among them, the incidence of atrophic gastritis increases with age, and the severity of the disease becomes more severe. Therefore, some people believe that chronic atrophic gastritis is the degeneration of the gastric mucosa in middle-aged and elderly people, and is a "semi-physiological" phenomenon.
Let’s talk about intestinal metaplasia
If you detect intestinal metaplasia today, will you get gastric cancer the day after tomorrow? No such thing.
Gastric cancer is mainly caused by Helicobacter pylori infection, bad living habits, bad habits, etc.
Chronic gastritis appears first. If treatment is not paid attention to, it will gradually worsen and the gastric mucosa becomes thinner, even the glands that secrete digestive juices. It will disappear or decrease. Under gastroscopy, the gastric mucosa will appear white and blood vessels will be exposed. At this time, many symptoms will appear, such as fullness, pantothenic acid, and not wanting to eat.
At this time, if it is not treated, it will be further aggravated. ;
I went for gastroscopy and pathology and found intestinal metaplasia!
Because intestinal metaplasia is indeed a precancerous lesion (now called a precancerous state, and the real precancerous lesion is atypical hyperplasia), people who don't know what is going on will be scared to death.
Actually, you don’t need to be too nervous:
Intestinal transformation is actually a self-protection and repair mechanism of our body, but we just used the wrong materials when repairing it.
You have gastritis, and if you don’t repair it, your body will repair it on its own;
When the body repairs itself, for many reasons, it should use gastric cells instead of intestinal cells. This is the intestine. change!
Let’s use another analogy. Your house is a tile house, and a tile is broken on the roof. But the poor mason took a handful of straw to repair it. It looks very inconsistent.
Gastroscopy and biopsy pathology
A. Chronic superficial gastritis (physiological); B, chronic superficial gastritis (HP+); C, chronic atrophic gastritis; D, intestinal metaplasia
However, it itself is still a normal cell morphology and has not occurred. Heteromorphic changes”, just growing in the wrong place.
Strictly speaking, it is just a state that may develop into cancer, but to develop into gastric cancer, it usually has to go through the stage of atypical hyperplasia.
This is nothing serious, it just doesn’t look good! The chance of developing stomach cancer is very small, smaller than your chance of winning a multi-million-dollar lottery jackpot.
So don’t worry about intestinal metaplasia. In many cases, it has the same symptoms and treatment strategies as atrophic gastritis.
Atrophic gastritis is usually detected at the same time as intestinal metaplasia. However, there are also cases where there is no atrophy but intestinal metaplasia? What's going on?
is very simple, just a matter of inspection. The piece of
shrank but was not caught; the piece of
shrank and also transformed into the intestines. During the examination, intestinal cells were found.
There is another reason, that is, intestinal transformation has not occurred.
This is very important. When doing a gastroscopy, try not to refuse the biopsy recommended by the doctor.
Because the little bit of meat we remove has to be handed over to the pathology department. The pathologist can look more carefully under the electron microscope . Is it cancer or ? Is there intestinal metaplasia, atypical hyperplasia, etc.?
Finally, let’s talk about atypical hyperplasia
Atypical hyperplasia is also called dysplasia, atypical hyperplasia, or intraepithelial neoplasia. Basically it's all the same thing.
Just by looking at the name, you can tell that the shape of the cells has undergone "atypical" changes , which is very close to the appearance of cancer cells.
It is generally divided into three grades: mild, moderate and severe, or high-grade intraepithelial neoplasia and low-grade intraepithelial neoplasia..
In mild cases, the cell abnormalities are limited to the lower half of the epithelium, while in moderate to severe cases, it indicates that the cytological lesions are widespread but there is no obvious evidence of infiltration.
Although they are not cancer yet, they are typical precancerous lesions.
At this time, gastric cancer is really not far away! How far is
? Only one step away!
Therefore, once the word "gastroscopy pathology" appears, not only should the living habits be improved and active treatment be given, but more importantly, the doctor should be listened to and regular gastroscopy reviews should be carried out.
Once it is found that it has progressed to "severe dysplasia" or "high-grade intraepithelial neoplasia", we can "remove" this layer of mucosa that is about to deteriorate under endoscopy, commonly known as "peeling the skin off". ", the professional term is "ESD", endoscopic mucosal dissection ; no surgery is required
As long as timely review is carried out, active treatment is given, and bad eating habits are changed, a person who deserves to live to be 100 years old can live longer than that. Ninety-nine.
In short, there is no need to worry too much about atrophic gastritis. It is a very common chronic disease. By the age of 50 or 60, almost two-fifths of people have it;
It’s just that some people have never had a gastroscopy. , I don’t know if there is;
Or a gastroscopy was performed but no biopsy was taken;
Or a biopsy was taken, but the atrophic area was not taken.
I suggest that all of you who have not had a gastroscopy take the time to do one, and it is best to take one. Biopsy.
"Treat if there is any, and encourage if there is none", don't adopt the ostrich policy of "out of sight, out of mind";
Because many people are not afraid of getting an examination, but are afraid of accepting the examination results:
What if it is cancer? Just like a child with poor grades, he is always afraid of the teacher reading his grades.
In fact, whether you check it or not, it is there...
If it is early-stage cancer, more than 90% of it can be cured. Cancer is a narrow escape;
If early cancer is found, wouldn’t it save your life?
The last question: Can atrophic gastritis be cured?
It is generally believed that mild to moderate intestinal metaplasia is possible after standard treatment and removal of the cause. Reversal (cured);
Once dysplasia occurs, it is irreversible; some doctors say that mild dysplasia may also be reversed;
Even if it cannot be reversed, as long as it does not progress, it is the best treatment. But. Remember:
review gastroscopy regularly! This is very important.
Treatment principles:
It is generally considered that simple and mild atrophic gastritis, accompanied by mild intestinal metaplasia, and asymptomatic, does not require treatment as long as Helicobacter pylori is eradicated. Pay attention to improving living habits and regular gastroscopy. Yes;
For those with symptoms, in addition to removing the cause mentioned above, symptomatic treatment is also required to control the symptoms;
For those with atypical hyperplasia, in addition to eradicating Helicobacter pylori, they also need to control bile reflux and symptomatic treatment. The most important thing is close regular gastroscopy + pathological biopsy review.
Finally, my suggestion:
. Gastroscopy is the first choice for stomach discomfort;. Check for Helicobacter pylori and kill it if there is any; it is not only the culprit of gastric cancer, but also related to dozens of diseases; it is also easily transmitted to you. Family;
3. If intestinal metaplasia occurs, Helicobacter pylori must be killed. If it is killed, there will be no symptoms and no treatment is needed; a gastroscopy should be done once every one to two years;
4. In case of atypical hyperplasia, this is necessary Attention, gastroscopy is done every six months! Moderate to severe atypical hyperplasia can be evaluated by experts and undergo endoscopic ESD to prevent future problems.
5. In addition, it is also important to quit smoking and drinking, and eat more fruits and vegetables. Also, don't get angry, relieve stress, sleep well, and exercise appropriately.
6. If you are really too worried, you can also try traditional Chinese medicine, such as traditional Chinese medicine decoction, Chinese patent medicine, etc.;
The current treatment plan for intestinal metaplasia in Western medicine is very simple and helpless, and there is no particularly good method. What I know is Morodan + folic acid , plus vitamin B12, etc.
If you choose traditional Chinese medicine and take decoctions, you may have more choices. If it is a reliable Chinese medicine doctor, the effect will be very good. There are many reports that TCM syndrome differentiation treatment can reverse intestinal metaplasia and mild to moderate dysplasia.
Thank you, I can finish my speech. If you don’t understand anything, you can call me or go to the hospital to see me directly.
Thank you everyone!
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