How to treat chronic atrophic gastritis

Chronic atrophic gastritis (CAG) is a digestive system disease characterized by atrophy of the gastric mucosal epithelium and glands, a decrease in number, thinning of the gastric mucosa, thickening of the mucosal base, or pyloric metaplasia and intestinal metaplasia, or atypical hyperplasia. Compared with non-atrophic gastritis, patients with atrophic gastritis have a correspondingly increased risk of gastric cancer. It is currently considered a precancerous disease of gastric cancer and needs to be taken seriously. This article will help you understand chronic atrophic gastritis.

1. What is chronic atrophic gastritis

Chronic atrophic gastritis is a type of gastritis characterized by chronic inflammation of the gastric mucosa, followed by atrophy and metaplasia of the intrinsic glands of the gastric mucosa, and then intraepithelial neoplasia. Helicobacter pylori (Hp) infection is the most important cause of chronic atrophic gastritis. Dietary factors and mental factors are key factors in inducing chronic atrophic gastritis.

2. Clinical symptoms of chronic atrophic gastritis

1. Indigestion: Common indigestion symptoms include flatulence, acid reflux, nausea, belching, hiccups, abdominal distension, etc. The above symptoms may worsen after meals.

2. Abdominal pain: Patients with atrophic gastritis will experience abdominal pain, mainly dull pain in the upper and middle abdomen.

3. Gastric bleeding: If the condition of atrophic gastritis is serious, patients may experience symptoms of gastric bleeding, including black stools, vomiting blood, etc.

4. Decreased appetite: The patient will not want to eat, and will not be interested in the food he usually likes.

3. Treatment measures for chronic atrophic gastritis

1. Change your lifestyle

Maintain a regular life and a good mood. Maintain a regular diet, eat more fresh vegetables and fruits, high-quality protein, a light and low-salt diet, eat less or avoid pickled, smoked and fried foods. You should also quit smoking and drinking to reduce the damage of nicotine to the gastric mucosa; appropriate exercise, such as running, skipping rope, swimming, etc., can improve gastrointestinal blood circulation, promote gastrointestinal motility and digestive function, and relieve the discomfort caused by the disease; maintain a good attitude, avoid long-term mental tension and anxiety, so as not to aggravate the condition, and stay optimistic to stimulate the recovery of the disease.

2. Regular follow-up

1. For patients without intestinal metaplasia and dysplasia, gastroscopy and pathological follow-up should be performed once every 1-2 years;

2. Patients with moderate to severe atrophy or intestinal metaplasia should be followed up once every year;

3. Patients with mild dysplasia should be followed up every 6 months;

4. Patients with moderate dysplasia should be followed up every 3 months;

5. Patients with severe dysplasia need to undergo another gastroscopy and pathological histological confirmation, and then receive endoscopic or surgical treatment after confirmation.

3. Drug treatment

HP eradication treatment, acid suppression or antacid treatment, gastric mucosal protectants, gastric motility promoters, and digestive enzyme supplementation. For patients who are positive for Helicobacter pylori (Hp), HP eradication is the most basic treatment for chronic atrophic gastritis, which can reverse atrophy and delay the progression of intestinal metaplasia. A follow-up study in Shandong, China showed that HP eradication can reduce the risk of gastric cancer by 39%. According to the consensus opinion on HP in my country, it is recommended to use a quadruple therapy consisting of any one of PPI (esomeprazole, rabeprazole, lansoprazole, omeprazole, pantoprazole, ilaprazole) + any one of bismuth (potassium citrate bismuth, colloidal pectin bismuth) + any two of antibacterial drugs (amoxicillin, furazolidone, metronidazole, tetracycline, levofloxacin), with a course of 14 days.

4. Endoscopic or surgical treatment

For patients with chronic atrophic gastritis, surgery can only be performed when the condition reaches a certain level. Generally, surgical treatment can be considered in two situations. One is atrophic gastritis combined with severe atypical hyperplasia, and the other is patients with severe or recurrent bleeding that is difficult to control by internal medicine. These two types of patients need surgical treatment, and the effect of surgical treatment is relatively good. They can be treated through endoscopic mucosal resection, endoscopic mucosal stripping, endoscopic radiofrequency ablation and other surgeries.

The above are some common treatment methods for patients with chronic atrophic gastritis. We need to understand the cause of chronic atrophic gastritis, and early detection, early diagnosis, and early treatment will help improve the condition. We must also insist on taking medication actively and maintain healthy living and eating habits to avoid recurrence of the disease.

Author: Peng Qi, Peng Gang, Sun Dan, Longmatan District People's Hospital