atrophic gastritis
Introduction
Introduction to atrophic gastritis Chronic atrophic gastritis, referred to as (CAG), also known as atrophic gastritis, is a common disease, the World Health Organization listed it as a pre-cancerous state, especially with intestinal metaplasia or dysplasia, the possibility of cancer Bigger. Its pathogenesis is slow, the disease is lingering, it is difficult to heal, and the treatment is difficult. The name of the disease is no atrophic gastritis in the medical literature of the motherland. It belongs to the category of "stomach pain" and "blood distension" in the motherland medicine, because of chronic atrophic gastritis, to the stomach The spleen is full of pain, or the spleen is full without pain. There are still a few patients with no obvious symptoms. Therefore, the Third Spleen and Stomach Academic Conference of the National Association of Chinese Medicine believes that the syndrome differentiation of chronic atrophic gastritis can be attributed to the stomach sputum syndrome. basic knowledge The proportion of the disease: 0.02% (16 to 30 years old suffering from atrophic gastritis accounted for 9%) Susceptible people: no special people Mode of infection: non-infectious Complications: stomach cancer
Cause
Cause of atrophic gastritis
Helicobacter pylori (Hp) infection (25%):
Hp can be cultured in the gastric mucosa of 60% to 90% of patients with chronic gastritis. In 1986, the eighth session of the World Gastroenterology Society proposed that Hp infection is one of the important causes of chronic gastritis.
Immunity factor (15%):
In atrophic gastritis, especially in the blood, gastric juice or plasma cells of the atrophic mucosa in patients with gastric gastritis, wall cell antibodies or endogenous antibody antibodies are often found, so the autoimmune response is considered to be the cause of atrophic gastritis.
Physical factors (10%):
Clinical statistics show that the incidence of this disease is significantly positively correlated with age. The older the age, the worse the "resistance" of the gastric mucosa is, and it is easily damaged by external adverse factors.
Genetic factors (10%):
The status in the pathogenesis of type A atrophic gastritis has been confirmed, and the positive rate of PCA and IFA is high in family members of pernicious anemia, and atrophic gastritis is common.
Metal contact (5%):
The incidence of gastric ulcer in lead workers is high, and the incidence of atrophic gastritis is also increased by gastric mucosal biopsy. In addition to lead, many heavy metals such as mercury, copper and zinc have certain damage to the gastric mucosa.
Eating habits (10%):
Smoking, drinking, food stimulation, drugs that damage the gastric mucosa.
Radiation (5%):
Radiation treatment of ulcer disease or other tumors can damage or even atrophy the gastric mucosa.
Prevention
Atrophic gastritis prevention
1. The foods to be eaten should be fresh and nutritious, ensuring adequate protein, vitamin and iron intake. Eat on time, do not overeating, do not eat cold or overheated food, do not use less or less irritating condiments such as fresh spicy powder.
2, control drinking, do not smoke, to avoid damage to the gastric mucosa of nicotine; avoid long-term use of anti-inflammatory painkillers, such as aspirin and corticosteroids, etc., to reduce gastric mucosal damage.
3, for superficial gastritis should adhere to treatment.
4, regular inspection, if necessary, for gastroscopy.
5, in case of increased symptoms, weight loss, anorexia, black feces, etc. should go to the hospital in time.
Complication
Atrophic gastritis complications Complications
Severe atrophy with severe intestinal epithelial dysplasia or metaplasia, due to increased likelihood of cancer, should be highly vigilant, close follow-up.
Symptom
Atrophic gastritis symptoms Common symptoms Painful dull pain Qiqi stomach Chronic hemorrhage Upper gastrointestinal bleeding constipation Tongue bile reflux Glucan anemia Pseudo-pyloric metaplasia
The clinical manifestations of chronic atrophic gastritis are not only lack of specificity, but also not completely consistent with the degree of disease. Clinically, some patients with chronic atrophic gastritis may have no obvious symptoms, but most patients may have upper abdominal burning, pain, and bluntness. Pain or fullness, suffocation, especially after eating, loss of appetite, nausea, belching, constipation or diarrhea, severe cases may have weight loss, anemia, crisp nails, glossitis or tongue nipple atrophy, a small number of gastric mucosal erosion Those may be associated with upper gastrointestinal bleeding, in which type A atrophic gastritis complicated with malignant anemia is rare in China, there is no specific sign of this disease, and there may be mild tenderness in the upper abdomen.
Examine
Examination of atrophic gastritis
Endoscopic findings of chronic atrophic gastritis are as follows:
(1) The color of the gastric mucosa becomes lighter: it is light red, grayish yellow, and the person is grayish or grayish blue. It may be diffuse or localized with plaque distribution. The surrounding boundary is unclear and can be expressed as red and white. Interphase, mainly white, it is the earliest manifestation of mucosal atrophy.
(2) submucosal vascular permeability: mucosal atrophy can be seen under the submucosal vessels, dark red reticular small blood vessels in the mucosa can be seen in the early stage of atrophy, and the blue dendritic veins in the mucosa can be seen in severe cases, and the blood vessels are exposed to chronic atrophic gastritis. Important endoscopic features, but it should be noted that when the stomach is over-inflated at the bottom of the normal stomach and the intragastric pressure is too high, the gastric mucosa can penetrate the vascular network.
(3) The mucosal folds are small or even disappear. When the gas is injected into the stomach, the folds disappear quickly. After the air is removed, the folds recover slowly, and the secretions in the stomach are less, sometimes the mucous membranes are dry and the reflection is weakened.
(4) When chronic atrophic gastritis is associated with glandular neck transitional hyperplasia or intestinal metaplasia, the mucosal surface is rough and uneven, granular or nodular, sometimes showing the formation of pseudopolyps, while the characteristics of submucosal vessels are often revealed. It is covered, and the microscopic observation under the microscope can initially determine the intestinal metaplasia, but it must be confirmed by gastric mucosal pathological examination.
(5) The atrophic mucosa is increased in fragility, easy to bleed, and may have erosive lesions.
(6) Chronic atrophic gastritis can be accompanied by the manifestations of chronic superficial gastritis, such as hyperemia and erythema, adhesion of mucus, and enhanced reflection. If superficial gastritis is changed, superficial atrophic gastritis is called chronic Atrophic gastritis changes mainly, it is called atrophic superficial gastritis.
Diagnosis
Diagnosis and differentiation of atrophic gastritis
Differential diagnosis
The degree of shrinkage can be divided into three levels:
Mild: The superficial gland of the antrum is focally atrophied and reduced, while the large and small curved glands are normal.
Moderate: The antrum and small curved glands have atrophy, reduction, and the range of cut is mild.
Severe: most of the antrum is atrophied and reduced, only a few residual glands remain, large and small bends and abdomen gland atrophy; or the mucosa is significantly thinner, the original gland completely atrophy, disappear, and replaced by metaplasia Gland.
A, B type atrophic gastritis identification:
According to the site of atrophic gastritis, combined with immunological changes, including autoimmune tests and serum gastrin determination, Strick land divides atrophic gastritis into A and B types.
Type A atrophic gastritis is an autoimmune disease, which is positive for autoantibodies. Because autoimmune damage occurs in parietal cells, the lesions are heavier in the body of the stomach, and the glands are destroyed and atrophied, so the function of gastric acid secretion is significantly reduced. Acid-free, and thus lead to increased serum gastrin levels, and finally develop into gastric atrophy, VitB12 in food can be combined with the internal factor (IF) secreted by parietal cells into an internal factor vitamin B12 complex, which helps Vit B12 Absorption, in the serum of patients with type A atrophic gastritis can be found in the internal factor antibody (IFA), mainly IgG, there are binding and blocking type, combined IFA can be combined with internal factor or internal factor vitamin B12 complex Combined, blocking IFA blocks the binding of internal factors to vitamin B12, which affects the absorption of vitamin B12. Type A patients often have pernicious anemia (16%), and 60% of them have blocked IFA, and China is atrophic. Gastritis is mainly found in the antrum of the stomach, and occurs in the corpus, which is consistent with the rare cases of pernicious anemia in China.
Type B atrophic gastritis is not an immune disease, and its autoantibodies are negative. Its pathogenesis is related to duodenal fluid reflux or other chemical and physical damage. The mucosa of the antrum is more permeable than the mucosa of the stomach (H+ inverse diffusion). The antrum of the antrum is 20 times stronger than the bottom of the stomach. Because the mucosal barrier of the antrum is smaller than other parts, it is susceptible to the reflux of the duodenal juice and its contents, so the antrum is most susceptible. Gastric body lesions are light, so the gastric acid function is generally normal, the gastric antrum lesions damage the G cells in the pyloric gland, gastrin secretion is reduced, so the general serum gastrin level is low, the atrophic gastritis cancer is B type Mainly, its canceration process can last for more than 10 years or more.
