Atrophic gastritis is only 4 steps away from gastric cancer. How to effectively diagnose and treat it to contain it in the cradle?

Only for medical professionals to read and refer to the wonderful sharing, not to be missed! According to a study from Sweden, the risk of gastric cancer in patients with chronic atrophic gastritis (CAG) is 4.
5 times that of the normal population
.

Once diagnosed with gastric cancer, the mortality rate of gastric cancer is high, and the prognosis is poor.
In severe cases, it will affect the patient's quality of life
.

Therefore, accurate diagnosis, early intervention, and regular follow-up of CAG have positive clinical significance for the prevention of gastric cancer
.

At the 21st National Gastroenterology Academic Conference of the Chinese Medical Association this year, Professor Tang Xudong from Xiyuan Hospital of the Chinese Academy of Chinese Medical Sciences explained the update of CAG and precancerous lesions
.

There are many classifications of CAG and precancerous lesions, and the following points should be avoided in diagnosis! According to the Correa model of intestinal gastric cancer, the pathological pattern of gastric cancer is: normal gastric mucosa-chronic inflammation-CAG-intestinal metaplasia-low-grade intraepithelial neoplasia (LGIN)-high-grade intraepithelial neoplasia ( HIGN)-gastric cancer
.

Among them, the cancer risk of CAG, LGIN and HIGN increased in turn
.

Figure 1: Correa model of intestinal gastric cancer Professor Tang Xudong introduced to you that there are many ways to classify CAG and precancerous lesions, such as the WHO in 1978, the WHO digestive system tumor two classification method in 2010, the vienna classification in 1998, and the 2000 vienna revision and so on
.

At present, precancerous lesions in China often use a five-class classification system: 1.
No intraepithelial tumors, that is, normal tissue and non-neoplastic lesions, 2.
Uncertain intraepithelial tumors, 3.
Low-grade intraepithelial tumors, 4.
High-grade epithelial tumors Internal tumor, 5.
Cancer
.

Figure 2 Domestic classification of gastric precancerous lesions The clinical diagnosis of CAG and precancerous lesions mainly relies on upper gastrointestinal examination combined with pathological diagnosis
.

However, the diagnosis of CAG and precancerous lesions in China currently has the following problems: 1.
There are few standard endoscopic biopsies and the diagnosis rate of gastric precancerous lesions is low
.

2.
The diagnosis level varies greatly across the country, and the diagnosis level in underdeveloped areas is low
.

3.
Diagnosis of dysplasia and intraepithelial neoplasia is not standardized in various regions, and "dysplasia" and "dysplasia" are mixed; at the meeting, Professor Tang Xudong introduced that atypical hyperplasia should not be used to describe gastric precancerous lesions.
Atypical hyperplasia can be used when describing cells Use, such as dysplastic cells
.

4.
Dichotomy of dysplasia (intraepithelial neoplasia) and uncertain diagnostic criteria for dysplasia (intraepithelial neoplasia) are not used
.

Correct risk assessment and reasonable monitoring will help reduce the risk of cancer.
Professor Tang Xudong introduced CAG risk assessment methods at the meeting, including Japanese serum ABCD method, Japanese kimura-takemoto classification, and gastritis evaluation (OLGA) system or Gastritis Evaluation System (OLGIM) based on intestinal metaplasia
.

At present, the international recommendation is to use OLGA/OLGIM to assess the severity of gastric mucosal atrophy, and to stratify the risk of gastric cancer in patients, which is helpful for the monitoring and follow-up of atrophy
.

Among them, stage III and IV in the OLGA/OLGIM system are high-risk patients with gastric cancer
.

Figure 3 OLGA and OLGIM staging system for clinical monitoring of CAG patients with medium to high risk.
The Chinese Chronic Gastritis Consensus (2017, Shanghai) recommends that CAG patients with moderate to severe atrophy and intestinal metaplasia should be followed up once a year
.

Patients with chronic atrophic gastritis without intestinal metaplasia or intraepithelial neoplasia can be followed up as appropriate
.

Those who are accompanied by low-grade intraepithelial neoplasia and prove that the specimens are not from cancer, according to the endoscopic and clinical conditions, the follow-up is shortened to about 6 months
.

High-grade intraepithelial neoplasia needs to be confirmed immediately, and endoscopic or surgical treatment is performed after confirmation
.

At the meeting, Professor Tang Xudong also shared with you the comparison of the detection system of gastric precancerous lesions in Japan (Kyoto Consensus) and Europe (MAPSH).
The main difference between the two lies in the choice of detection method and the difference in detection cycle.
The specific content is shown in Figure 4 Shown
.

In contrast, the monitoring of precancerous lesions of the stomach in Europe is lower than the domestic monitoring
.

Figure 4 The difference between the Kyoto Consensus and the MAPSH detection system for gastric precancerous lesions.
CAG and the evaluation of the efficacy of precancerous lesions are equally important! The diagnosis and treatment of CAG is mainly based on determining whether it is associated with inflammation, precancerous lesions, and other causes, and then individualized treatment is performed for the cause
.

At present, the treatment methods for CAG and gastric precancerous lesions (MAPS) include: 1.
Eradication of Helicobacter pylori
.

2.
COX-1 or COX-2 inhibitor
.

3.
NSAIDs (such as aspirin) can reduce the risk of non-cardiac cancer
.

4.
Rebate
.

5.
Traditional Chinese medicine treatment (the study of Morodan in the treatment of gastric precancerous lesions is cited in the 2019 European Guidelines)
.

6.
Low-dose vitamins (A, C, E)
.

7.
Surgical or endoscopic treatment (high-grade intraepithelial neoplasia)
.

After CAG patients are treated, it is also very important to evaluate their efficacy
.

At the meeting, Professor Tang Xudong introduced that the current efficacy evaluation of CAG and precancerous lesions mainly focuses on the following aspects: 1.
The quality of biopsy
.

2.
Whether the biopsy sites are the same before and after
.

Figure 5 Gastric mucosal calibration biopsy technology 3.
Whether the pathological diagnosis is standardized (removal, embedding, film reading, etc.
)
.

4.
Whether the curative effect evaluation target is reasonable
.

5.
CAG and intestinal metaplasia, background lesions and cancer risk assessment
.

6.
Whether there is precise positioning of dysplasia and early treatment
.

Summary: At the end of the meeting, Professor Tang Xudong concluded: At present, we still need to focus on atrophic gastritis with dysplasia as the research object, taking into account type III intestinal metaplasia and uncertain dysplasia, and attaching importance to gastric body and total gastric atrophy and intestinal metaplasia
.

And it is necessary to establish a pathological-based comprehensive curative effect evaluation method, and carry out long-term treatment and follow-up for patients with CAG and gastric precancerous lesions, and pay attention to the long-term curative effect
.