The second lecture of expert interpretation of "Clinical Expert Consensus on Gastrointestinal Mucosa Protection"!

*For medical professionals to read and refer to.
Pay attention to the protection of the mucosal barrier and standardize the treatment of mucosal damage
.

The gastrointestinal mucosa covers the entire gastrointestinal tract and plays an important physiological role
.

The head of the Gastrointestinal Hormone and Mucosal Barrier Research Group of the Chinese Medical Association Gastroenterology Branch, led by Professor Li Jingnan of Peking Union Medical College Hospital, referred to a large number of domestic and foreign literatures, and wrote the first domestically based on the joint discussion of many domestic experts and professors.
Focusing on the expert consensus on total gastrointestinal mucosal protection, in December 2021, the "Clinical Expert Consensus on Gastrointestinal mucosal protection" (hereinafter referred to as the "Consensus") was released
.

The consensus discusses the three major parts of gastrointestinal mucosal barrier and protection, gastrointestinal mucosal injury and related diseases, classification and rational application of mucosal protective agents, and provides authoritative guidance for the clinical use of gastrointestinal mucosal protective agents, and serves as a standard for standardizing the use of gastrointestinal mucosal protective agents.
The diagnosis and treatment of gastrointestinal mucosal protection in China is of great significance
.

In order to help clinical medical workers deeply understand the content of the consensus, the "medical community" specially invited a number of experts to share relevant knowledge in a series
.

In the last issue, four experts reviewed the background and significance of the "Consensus", the physiological role of the gastrointestinal mucosa, and the main points of protection, and received extensive attention and comments
.

In this issue, we have invited Professor Li Jingnan, the corresponding author of the consensus, to give a further in-depth interpretation of the consensus
.

 Expert introduction The protection of the gastrointestinal mucosal barrier requires urgent attention to the gastrointestinal mucosa covering the entire gastrointestinal tract, which plays an important physiological role
.

Professor Li Jingnan said that the digestive tract is the largest organ in the human body that communicates with the outside world
.

As the largest barrier organ in the human body, the gastrointestinal mucosa is composed of mechanical barriers, chemical barriers, immune barriers and biological barriers, and the secretion of various hormones is also closely related to the barrier function of the gastrointestinal mucosa
.

As the first domestic expert consensus focusing on the protection of the whole gastrointestinal mucosa, the "Consensus" mainly expounds three aspects.
The first aspect is the gastrointestinal mucosal barrier and protection, focusing on the gastric mucosal and intestinal mucosal barriers.
features and functions, including a total of 9 statements
.

In addition, because the damage of the mucosal barrier can lead to diseases, the second aspect of the consensus is the occurrence of gastrointestinal mucosal damage and related diseases, a total of 7 statements, covering Helicobacter pylori (HP) infection, drug-induced , stress, psychology and many other representative diseases
.

We know that the rational application of drugs is very important for mucosal barrier protection.
The third aspect of the "Consensus" elaborates the classification and rational application of mucosal protective agents with 9 statements, in order to standardize the application of clinical mucosal protective agents
.

Professor Li Jingnan said that although the gastrointestinal mucosa seems to be a whole, the barrier protection mechanisms of the gastric mucosa and the intestinal mucosa are not exactly the same
.

There are many previous studies on the damage and protection of gastric mucosa.
In addition to focusing on gastric mucosa, the "Consensus" also focuses on the damage mechanism and barrier protection of intestinal mucosa, especially the small intestinal mucosa
.

The protection of the gastric mucosal barrier is mainly related to the acidic barrier, junctions between epithelial cells and the composition of gastric juice.
The theory of the imbalance between gastric mucosal damage and defense factors is the current classic theory, that is, when the mucosal damage factors are greater than the defense factors, acid-related mucosal damage may occur.
such as peptic ulcers
.

In recent years, studies have found that the number of parietal cells in Asian populations is less than that of Western populations, and the maximum secretion of gastric acid is lower than that of Western populations.
Therefore, for Asian populations, impaired mucosal defense and repair functions are the main reasons for acid-related mucosal damage
.

The intestinal mucosal barrier is mainly based on the blocking effect of the special structure of mucus and intestinal epithelial cells on the direct contact between pathogenic microorganisms and the intestinal mucosa.
In addition, the immune barrier and microbial barrier also participate in the maintenance of the intestinal mucosal barrier to a certain extent
.

Professor Li emphasized that various factors can lead to damage to the gastrointestinal mucosal barrier.
In addition to paying attention to attack factors, the protection of the mucosal barrier is also worthy of attention
.

The release of the "Consensus" will help raise the focus on barrier protection and help standardize the clinical application of mucosal protective agents
.

Mucosal damage is closely related to the occurrence of diseases.
The gastrointestinal mucosa is a watershed between the internal and external environment of the body, and the integrity of the mucosa plays an important barrier role
.

Damage to the mucosal barrier is a common pathogenesis of digestive tract diseases, which may not only lead to erosion and ulcers, but also cause gastrointestinal motility and digestion and absorption disorders, or intestinal microecological abnormalities
.

While paying attention to attack factors, we should also pay more attention to the function of our own mucosal barrier
.

Impairment of barrier function is closely related to almost all gastrointestinal diseases
.

At the same time, various factors such as physical and chemical, infection, stress, and psychology can lead to damage to the gastrointestinal mucosal barrier
.

For example, after the epidemic was isolated at home, many patients developed gastrointestinal symptoms such as acid reflux, belching, indigestion, etc.
, which may be related to nervousness, anxiety and irregular diet during the stay at home
.

The essence of HP infection is that bacteria break through the defense barrier in the stomach, triggering immune and inflammatory responses to induce mucosal damage
.

In addition, there are many chronic diseases and elderly patients in China.
Long-term use of various drugs including non-steroidal anti-inflammatory drugs (NSAIDs), antiplatelet drugs, glucocorticoids and chemotherapy drugs may also cause damage to the gastrointestinal mucosa and cause intestinal mucosal damage.
damage
.

In addition, for inflammatory bowel disease, regardless of its etiology, it is ultimately intestinal mucosal damage, and its barrier dysfunction is also an important aspect of the pathophysiological mechanism and clinical manifestations of inflammatory bowel disease.
Mucosal damage can lead to mucosal barrier damage, which can further Induces mucosal inflammation
.

In other words, the final manifestation of inflammatory bowel disease is also mucosal barrier damage
.

Although reflux esophagitis is related to acid, the final outcome is that the esophageal mucosa is damaged by the stimulation of acid.
Therefore, we say that from the esophagus to the stomach to the small intestine to the colon, mucosal damage is a common pathophysiology of different diseases.
Basically, no matter what the cause of the injury is, the result is damage to the mucosal barrier and damage to the mucosal tissue
.

The occurrence and development of gastrointestinal diseases are closely related to the damage of the mucosal barrier, and the final outcome of gastrointestinal diseases is the damaged mucosal barrier.
Therefore, how to strengthen the barrier function and protection is very important for the prevention and treatment of diseases
.

In recent years, proton pump inhibitors (PPIs) and anti-Helicobacter pylori regimens and immunotherapy have made great progress in the treatment of gastrointestinal diseases
.

While paying attention to damage factors, more attention should be paid to and strengthened mucosal barrier protection and treatment
.

It is hoped that with the help of consensus, colleagues can pay attention to the largest mucosal barrier organ, and pay attention to the function and integrity of the barrier, so as to have a more comprehensive understanding of the pathogenesis of the disease and better diagnosis and treatment of the disease
.

The main purpose of the release of the "Consensus" to regulate the application of mucosal protective agents and assist in disease management is to remind clinicians to pay attention to the function and protection of the mucosal barrier.
The integrity of the barrier function is of great significance to the prevention of diseases
.

Mucosal barrier damage is the common pathological basis of various digestive diseases such as chronic gastritis, peptic ulcer, gastroesophageal reflux disease, drug-induced gastrointestinal injury, and inflammatory bowel disease
.

According to the pharmacokinetic mode of action, mucosal protective agents can be divided into exogenous and endogenous mucosal protective agents
.

Exogenous mucosal protective agents, such as various aluminum-magnesium agents and bismuth agents, mainly play a protective role in gastric mucosa by promoting mucus secretion and increasing bicarbonate; they are usually not absorbed by the human body, and play a short-term effect by forming a covering film on the lesion.
protective effect
.

Endogenous mucosal protective agents such as teprenone mainly function by stabilizing cell membranes, increasing submucosal protective factors, increasing mucosal blood flow, and anti-oxidation.
They can usually be absorbed by the body and promote the synthesis of endogenous prostaglandins.
And the release of growth factors to change the mucosal blood flow, so as to protect and repair the gastric mucosa
.

Teprenone increases the content of nitric oxide synthase and nitric oxide in mucosal tissue, promotes the synthesis of local endogenous prostaglandins, and upregulates the expression of heat shock protein 70, thereby achieving the dual role of defense and repair of mucosal damage
.

In addition, it can also be used in combination with PPI, folic acid and other drugs to improve the curative effect, and has good safety
.

Studies have shown that patients with chronic atrophic gastritis treated with teprenone for 1 year can significantly improve mucosal histological lesions
.

While paying attention to attack factors, we should also pay more attention to the function and protection of our own mucosal barrier
.

In clinical practice, it has been observed that in the treatment of some patients with abdominal distension or abdominal discomfort but no acid regurgitation, the use of PPI will aggravate the symptoms of the patients.
The reason is that these patients may have minor damage to the mucosal barrier.
Protective therapy to improve symptoms
.

Studies have shown that in the treatment of erosive gastritis caused by various etiologies, the efficacy of mucosal protective agents is comparable to that of PPI; the efficacy of mucosal protective agents is better than that of PPI in relieving symptoms such as abdominal distension and belching
.

For the above situation, in actual clinical work, the first choice of most doctors is acid suppressant, and the dosage of mucosal protective agent is much lower than that of PPI (the dosage of mucosal protective agent occupies the second position)
.

In fact, PPIs also have a series of problems.
For example, clinical studies have shown that PPIs may increase the risk of NSAID-induced small bowel damage
.

The Canadian Society of Gastroenterology also pointed out that the use of NSAIDs and the moderately increased risk of gastrointestinal complications should pay attention to the use of mucosal protective agents
.

PPIs in combination with misoprostol or teprenone can prevent and treat NSAIDs-related gastric and small bowel injury
.

Animal studies on drug-induced small intestinal mucosal injury by endogenous mucosal protective agents have shown that teprenone can protect the small intestinal mucosa of rats by increasing the content of mucin, the content of mucosal vascular endothelial growth factor, and reducing free radical damage.
Intestinal mucosal protection from loxoprofen sodium-induced ulcer risk and small intestinal epithelial barrier damage
.

In the treatment of gastrointestinal mucosal injury, in addition to eliminating damaging factors, mucosal protection should also be enhanced
.

Clinical studies have shown that the combination of teprenone and other mucosal protective agents (bismuth, sucralfate, beraprost) with different mechanisms can more significantly improve gastric mucosal inflammation with fewer adverse reactions
.

Summary: The mucosa is the first-line barrier for the body to resist the invasion of pathogens and maintain the stability of the internal environment.
The integrity of the gastrointestinal mucosa is very important to the body
.

The "Consensus" elaborated on the gastrointestinal mucosal barrier and protection, gastrointestinal mucosal injury and related diseases, classification and rational application of mucosal protective agents with 25 statements, which facilitated the standardized management of mucosal protection
.

Clinicians are advised to pay more attention to barrier function
.

Too little to see enough? Don't worry~Professor Zhang Bingyong will continue to bring us a wonderful interpretation of "Consensus" on May 3, not to be missed! Click the link below to view the in-depth interpretation of the previous excellent article "Clinical Expert Consensus on Gastrointestinal Mucosa Protection" - the official lecture! Reference: [1] Clinical Expert Consensus on Gastrointestinal Mucosa Protection (2021, Fuzhou) [J].
Chinese Journal of Digestion, 2021, 41(12):798-806 Statement: This content is only for Chinese medical and health professionals, It is intended to provide scientific information, and only to healthcare professionals, for personal study and reference
.

If you are not a healthcare professional, please do not participate or spread
.

- End - This article is only used to provide scientific information to medical professionals and does not represent the platform's position
.