Only the whole stomach, atrophic gastritis, intestinal metaplasia only need to monitor the follow-up gastroscopy

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Because part of the stomach cancer is in atrophic gastritis, intestinal metaplasia, based on the development, so many patients with high ten

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Because part of the stomach cancer is in atrophic gastritis, intestinal metaplasia, based on the development, so many patients with high tension, every year review of gastroscope. In fact, only a few involve the whole stomach "atrophic gastritis, intestinal metaplasia of the patients need regular gastroscopy follow-up supervision, and those who are very common, only in the antrum" atrophic gastritis, intestinal metaplasia is without follow-up.

Atrophic gastritis, intestinal metaplasia is a new cell (intestinal metaplasia) in which the normal gastric mucosa is destroyed (atrophy), white cell infiltration (inflammation), and the appearance of intestinal epithelial cells under various conditions. The main cause of atrophic gastritis and intestinal metaplasia is the infection of Helicobacter pylori (Helicobacter pylori, HP). Atrophic gastritis, intestinal metaplasia occurs in most of the parts of the gastric antrum, a few can affect the whole stomach. There is no significant correlation between the clinical feeling and the severity of the disease, that is, people who have obvious stomach trouble are actually atrophic gastritis and intestinal metaplasia. The eradication of Helicobacter pylori infection and gastric antrum of mild to moderate atrophic gastritis, intestinal metaplasia "can be completely restored to normal (severe will involve the whole stomach), which involved the whole stomach, atrophic gastritis, intestinal metaplasia is not easy to fully repair, few can be further developed into gastric cancer. Therefore, the eradication of Helicobacter pylori infection and the whole stomach involved in the "atrophic gastritis, intestinal metaplasia," regular follow-up monitoring of patients with gastric cancer prevention and treatment of the two major strategies.

The methods to confirm the infection of Helicobacter pylori include 13/14C- urea breath test, serum antibody test, rapid enzyme test and biopsy pathology.

To confirm the "reliable method of atrophic gastritis, intestinal metaplasia is full range gastric biopsy, namely gastroscopy in biopsy of the lesion, but also were in the gastric antrum, gastric body size of at least 4 parts of the bending of a piece of tissue for pathological examination. If 4 are showing atrophic gastritis, intestinal metaplasia "shows the whole stomach involvement, if only occurred in the antrum that is distributed (Note: for the community, to the stomach angle can be divided into the small intestine after gastric antrum and the esophageal gastric body of two parts).

Determination of serum pepsinogen I:II ratio will also help find involving the stomach "atrophic gastritis, intestinal metaplasia". Therefore, it is necessary to select the objects that need to be examined by gastroscopy and gastric biopsy. Pepsinogen I by secretion of gastric mucosa and pepsinogen II by gastric mucosa and duodenum mucosa secretion. Under normal circumstances, the secretion of I was much higher than that of II. "Atrophic gastritis, intestinal metaplasia involving stomach, secretion of I and II is still severely reduced by duodenal secretion, thus, pepsinogen I:II ratio will be decreased.

In June 2011, 24 European countries jointly issued the "precancerous disease / precancerous lesion treatment guide" is worthy of our reference [1], the guidelines, endoscopic biopsy of atrophic gastritis, intestinal metaplasia and recommended every 3 years to review the first endoscopic, occurs only in the gastric antrum of mild and moderate atrophic gastritis, intestinal metaplasia without follow-up. Helicobacter pylori infection should be eradicated. Not recommended COX-2 inhibitors or dietary supplementation with antioxidants (ascorbic acid and beta carotene) cancer, their effect is not exact.

Reference

M. Dinis-Ribeiro, M. Areia, A. C. de Vries, et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) 2012. Endoscopy. January; 44 (1): 74 - 94

 

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