Preventing Chronic Atrophic Gastritis and Intestinal Metaplasia: Important Steps to Avoid Stomach Cancer

Hong Eui-je, Chief of Gastroenterology, Gimhae Gospel Hospital

In Korea, where the incidence of stomach cancer is high, people over 40 must undergo a gastroscopy through a national screening. A commonly heard diagnosis after investigation is chronic atrophic gastritis and intestinal metaplasia. The prevalence of chronic atrophic gastritis is often reported to be 40-50%, and intestinal metaplasia is reported to be 20-30%.

So what are the commonly heard chronic atrophic gastritis and intestinal metaplasia? Exposure to alcohol, smoking, salty food, or Helicobacter pylori causes damage to the gastric mucosa. Initially, superficial gastritis occurs, limited to the surface of the mucosa, but if it continues, it will destroy the gastric glands, the mucosa becomes thinner, and blood vessels under the mucosa become visible. In the case of chronic atrophic gastritis, the risk of developing stomach cancer is about 6 times higher than in cases without chronic atrophic gastritis, making it meaningful as the first step in the progression of stomach cancer. Intestinal metaplasia is a condition in which chronic atrophic gastritis progresses and changes the structure of the stomach mucosa into the colon or small intestine mucosa. It is reported that if intestinal metaplasia progresses, the risk of ‘ development of stomach cancer up to 11 times higher.

If chronic atrophic gastritis or intestinal metaplasia is accompanied by heartburn or nausea, improvement of symptoms can be expected by taking gastric mucosa protectors, gastric acid suppressors, or gastric motility stimulators is not necessary on drug therapy. Instead, as mentioned earlier, it is important not to drink and smoke, improve eating habits by reducing the amount of salty or spicy food, and drinks containing caffeine, and testing and treating patients, especially when Helicobacter pylori is suspected.

Helicobacter pylori is a spiral-shaped bacterium that lives in the pyloric mucosa of the stomach and causes chronic inflammation of the gastric mucosa. Although the route of transmission is still unclear, it is known to transmitted mainly through the mouth and feces of people, and infection can occur from childhood.

In the case of gastric/duodenal ulcers, lymphoid tissue lymphoma associated with the gastric mucosa (MALT), early gastric cancer, and idiopathic thrombocytopenia, the Helicobacter pylori test is recognized as beneficial, but unfortunately, it is not recognized as an advantage in the case of chronic atrophic gastritis or intestinal metaplasia. However, if you have chronic atrophic gastritis or intestinal metaplasia, it is recommended to have an unpaid test because the treatment of Helicobacter pylori can prevent further progression is a partial benefit of 50%. Since it is recognized in %, it is important to undergo active tests if there is a family history and to undergo elimination treatment if Helicobacter pylori is found to be present.

At the same time, even if atrophic gastritis and intestinal metaplasia are seen on endoscopy and a Helicobacter pylori test is performed, but the results are negative, it is important to check for any changes or abnormalities in the mucous membrane through regular gastroscopy at least every 1 to 2. years.

In the case of chronic atrophic gastritis and intestinal metaplasia, as they occur over a long period of time, they are not easy to treat, and since they are associated with the risk of gastric cancer, there may be concerns that they go on gastric. However, improvement in eating habits, treatment of Helicobacter pylori, and regular gastroscopy examination If you remember and manage three things, you can prevent stomach cancer completely.