Atrophic Gastritis Is a Precancerous Lesion of Gastric Cancer

Atrophic gastritis is a chronic gastritis with complex causes. It is generally thought that Helicobacter pylori infection and long-term use of proton pump inhibitors (PPIs) may be related to atrophic gastritis. Acid-suppressing drugs such as omeprazole and lansoprazole are PPIs; PPIs usually carry the suffix "-prazole." Long-term use may not only induce atrophic gastritis but also intestinal metaplasia, both precancerous lesions of gastric cancer. Therefore such drugs must be taken according to medical advice and not used long-term. Clinicians treating gastric patients should also avoid long-term PPI use where possible.

In atrophic gastritis, the number of parietal cells in the gastric mucosa decreases. The intrinsic factor secreted by parietal cells binds vitamin B12 from food in the gastric lumen into a complex, protecting B12 from enzymatic breakdown in the intestine and promoting its absorption in the ileum for erythropoiesis. Patients with chronic atrophic gastritis therefore have impaired vitamin B12 absorption and may develop pernicious anemia.

Besides intrinsic factor, parietal cells also secrete gastric acid, so atrophic gastritis patients have reduced gastric acid. Insufficient acid slows digestion of food (especially protein), causing bloating, early satiety, acid regurgitation or diarrhea; this makes it hard for atrophic gastritis patients to digest high-protein food, and over time can cause iron-deficiency anemia.

Gastric acid also kills bacteria; many bacteria ingested with food are cleared by acid. Reduced acid removes this natural barrier against harmful microbes, allowing bacteria to thrive in the stomach.

The cancer risk of chronic atrophic gastritis is 0.5%-10%, and there is no definitively effective treatment. Patients therefore need a gastroscopy every 1-2 years, which serves to screen for and detect early gastric cancer. But gastric cancer usually has multiple causes; the cancer risk of simple atrophic gastritis is only about 0.5%-1%. If the patient also has H. pylori infection and unhealthy dietary and lifestyle habits, the cancer risk rises substantially.

H. pylori infection can be treated with quadruple therapy at a hospital gastroenterology department. Habits linked to gastric cancer include eating very hot food, high-salt and pickled foods, hot pot and barbecue, spicy and greasy food, alcohol, smoking, and irregular sleep schedules. By adjusting diet and daily routine, atrophic gastritis patients can reduce their cancer risk.

The loss of parietal cells is difficult to reverse. At present, neither Western nor TCM medicine offers more than symptomatic treatment for chronic atrophic gastritis; an occasional patient may be cured, but such results are hard to replicate, and it remains doubtful whether these isolated cases are truly cured.

For chronic atrophic gastritis patients, the more realistic approach is to protect the stomach, reduce other gastric-cancer risks, and undergo regular follow-up. The point of regular follow-up is to detect early gastric cancer, which can usually be cured surgically. If atrophic gastritis has reached a very-high-risk stage, prophylactic surgery can also prevent gastric cancer.