Atrophic Gastritis: Is It Difficult to Treat?

Atrophic gastritis, also known as chronic atrophic gastritis (CAG), is a type of chronic inflammation of the stomach lining. It is characterized by the thinning of the gastric mucosa due to the loss of gastric glandular cells, often accompanied by intestinal metaplasia, pyloric metaplasia, or dysplasia. Common symptoms include upper abdominal discomfort, bloating, belching, reduced appetite, weight loss, and anemia, although these signs are not unique to this condition.

Understanding the Causes and Risk Factors

The development of atrophic gastritis can be linked to several factors such as Helicobacter pylori (H. pylori) infection, autoimmune disorders, long-term use of certain medications, poor dietary habits, smoking, and alcohol consumption. Identifying and addressing these underlying causes is crucial for effective treatment.

Lifestyle and Dietary Adjustments

To manage atrophic gastritis, it's essential to eliminate irritants that affect the stomach. This includes quitting smoking, avoiding alcohol, and maintaining good oral hygiene to prevent infections that may spread to the digestive tract. A diet rich in soft, easily digestible foods and low in spicy or coarse ingredients is recommended. Additionally, patients should avoid medications that can damage the stomach lining, such as NSAIDs.

Medical Treatment Options

1. H. pylori Eradication: For individuals with H. pylori infection, eradication therapy is the cornerstone of treatment. A standard regimen typically involves a quadruple therapy combining bismuth, a proton pump inhibitor (PPI), and two antibiotics. Studies show that clearing H. pylori can slow down or even reverse the progression of gastric atrophy and intestinal metaplasia.

2. Symptomatic Relief: Depending on the patient's specific symptoms, various medications may be used. Prokinetics can help alleviate bloating, nausea, and vomiting. Digestive enzymes may assist those experiencing meal-related discomfort. Acid-suppressing drugs like PPIs or H2 blockers can provide relief from pain and acid reflux. In cases involving psychological stress or sleep disturbances, mental health support may be beneficial.

3. Nutritional Supplements: Research suggests that supplements such as folic acid and vitamin C may play a role in reducing the risk of gastric cancer in patients with chronic atrophic gastritis.

Integrative and Personalized Approaches

Combining Western medicine with traditional Chinese medicine (TCM) offers a holistic approach to managing atrophic gastritis. By analyzing medical history, endoscopic findings, and lab results, doctors can tailor treatments to each individual's unique pathology and symptom profile.

Monitoring and Advanced Interventions

While atrophic gastritis itself is not an immediate indication for surgery, regular endoscopic surveillance is highly recommended, especially for patients with intestinal metaplasia or dysplasia. In cases of severe dysplasia or focal lesions, endoscopic submucosal dissection (ESD) may be considered to remove abnormal tissue and prevent cancer progression.

In conclusion, while atrophic gastritis presents challenges, a comprehensive and personalized treatment plan—including lifestyle changes, medical therapies, and regular monitoring—can significantly improve outcomes and quality of life for patients.