Gastritis and inflammatory bowel disease in the stomach

Article written by Master, Doctor Mai Vien Phuong- Gastrointestinal endoscopist - Department of Medical Examination & Internal Medicine - Vinmec Central Park International General Hospital

Intestinal metaplasia is a phenomenon in which cells have changed morphology and structure to become a cell type with a different morphology and structure than before. Gastric intestinal metaplasia occurs when the cells in the stomach change and are similar in structure to intestinal cells. The disease usually occurs in people with chronic acid reflux or gastroesophageal reflux disease (GERD) but have no specific symptoms.

The stomach (stomach) is the first part of the digestive system located inside the abdomen. This is the largest bulge of the digestive tract system in the human body, the stomach has a complex structure, performing two main functions: mechanical grinding of food, permeation of gastric juice and decomposition of food by the enzyme system. digestion in gastric juice. Although, is a part of the body, but not everyone knows what the stomach is?
The stomach is located between the esophagus and duodenum, the first part of the small intestine. This is considered the largest digestive organ with the function of storing and digesting food.

In recent years, gastrointestinal diseases, especially stomach-related diseases, have shown signs of rapid flare-ups. The reason is due to unsafe food, drinking water and bad eating habits of many people. Common stomach diseases are:
Gastritis: A disease that occurs in many ages, many subjects mainly due to inappropriate diet, eating a lot of hot, spicy food, smoking, smoking. drugs, drink alcohol regularly. If not detected in time, it can cause stomach bleeding or stomach cancer. Peptic ulcer: A condition in which the mucosa is damaged, congested, and deep ulcers are caused by acid and pepsin stimulation. In each ulcer location, there will be different names such as antral ulcer, duodenal ulcer, gastritis... The cause is Hp infection, erratic diet, side effects of drugs. Gastroesophageal Reflux: Approximately 14 million people with gastroesophageal reflux disease have been examined. This is a phenomenon in which food and gastric juices in the stomach are pushed back up into the esophagus, causing discomfort. Helicobacter pylori bacteria are commonly found in the mucous membrane of the stomach and duodenum. If the environment is favorable, the body's resistance is weakened, they will attack and cause damage to the gastric mucosa. thick. Other common diseases are antral inflammation, gastric bleeding, gastric cancer...

Intestinal metaplasia is a phenomenon in which cells have changed morphology and structure to become a cell type with a different morphology and structure than before. Intestinal metaplasia most commonly occurs in the stomach. Gastric intestinal metaplasia occurs when the cells in the stomach change and are similar in structure to intestinal cells. It usually occurs in people with chronic acid reflux or gastroesophageal reflux disease (GERD). In addition, Hpv infection can also be the cause of intestinal metaplasia in the stomach. The interaction between bacteria and food in the digestive system can produce certain chemicals that cause cells to change shape and structure.

Gastrointestinal metaplasia is usually asymptomatic. The symptoms that appear are usually those caused by other digestive problems, such as acid reflux, GERD, gastritis, etc. Doctors can only diagnose intestinal metaplasia when a biopsy is taken to examine the tissues in the mucosa and gastrointestinal tract. Therefore, patients with digestive problems need regular health check-ups to detect the disease early.

Helicobacter pylori is considered the main cause of intestinal metaplasia in the stomach. Helicobacter pylori occurs in the digestive tract, but in some cases, the bacteria do not grow and do not cause any symptoms. Scientists believe that Hp bacteria only grow out of control when the body ingests food or is exposed to chemicals that upset the environmental balance in the digestive system.
Bacteria have a tendency to attack the mucosa, which is why scientists suspect H. pylori causes intestinal metaplasia in the stomach.

Heredity can also be the cause of intestinal metaplasia in the stomach. People whose blood relatives have had digestive problems or stomach cancer are more likely to develop similar conditions.

Smoking is a lifestyle habit that can affect the progression of intestinal metaplasia. Smoking damages the food pipe, causes an imbalance in the esophagus, and creates favorable conditions for bacteria to flourish and cause dangerous complications.
In addition to the above causes, scientists believe that intestinal metaplasia in the stomach can be increased if you live in a polluted environment, have a high-salt diet, abuse alcohol, or because you have reflux. chronic acid reverse,...

HP infection, if left untreated, will lead to atrophic gastritis, then to mediating processes and finally to gastric cancer.
Progression from HP infection to gastric cancer progresses slowly over many years, through many stages mediated by cellular changes of the mucosa (the innermost structural layer of the stomach wall) before cancer forms. really. Patients infected with H.Pylori, will think they will be at risk of stomach cancer, thereby having pessimism and excessive anxiety. In some cases, during gastroscopy, due to the excessive inflammation, the endoscopist will biopsy a sample of gastric tissue for histopathology (see the tissue sample under a microscope), and the results of the histology study is inflammation of the metaplasia, dysplasia ... making the patient even more worried.

In the opinion of experts, these intermediate stages (also known as precancerous stages) include gastric mucosa atrophy (the lining is thinning), intestinal metaplasia (cells in the lining of the stomach). gastric mucosa changes morphology like cells in the small intestine and colon), dysplasia (cells in the gastric mucosa have undergone more important structural changes in the direction of escape from the body's control mechanisms) ). Each of the above stages has different degrees of structural changes and has different levels of risk of developing gastric cancer.
When patients hear the diagnosis of "pre-cancerous" lesions, they will have panic and anxiety, thinking they will have cancer and searching for information on the internet, but the information on the internet often makes them feel worse. more bewildered.

According to the opinion of Associate Professor, Doctor, Doctor Quach Trong Duc, General Secretary, Joint Branch of Vietnam Endoscopy - Gastroenterology Association, the condition called pre-cancer is quite common, especially in other countries. East Asia, but only a small percentage progress to UTI. In Vietnam, studies on patients with chronic gastritis showed that the rate of gastric mucosal atrophy accounted for 68-88%, intestinal metaplasia about 12-29% and dysplasia about 3-11%. The annual rate of gastric cancer formation in people with gastric mucosal atrophy is only about 0.1%, intestinal metaplasia 0.25%, mild dysplasia 0.6% and severe dysplasia 6%.

According to this statistic, it can be estimated that out of 100 patients with intestinal metaplasia after 40 years, only 10 will turn into gastric cancer, the remaining 90 people still only need to follow up. However, with these 10 cases of gastric cancer, if periodically monitored and detected at an early stage, it can be completely cured, even without the need for surgery to remove part or all of the stomach. The same calculations can be applied to cases of mucosal atrophy and gastric dysplasia.

Also in the opinion of Associate Professor, Doctor, Doctor Quach Trong Duc, the rate of progression to gastric cancer also depends a lot on the severity and spread of the precancerous stage. Cases of dysplasia need to be monitored more closely because of a higher cancer risk than mucosal atrophy and intestinal metaplasia.

Thus, patients with precancerous lesions should not be too pessimistic and worried about their disease status, but also need to have a more serious attitude in cooperating with doctors to monitor and take care of their own health. Dear.

People who have been treated for Hp eradication will still be at risk of reinfection with Hp and even if they do not get reinfected, there is still a small rate of progression to intestinal metaplasia, of course the risk is very low, if habits are maintained. Unhygienic eating, salty foods, smoking, alcohol use or family members infected with Hp without treatment.

Unlike colon polyps, most gastric polyps (adenomatous polyps, hyperplastic polyps...) have very little risk of transitioning to intestinal metaplasia or gastric cancer, only a small number of gastric polypoid lesions. risk of becoming evil. Therefore, patients should not be too worried about gastric polyps. Some gastric polyps are also the result of prolonged use of antacids, these polyps will disappear if these drugs are stopped.

Previously, when being diagnosed with stomach cancer, the patient had to undergo surgery to remove part or all of the stomach. Today, less invasive endoscopic techniques in these cases help preserve the stomach with a short hospital stay. Today, ESD technique (submucosal dissection) has been proven to be an effective treatment method for the treatment of early stage cancer, for tumors that are still localized in such mucosal layer, only It is necessary to select the mucosal area containing the tumor to be able to completely treat this disease.

Preventing the risk of Hp infection, treating Hp exactly as indicated, avoiding reinfection and infection are important factors to prevent inflammatory bowel disease. In addition, the patient should follow the following tips:
Eliminate stress, always keep your mind comfortable, avoid affecting the digestive system Eat a lot of green vegetables, ensure adequate nutrition for the body Eat slowly, chew well, eat enough meals on time, avoid fasting, eat while working, eat on the go. Limit alcohol, stimulants, limit spicy, hot and greasy foods Do not eat before going to bed, drink plenty of water, keep your weight in balance Do not smoke, do not let your stomach be too hungry or too full Increase exercise exercise, get enough sleep to improve health Regularly visit health periodically to promptly detect stomach diseases and take appropriate treatment measures

Vinmec International General Hospital is a prestigious address trusted by many patients in performing diagnostic techniques for digestive diseases, treating H.Pylori with high success rate.. Along with that, at Vinmec, gastric cancer screening is done through gastroscopy with Olympus CV 190 endoscope, with NBI (Narrow Banding Imaging) function for analytical imaging results. Mucosal pathology is more obvious than with conventional endoscopy, detecting atrophic gastritis lesions, intestinal metaplasia, low-grade, high-grade gastric dysplasia, and stage gastric cancer lesions. Soon. Vinmec International General Hospital has modern facilities and equipment and a team of experienced experts who are always dedicated in medical examination and treatment, customers can be assured of gastroscopy services. , esophagus here.
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