| Research BackgroundChronic atrophic gastritis is a clinical common disease,often accompanied by intestinal metaplasia.At home and abroad,Correa has always been recognized as the development model of intestinal type gastric cancer,and intestinal metaplasia is the central link in the pathogenesis of gastric cancer.Director Zhou Bin is engaged in the theoretical research and clinical practice of CAG(with intestinal metaplasia or dysplasia)for more than 20 years.He has long adhered to the use of gastroscopes and is skilled in the process,and he has a precise understanding of microscopic atrophy and intestinal metaplasia.During the course of learning gastroscopy with the tutor,it was found that some patients showed mucosal roughness under gastroscope,with large nodules or diffusely distributed flat bulges at the gastric antrum,angle,and corpus.My tutor often took biopsies carefully from the antrum large curvature,antrum small curvature,angle,corpus large curvature,corpus small curvature and other abnormal mucosas.After tracking the pathological results,we found that the above-mentioned sites had different degrees of atrophy and intestinal metaplasia.The tutor pointed out that these patients had a wide range of atrophy and intestinal metaplasia,heavier than the average patients,and the treatment would be more difficult.At present,the treatments of western medicine for CAG with IM include eradicating Hp,reducing bile reflux,increasing gastric motility,and supplementing folic acid and vitamin B12 etc.However,there is controversy about whether it can reverse pathology.Domestic Chinese medicine practitioners use the unique theory and thinking of Chinese medicine to treat the disease,And many studies have shown that Chinese medicine has a significant effect in improving symptoms and reversing pathology.CAG(with IM)belongs to the category of "stomach distension" in traditional Chinese medicine.Modern Chinese medicine practitioners combined with the knowledge of ancient sages have systematically expounded the etiology,pathogenesis,syndromes,and treatment of this disease.Most doctors believe that this disease is based on the weakness of the spleen and stomach,and stomach collateral stasis is the pathological key.Many domestic studies have shown that Chinese medicine has significant advantages in the treatment of CAG with IM and Dys.My tutor has long been committed to the research of CAG with IM and Dys,and believes that the disease belongs to the category of "collateral diseases" in Chinese medicine.Spleen deficiency and Collateral stasis is the key to the pathogenesis of this disease,thus creating "Jian Pi Tong luo Decoction".Previous studies found that spleen-stomach deficiency syndromes were found most in CAG patients(168/431 cases),followed by stomach collateral stasis(93/431 cases);and previous studies showed that "Jian Pi Tong luo Decoction" had a good clinical efficacy on the spleen-stomach deficiency syndrome of CAG,not only improving symptoms but also reversing pathology.Research purposeThe purpose of this study is to observe the clinical efficacy of the "Jian Pi Tong Luo Decoction" in the treatment of CAG with extensive IM with spleen-stomach deficiency syndrome,so as to provide an objective basis for the treatment of this disease by Chinese medicine,and to provide ideas for clinicians to use traditional Chinese medicine to treat the disease.Research contentsThis study included literature review and clinical trial study.The first part:Firstly,I write the modern medical research of CAG with IM,explaining modern medicine's understanding of the etiology and pathogenesis of the disease,the current status of diagnosis and treatment,and the assessment of the risk of gastric cancer in this disease,etc.Secondly,I write the motherland medical research of CAG wtih IM,concluding the understanding of the etiology and pathogenesis of this disease and the treatment experience of modern Chinese doctors.On the one hand,collect general data of 40 cases of CAG patients with extensive IM with spleen-stomach deficiency syndrome,including age,gender,living habits,predisposing factors,past and family history,etc.,to conduct a study of baseline data,summarizing the characteristics.Then,compare the different parts of the gastroscope pathology before treatment,and stage according to the gastritis staging system(Operative Link for Gastritis Assessment,OLGA)and another standard(Operative Link for Gastritis Intestinal Metaplasia Assessment,OLGIM),to evaluate the stomach cancer risk of CAG with extensive IM.On the other hand,forty patients were given oral treatment of "Jian Pi Tong Luo Decoction" for 12 weeks.The patients were reexamined for gastroscopy after one course of treatment.Record symptom scores and pathological scores before and after treatment,and then perform statistical analysis on the data,compare symptom scores and pathological results before and after treatment,and objectively evaluate the clinical curative effect.In addition,OLGA and OLGIM staging were performed on the pathology after treatment,and staging changes before and after treatment were compared.Research resultsAmong the 40 patients,25 were males and 15 were females,the male to female ratio was 5:3.The average age of the patients was 49.65 ± 10.68 years,19 cases were middle-aged,12 were young,and 9 were elderly.The mean BMI of 40 patients was 22.46 ± 3.47.There were 16 patients with smoking history and drinking history,respectively,all male.In terms of precipitating factors,emotional disorder,mental stress,and irregular eating habits were ranked in the top three positions,each accounting for 47.5%(19/40),35.0%(14/40),and 30.0%(12/40).In this study,72.5%(29/40)patients had a history of Hp infection and treatment,but just 4 of them had a current infection.In addition,15 out of 40 patients had a family history of esophageal or gastric cancer,which accounts for 37.5%of all patients.Before treatment,the degree of gastric mucosal atrophy and pathological scores were different at antrum large curvature,antrum small curvature,angle,corpus large curvature,and corpus small curvature.The degree of intestinal metaplasia and pathological scores were also different in each site,P=0.000(p<0,001).The degrees of atrophy and intestinalization at angle were the most serious,followed by antrum small curvature.The OLGA staging results of 40 patients before treatment were:22 cases in stage ?,accounting for 55.0%;13 cases in stage ?,32.5%;5 cases in stage ?,12.5%;no stage I and stage 0 patients.The OLGIM staging results:16 cases in stage ?,accounting for 40.0%;15 cases in stage ?,37.5%;9 cases in stage ?,22.5%;no stage I and stage 0 patients.After a course of 12 weeks of treatment,the total scores of TCM symptoms,the scores of the main symptoms,and the scores of the second symptoms were significantly lower than before treatment,P=0.000(P<0.001).Symptom treatment cure recovery rate was 55.0%,the markedly effective rate was 42.5%,the efficiency was 2.5%,and the total efficiency came to 100%.There were 36 cases having completed pathological observation of the endoscope.The pathological scores of atrophy and intestinal metaplasia after treatment at angle,antrum large curvature,antrum small curvature,corpus small curvature and corpus large curvature were significantly different from those before treatment,p<0.01.The effective rates of atrophy and intestinal metastasia at angle were 48.48%and 47.22%respectively;antrum large curvature,72.22%and 64.00%,respectively;antrum small curvature,54.55%and 50.00%respectively;corpus small curvature,52.63%,53.33%;corpus large curvature,63.16%,65.22%.After treatment,there were 18 cases of OLGA stage reduction and 2 cases of increase;OLGIM stage decreased in 16 cases,and increased in 3 cases.Conclusions:(1)The results of this study indicated:there were 25 males and 15 females in 40 cases of CAG with extensive IM,the male-female ratio was 5:3,and males were slightly more than females.The average age was 49.65 ± 10.68 years old,and the majority were middle-aged(19/40 cases).Emotional disorder was the main precipitating factor for atrophic gastritis.72.5%(29/40)of patients had a history of Hp infection,but just 4 of them had a current infection.37.5%(15/40)patients had a family history of esophageal or gastric cancer.(2)The research data suggested that the degrees of atrophy and intestinal metaplasia at angle were the heaviest,followed by the antrum small curvature.The majority of patients with CAG with extensive IM were at high risk of OLGA and OLGIM levels,staging ? and IV,with a higher risk of gastric cancer.(3)"Jian Pi Tong Luo Decoction" has a significant effect in improving symptoms in the treatment of CAG with extensive IM with spleen-stomach deficiency syndrome,and has a good effect in pathological reversal of atrophy and intestinal metaplasia,and it is beneficial to reduce the risk stratification of OLGA and OLGIM,reducing the risk of gastric cancer to a certain extent. |
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