Mechanisms of inflammation-cancer transformation in chronic atrophic gastritis and therapeutic potential of traditional Chinese medicine

Chronic atrophic gastritis (CAG) is a chronic digestive system disease characterized by atrophy of gastric mucosal epithelium and innate glands, thinning of the gastric mucosa, thickening of muscular mucosa, with or without intestinal metaplasia. Recognized as a precancerous lesion of gastric cancer, CAG progresses to gastric cancer through the classic “inflammation-cancer” transformation pathway: “chronic atrophic gastritis-intestinal metaplasia-dysplasia-gastric cancer”. Therefore, intervening in the “inflammation-cancer” transformation of CAG is a crucial step to effectively block its malignant progression. Current clinical strategies for intervening in this transformation primarily involve Helicobacter pylori eradication, gastric acid suppression, and gastric mucosal protection. However, these approaches are often limited by issues such as drug resistance and side effects. In contrast, traditional Chinese medicine (TCM), with its multi-components, multi-targets, and holistic regulatory characteristics, has demonstrated considerable potential in intervening in the CAG inflammation-cancer transformation process. This review summarizes the mechanisms underlining the “inflammation-cancer” transformation in CAG, the commonly used therapeutic drugs to intervene in the “inflammation-cancer” transformation, and the therapeutic potential of traditional Chinese medicine. The aim of this study is to elucidate the regulatory mechanism and therapeutic targets of CAG “inflammation-cancer” transformation, in order to provide insights for future drug development in this field.