Diabetes mellitus and atrophic gastritis: progress in the study of interactive pathogenesis

Diabetes mellitus and atrophic gastritis are two chronic diseases with high incidence, and their comorbidity has attracted increasing attention. The traditional view primarily focuses on the unidirectional damage caused by diabetes to the gastric mucosa, but ignores the possible bidirectional pathological relationship between the two diseases. This article reviews research progress on the reciprocal pathogenesis between DM and the gastric mucosa and posits a theoretical framework of a "bidirectional vicious cycle." On the one hand, diabetes may promote the occurrence and development of atrophic gastritis through multiple pathways. On the other hand, atrophic gastritis may have a profound reverse effect on glucose metabolism. The "common soil" for the coexistence of the two diseases is also revealed, including shared HLA class II susceptibility genes, Th17/Treg immune imbalance, and ROS-NF-κB-mitophagy disorders coupled with a molecular network. It should be noted that most of the proposed bidirectional framework is based on accumulating preclinical and observational evidence, and large-scale prospective cohort studies are urgently needed to establish causal temporal relationships. Based on the above mechanisms, this paper presents antioxidant-related intervention strategies and identifies the current study's limitations. The purpose of this review is to promote the new clinical concept of "glucose-gastrotube co-administration" and provide a theoretical basis for breaking the mutually reinforcing cycle between the two diseases and reducing the risk of decompensation in gastric precancerous lesions and diabetes.