Pathogenesis evolution and traditional Chinese medicine interception strategies of inflammation-cancer transformation in Barrett′s esophagus from the perspective of "two critical nodes-three stages"

Barrett′s esophagus (BE), a precancerous state of esophageal adenocarcinoma, poses a major challenge for prevention and treatment owing to its complex mechanism of inflammation-cancer transformation and the lack of effective clinical treatment and torsion strategies. Building upon the "preventing disease progression" theory, this study aimed to address the critical clinical challenge of intercepting the pathological progression during the inflammation-cancer transformation of BE by proposing an innovative "two critical nodes-three stages" pathomechanism framework. The pathogenesis of BE originates from liver depression and qi stagnation. The pathological progression evolves through two critical nodes: liver depression transforming into heat and heat transforming into blood stasis, representing a three-stage evolutionary pattern of qi stagnation, heat transformation, and blood stasis formation. Acidic bile salts, acting as a pathogenic toxin, permeate the entire process and catalyze carcinogenesis. Based on this understanding, the therapeutic principles of "treatment from the liver" and "truncation and torsion" were established, emphasizing stage-specific interventions. For the qi stagnation stage, treatment focuses on soothing the liver and regulating qi, as well as moistening, harmonizing, and descending the qi. This is achieved by combining modified Chaihu Shugan Powder with Xuanfu Daizhe Decoction, while using pungent and drying herbs cautiously and supplementing them with light and floral herbs. In the heat transformation stage, the strategy aims to clear the liver and drain heat while protecting yin and harmonizing the stomach, employing modified Huaganjian combined with Yiguanjian and supplemented with Jinlingzi Powder to clear depressed fire. For the blood stasis formation stage, treatment involves activating blood and resolving stasis, combined with supporting healthy qi and removing toxins. This is achieved using a modified Gexia Zhuyu Decoction, supplemented with Liujunzi Decoction, and additions such as Radix Salviae Miltiorrhizae and turtle carapace to disperse nodules and reduce masses. This theoretical framework establishes a diagnostic and therapeutic model characterized by the integration of disease mechanisms with pathology and the mutual reference of macro-level signs with micro-level indicators. It provides a comprehensive clinical practice pathway, complete with principles, methods, formulas, and herbs, for the stage-specific interception of inflammation-cancer transformation in BE using traditional Chinese medicine.