- Volume 14 Issue 6
DOI QR Code
Outcome of Intestinal Metaplasia in Gastric Biopsy of Patients with Dyspepsia in Guilan Province, North Iran
- Mansour-Ghanaei, Fariborz (Division of Gastroenterology and Hepatology, Guilan University of Medical Sciences) ;
- Joukar, Farahnaz (Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences) ;
- Soati, Fatemeh (Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences) ;
- Mansour-Ghanaei, Alireza (Shahid Beheshti University of Medical Sciences) ;
- Atrkar-Roushan, Zahra (Gastrointestinal and Liver Diseases Research Center (GLDRC), Guilan University of Medical Sciences)
- Published : 2013.06.30
Background: It is generally accepted that gastric carcinomas are preceded by a sequential multistage process that includes chronic gastritis, gastric atrophy, usually with intestinal metaplasia (IM), and dysplasia. This series of changes in gastric carcinogenesis is often initiated by Helicobacter pylori (H pylori) infection. The aim of the present study was determination of gastric histopathologic changes in IM patients after at least one year in Guilan province, Iran. Materials and Methods: This case-series study was conducted in Guilan Gastrointestinal and Liver Disease Research Center (GLDRC) during 2010 to 2011. Gastric biopsy was performed for all 71 known cases of IM and precanceric lesions including gastric atrophy, IM, dysplasia and H pylori infection were determined after at least one year. Results: Of the total of 71 patients with established IM who were enrolled, 50 had complete-type IM and 21 had incomplete-type IM. Fifty two people had H pylori infection. H pylori eradication was achieved in 39 patients (75%). Secondary pathology findings of patients with IM were complete metaplasia (39.4%), incomplete metaplasia (32.4%), dysplasia (23.9%) and other precanceric lesions (4.2%). Dysplasia (20%vs 33%) occurred in patients who had complete and incomplete IM at baseline respectively (p>0.05). Age, gender, family history of gastric cancer(GC); smoking habits and NSAIDs use were not associated with gastric premalignant lesions in initial and secondary pathologies (p>0.05). The difference became statistically significant between H pylori infection in patients with more than 3 years diagnostic intervals (p<0.05). Statistical difference between eradicators and non-eradicators was not significant. Conclusions: We found that incomplete IM increased the risk of subsequent dysplasia in this study.
H pylori infection;histopathologic changes;intestinal metaplasia
- Capelle LG, Haringsma J, de Vries AC, et al (2010). Narrow band imaging for the detection of gastric intestinal metaplasia and dysplasia during surveillance endoscopy. Dig Dis Sci, 55, 3442-8. https://doi.org/10.1007/s10620-010-1189-2
- Babaei M, Pourfarzi F, Yazdanbod A, et al (2010). Gastric cancer in Ardabil, Iran - a review and update on cancer registry data. Asian Pac J Cancer Prev, 11, 595-9.
- Cazacu SM, Vere CC, Bodrug N, et al (2009). The influence of risk factors to the prevalence of gastric mucosal atrophy, intestinal metaplasia and dysplasia in oltenia region. Curr Hlth Sci J, 35, 98-105.
- Camorlinga-Ponce M, Flores-Luna L, Lazcano-Ponce E, et al (2008). Age and severity of mucosal lesions influence the performance of serologic markers in Helicobacter pylori-associated gastroduodenal pathologies. Cancer Epidemiol Biomarkers Prev, 17, 2498-504. https://doi.org/10.1158/1055-9965.EPI-08-0289
- Chacaltana A, Rodriguez C, Urday C, et al (2009). Preneoplastic gastric lesions and helicobacter pylori in endoscopic detection and early diagnosis of gastric cancer in a population of a medium and high socio-economic level. Rev Gastroenterol Peru, 29, 218-25.
- Ciok J, Dzieniszewski J, Lucer C (1997). Helicobacter pylori eradication and antral intestinal metaplasia--two years follow-up study. J Physiol Pharmacol, 48, 115-22.
- Correa P, Piazuelo MB (2012). The gastric precancerous cascade. J Dig Dis, 13, 2-9. https://doi.org/10.1111/j.1751-2980.2011.00550.x
- Correa P, Piazuelo MB, Wilson KT (2010). Pathology of gastric intestinal metaplasia: clinical implications. Am J Gastroenterol, 105, 493-8. https://doi.org/10.1038/ajg.2009.728
- Correa P, Fontham ET, Bravo JC, et al (2000). Chemoprevention of gastric dysplasia: randomized trial of antioxidant supplements and anti-helicobacter pylori therapy. J Natl Cancer Inst, 92, 1881-8. https://doi.org/10.1093/jnci/92.23.1881
- de Vries AC, Haringsma J, de Vries RA, et al (2010). Biopsy strategies for endoscopic surveillance of pre-malignant gastric lesions. Helicobacter, 15, 259-64. https://doi.org/10.1111/j.1523-5378.2010.00760.x
- de Vries AC, Haringsma J, de Vries RA, et al (2009a). The use of clinical, histologic, and serologic parameters to predict the intragastric extent of intestinal metaplasia: a recommendation for routine practice. Gastrointest Endosc, 70, 18-25. https://doi.org/10.1016/j.gie.2008.08.041
- de Vries AC, Capelle LG, Looman CW, et al (2009b). Increased risk of esophageal squamous cell carcinoma in patients with gastric atrophy: independent of the severity of atrophic changes. Int J Cancer, 124, 2135-8. https://doi.org/10.1002/ijc.23955
- de Vries AC, van Grieken NC, Looman CW, et al (2008). Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology, 134, 945-52. https://doi.org/10.1053/j.gastro.2008.01.071
- de Vries AC, Kuipers EJ (2007a). Epidemiology of premalignant gastric lesions: implications for the development of screening and surveillance strategies. Helicobacter, 12, 22-31. https://doi.org/10.1111/j.1523-5378.2007.00562.x
- de Vries AC, Kuipers EJ (2007b). Review article: Helicobacter pylori eradication for the prevention of gastric cancer. Aliment Pharmacol Ther, 2, 25-35.
- Dinis-Ribeiro M, Areia M, de Vries AC, et al (2012). Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy, 44, 74-94. https://doi.org/10.1055/s-0031-1291491
- Dinis - RibeiroM, Lopes C, da Costa-Pereina A, et al (2004). A follow up model for patients with atrophic chronic gastritis and intestinal metaplasia. J Clin Pathol, 57, 177-82. https://doi.org/10.1136/jcp.2003.11270
- Eriksson NK, Karkkainen PA, Farkkila MA, et al (2008). Prevalence and distribution of gastric intestinal metaplasia and its subtypes. Dig Liver Dis, 40, 355-60. https://doi.org/10.1016/j.dld.2007.12.012
- Ferlay JSH, Bray F, Forman D, et al (2010). GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer. Available from: URL: http://globocan.iarc.fr.
- Filipe MI, Munoz N, Matko I, et al (1994). Intestinal metaplasia types and the risk of gastric cancer: a cohort study in Slovenia. Int J Cancer, 57, 324-9. https://doi.org/10.1002/ijc.2910570306
- Fuccio L, Eusebi LH, Bazzoli F (2010). Gastric cancer, Helicobacter pylori infection and other risk factors. World J Gastrointest Oncol, 2, 342-47. https://doi.org/10.4251/wjgo.v2.i9.342
- Gonzalez CA, Pardo ML, Liso JM, et al (2010). Gastric cancer occurrence in preneoplastic lesions: a long-term follow-up in a high-risk area in Spain. Int J Cancer, 127, 2654-60. https://doi.org/10.1002/ijc.25273
- Kang JM, Kim N, Yoo JY, et al (2008). The role of serum pepsinogen and gastrin test for the detection of gastric cancer in Korea. Helicobacter, 13, 146-56. https://doi.org/10.1111/j.1523-5378.2008.00592.x
- Kim N, Lim SH, Lee KH, et al (2000). Longterm effects of Helicobacter pylori eradication on intestinal metaplasia in patients with duodenal and benign gastric ulcers. Dig Dis Sci, 45, 1754-62. https://doi.org/10.1023/A:1005534328511
- Kokkola A, Sipponen P, Rautelin H, et al (2002). The effect of Helicobacter pylori eradication on the natural course of atrophic gastritis with dysplasia. Aliment Pharmacol Ther, 16, 515-20. https://doi.org/10.1046/j.1365-2036.2002.01214.x
- Konturek PC, Konturek SJ, Brzozowski T (2009). Helicobacter pylori infection in gastric cancerogenesis. J Physiol Pharmacol, 60, 3-21.
- Lastraioli E, Romoli MR, Arcangeli A (2012). Immunohistochemical biomarkers in gastric cancer research and management. Int J Surg Oncol, 2012, 868645.
- Lahner E, Bordi C, Cattaruzza MS, et al (2005). Long-term follow-up in atrophic body gastritis patients: atrophy and intestinal metaplasia are persistent lesions irrespective of Helicobacter pylori infection. Aliment Pharmacol Ther, 22, 471-81. https://doi.org/10.1111/j.1365-2036.2005.02582.x
- Lee YC, Chen TH, Chiu HM, et al (2013). The benefit of mass eradication of Helicobacter pylori infection: a communitybased study of gastric cancer prevention. Gut, 62, 676-82. https://doi.org/10.1136/gutjnl-2012-302240
- Lee Y, Jeon YC, Koo TY, et al (2007). Histological changes of gastric atrophy and intestinal metaplasia after Helicobacter pylori eradication. Korean J Gastroenterol, 50, 299-305.
- Leung WK, Ng EK, Chan WY, et al (2005). Risk factors associated with the development of intestinal metaplasia in first-degree relatives of gastric cancer patients. Cancer Epidemiol Biomarkers Prev, 14, 2982-6. https://doi.org/10.1158/1055-9965.EPI-05-0181
- Mansour-Ghanaei F, Joukar F, Baghaei SM, et al (2012). Gastric precancerous lesions in first degree relatives of patients with known gastric cancer: a cross-sectional prospective study in Guilan Province, north of Iran. Asian Pac J Cancer Prev, 13, 1779-82. https://doi.org/10.7314/APJCP.2012.13.5.1779
- Massarrat S, Haj-Sheykholeslami A, Mohamadkhani A, et al (2012). Precancerous conditions after H pylori eradication: a randomized double blind study in first degree relatives of gastric cancer patients. Arch Iran Med, 15, 664-9.
- Mehrabian AA, Esna-Ashari F, Zham H, et al (2010). Gastric cancer prevalence, according to survival data in Iran (National Study-2007). Iranian J Publ Health, 39, 27-31.
- Mera R, Fontham ET, Bravo LE, et al (2005). Long term followup of patients treated for Helicobacter. Gut, 54, 1536-40. https://doi.org/10.1136/gut.2005.072009
- Peleteiro B, Bastos J, Barros H, et al (2008). Systematic review of the prevalence of gastric intestinalmetaplasia and its area-level association with smoking. Gac Sanit, 22, 236-47. https://doi.org/10.1157/13123970
- Peleteiro B, Lunet N, Figueiredo C, et al (2007). Smoking, Helicobacter pylori virulence, and type of intestinal metaplasia in Portuguese males. Cancer Epidemiol Biomarkers Prev, 16, 322-6. https://doi.org/10.1158/1055-9965.EPI-06-0885
- Roesler BM, Costa SC, Zeitune JM (2012). Eradication treatment of Helicobacter pylori infection: its importance and possible relationship in preventing the development of gastric cancer. SRN Gastroenterol, 2012, 935410.
- Rokkas T, Pistiolas D, Sechopoulos P, et al (2007). The long-term impact of Helicobacter pylori eradication on gastric histology: a systematic review and meta-analysis. Helicobacter, 12, 32-8. https://doi.org/10.1111/j.1523-5378.2007.00563.x
- Sakaki N, Kozawa H (2001). Intestinal metaplasia and Helicobacter pylori infection, their relationship and effects of eradication therapy. Nihon Rinsho, 59, 361-6.
- Satoh K, Kihira K, Kimura K, et al (1999). Changes in the severity of atrophic gastritis after Helicobacter pylori eradication. Nihon Rinsho, 57, 185-90.
- Shikata K, Doi Y, Yonemoto K, et al (2008). Population-based prospective study of the combined influence of cigarette smoking and Helicobacter pylori infection on gastric cancer incidence: the Hisayama study. Am J Epidemiol, 168, 1409-15. https://doi.org/10.1093/aje/kwn276
- Steevens J, Schouten LJ, Goldbohm RA, et al (2010). Alcohol consumption, cigarette smoking and risk of subtypes of oesophageal and gastric cancer: a prospective cohort study. Gut, 59, 39-48. https://doi.org/10.1136/gut.2009.191080
- Talebi A, Abadi B, Rafiei A, et al (2011). Helicobacter pylori homB, but not cagA, is associated with gastric cancer in Iran. J Clin Microbiol, 49, 3191-7. https://doi.org/10.1128/JCM.00947-11
- Testino G (2006). Gastric precancerous changes: carcinogenesis, clinical behavior immune phenotype study and surveillance. Panminerva Med, 48, 109-18.
- Vannella L, Lahner E, Bordi C, et al (2011). Reversal of atrophic body gastritis after H pylori eradication at long-term followup. Dig Liver Dis, 43, 295-9. https://doi.org/10.1016/j.dld.2010.10.012
- Wroblewski LE, Peek RM Jr, Wilson KT (2010). Helicobacter pylori and gastric cancer: factors that modulate disease risk. Clin Microbiol Rev, 23, 713-39. https://doi.org/10.1128/CMR.00011-10
- Yaghoobi M, Bijarchi R, Narod SA (2010). Family history and the risk of gastric cancer. Br J Cancer, 102, 237-42. https://doi.org/10.1038/sj.bjc.6605380
- You WC, Brown LM, Zhang L, et al (2006). Randomized double-blind factorial trial of three treatments to reduce the prevalence of precancerous gastric lesions. J Natl Cancer Inst, 98, 974-83. https://doi.org/10.1093/jnci/djj264
- Zendehdel N, Massarrat S, Sheykholeslami A, et al (2010). Topography of gastritis and its severity in 864 first degree relatives of gastric cancer patients. Arch Iran Med, 13, 469-75.
- Zhang C, Yamada N, Wu YL, et al (2005). Helicobacter pylori infection, glandular atrophy and intestinal metaplasia in superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer and early gastric cancer. World J Gastroenterol, 11, 791-6. https://doi.org/10.3748/wjg.v11.i6.791
- Zullo A, Hassan C, Romiti A, et al (2012). Follow-up of intestinal metaplasia in the stomach: When, how and why. World J Gastrointest Oncol, 15, 30-6.