• Korean Journal of Clinical Laboratory Science
• /
• v.37 no.3
• /
• pp.190-196
• /
• 2005

Helicobacter pylori (H. pylori) infection is uncommon in developed countries, yet is common in underdeveloped and developing countries. Infection rate of H. pylori is minimally influenced by economic, environmental, and public health status and genetic factors. Korea is a developing country with a high incidence of H. pylori infection and gastric carcinoma, which is one of the leading causes of death. For this reason, accurate clinical and pathologic data on H. pylori-associated disease are very important. Intestinal metaplasia accompanies chronic gastritis and increases the risk of gastric carcinoma. For this reason, the relationship between H. pylori infection and intestinal metaplasia is very closely linked. Because of this, as the antecedent condition is guessed, it examines the relationship of the H. pylori and the intestinal metaplasia. Intestinal metaplasia is thought to be the basis in the development of intestinal type gastric carcinomas. Recent investigations showed that inflammatory reaction in the gastric fundus affect the development of gastric carcinogenesis. To verify neutrophilic activity in the gastric fundus and development of intestinal metaplasia in both gastric fundus and antral mucosa, their relationship was studied using 159 healthy patients who had undergone gastric endoscopic biopsies without any identifiable pathologic disesaes. When neutrophilic activity accompanied, incidence of intestinal metaplasia was significantly increased (p<0.05). H. pylori infection was statistically and significantly associated with the presence of intestinal metaplasia (p<0.05). These results suggest that H. pylori infection affected the development of intestinal metaplasia in the stomach. These results will help our understanding of H. pylori infection in the pathogenesis of intestinal metaplasia, a preneoplastic condition of the stomach. To reduce the incidence of gastric adenocarcinoma, eradication treatment of H. pylori is recommended when there's a neutrophilic activity in the gastric fundus.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.22
• /
• pp.9905-9908
• /
• 2014

Background: Helicobacter pylori (H. pylori) is the most common chronic infectious agent in the stomach. Most importantly, it may lead to atrophy, metaplasia and cancer. The aim of this study was to investigate the incidence of H. pylori infection and to detect early mucosal changes that may lead to malignant degeneration in children. Materials and Methods: Children who underwent upper gastrointestinal endoscopy were included. Familial history of gastric cancer was noted. Endoscopic examinations were performed by a single pediatric gastroenterologist. A minimum of three biopsy samples were collected during endoscopy. The patients were accepted as H. pylori infected if results of biopsies and rapid urease test were both positive. Biopsies were evaluated for the presence and degree of chronic inflammation, the activity and severity of gastritis, glandular atrophy and intestinal metaplasia. Results: A total of 750 children (388 boys, 362 girls) were evaluated in our study, with a mean age of 10.1 years. A total of 390 patients (52%) were found to be infected with H. pylori. Among the H. pylori infected patients, 289 (74%) were diagnosed to have chronic superficial gastritis, 24 (6.2%) had gastric atrophy. Most strikingly, intestinal metaplasia was observed in 11 children, all were in the H. pylori positive group. There was no difference in the mean of age, gender and socioeconomic class between H. pylori infected and non-infected groups. The frequency of gastric cancer in family members (4 in number) was higher in patients with H. pylori infection. No gastric cancer case was reported from the parents of non-infected children. The worst biopsy parameters (atropy and metaplasia) were improved after H. pylori eradication on control endoscopy. Conclusions: The current study shows a higher prevalence of familial history of gastric cancer in H. pylori infected children. Intestinal metaplasia was also higher in the infected children. Eradication of H. pylori infection for this risk group may prevent subsequent development of gastric cancer.

• Asian Pacific Journal of Cancer Prevention
• /
• v.14 no.6
• /
• pp.3549-3554
• /
• 2013

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.

• Clinical Endoscopy
• /
• v.56 no.2
• /
• pp.203-213
• /
• 2023

Background/Aims: Intestinal metaplasia (IM) of the stomach is a precancerous condition that is often not visible during conventional endoscopy. Hence, we evaluated the utility of magnification endoscopy and methylene blue (MB) chromoendoscopy to detect IM. Methods: We estimated the percentage of gastric mucosa surface staining with MB, mucosal pit pattern, and vessel visibility and correlated it with the presence of IM and the percentage of metaplastic cells in histology, similar to the Operative Link on Gastric Intestinal Metaplasia (OLGIM) stage. Results: IM was found in 25 of 33 (75.8%) patients and in 61 of 135 biopsies (45.2%). IM correlated with positive MB staining (p<0.001) and other than dot pit patterns (p=0.015). MB staining indicated IM with better accuracy than the pit pattern or vessel evaluation (71.7% vs. 60.5% and 49.6%, respectively). At a cut-off point of 16.5% for the MB-stained gastric surface, the sensitivity, specificity, and accuracy of chromoendoscopy in the detection of advanced OLGIM stages were 88.9%, 91.7%, and 90.9%, respectively. The percentage of metaplastic cells detected on histology was the strongest predictor of positive MB staining. Conclusions: MB chromoendoscopy can serve as a screening method for detecting advanced OLGIM stages. MB mainly stains IM areas with a high concentration of metaplastic cells.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.19
• /
• pp.8027-8034
• /
• 2014

Genetic instability contributes to the development and progression of gastric cancer, one of the leading causes of cancer death worldwide. Microsatellite instability (MSI) has been hypothesized to be involved in carcinogenesis, althgough its mechanisms and exact roles in gastric cancer remain largely unknown. Our aim was to identify associated clinicopathological characteristics and prognostic value of MSI in gastric cancer and precancerous lesions including gastritis, metaplasia, dysplasia, and adenoma. Because mitochondrial DNA has a different genetic system from nuclear DNA, the results of both nuclear MSI and mitochondrial MSI in gastric cancer were reviewed. This review provides evidence that genetic instability of nuclear and mitochondrial DNAs contributes to early stages of gastric carcinogenesis and suggests possible roles in predicting prognosis.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.23
• /
• pp.10489-10493
• /
• 2015

Background: Gastric cancer is the second most common gastrointestinal cancer and is largely attributed to Helicobacter pylori (H. pylori) infection. In addition, studies have also shown association with Epstein-Barr virus (EBV) in 10% of gastric cancers. This study assessed the characteristics of EBV associated gastric cancers (EBVaGC) in Brunei Darussalam. Materials and Methods: This study included gastric cancers diagnosed between 2008 and 2012, registered with the Department of Pathology RIPAS Hospital, Brunei Darussalam. Clinical case notes were systematically reviewed. Histology specimens were all stained for EBV and also assessed for intestinal metaplasia and H. pylori. Results: There were a total of 81 patients (54 male and 27 females) with a mean age of $65.8{\pm}14.8years$ included in the study. Intestinal metaplasia and active H. pylori infection were detected in 40.7% and 30.9% respectively. A majority of the tumors were proximally located (55.6%), most poorly differentiated (well differentiated 16%, moderately differentiated 30.9% and poorly differentiated 53.1%) and the stages at diagnosis were; stage I (44.4%), stage II (23.5%), stage III (8.6%) and stage IV (23.5%). EBV positivity (EBVaGC) was seen in 30.9%. Between EBVaGC and EBV negative gastric cancers, there were no significant differences (age, gender, ethnic group, presence of Intestinal metaplasia, tumor locations, stages of disease and degree of tumor differentiation). Conclusions: This study showed that a third of gastric cancers in Brunei Darussalam were positive for EBV, higher than what have been reported in the literature. However, there were no significant differences between EBVaGC and EBV negative gastric cancers. This suggests that the role of EBV in gastric cancer may be mostly incidental rather than any causal relation. However, further studies are required.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.16
• /
• pp.6983-6987
• /
• 2014

Background: Modified toluidine blue staining (MTBs) is a simple, inexpensive and time saving method to detect H. pylori in gastric biopsy specimens. As a metachromatic stain, it simultaneously highlights intestinal metaplasia, a gastric cancer precancerous lesion. The aim of this study was to assess the reliability of MTBs compared with hematoxylin-eosin (H&E) for H. pylori detection using immunoperoxidase staining as the gold standard. This technique would be beneficial for a routine diagnosis and confirmation of H. pylori eradication in developing countries where endoscopic-based approaches are dominant. Materials and Methods: Esophagogastroduodenoscopy with triple site gastric biopsies was undertaken in 207 dyspeptic patients at Thammasat University Hospital, Thailand between 1997 and 1999. H&E, MTBs and immunoperoxidase staining were applied to each specimen. The presence or absence of H. pylori with each stain was interpreted separately and the sensitivity, specificity, positive and negative predictive values of H&E and MTBs were calculated. Results: A total of 282 specimens from 207 patients were evaluated. Using immunoperoxidase staining, organisms were positive in 117 specimens (41%). MTBs proved almost equally sensitive as immunoperoxidase (99%) and significantly more sensitive than H&E (85%). It has comparable specificity (96% vs 96%), PPV (95% vs 94%), and NPV (99% vs 90%) to H&E, using immunoperoxidase staining as gold standard. MTBs compared with immunoperoxidase staining, is cheaper (2 USD vs 12 USD) and faster (20 min vs 16 hrs) compared to immunoperoxidase staining. Conclusions: MTBs is effective, economical and easy to use in daily practice for the detection of H. pylori in gastric biopsy specimens. In addition to saving time in evaluating H. pylori associated gastritis, with a high sensitivity and ability to demonstrate intestinal metaplasia, the technique may have a role in confirmation of H. pylori eradication for gastric cancer prevention in a developing country setting.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.7 no.2
• /
• pp.170-178
• /
• 2004

Purpose: Helicobacter pylori (H. pylori) infection has been known to be vital in the pathogenesis of duodenal ulcer disease in children as well as in adults. But the relationship between H. pylori infection and the histopathologic findings of the duodenum has not been explained obviously in children yet. So the aim of this study is to determine whether duodenitis and/or gastric metaplasia in the duodenum increases the risk of duodenal ulcer disease in children infected by H. pylori. Methods: From October 2001 to April 2004 gastric and duodenal biopsies were performed in 177 children who visited Department of Pediatrics, Gil Hospital, Gachon Medical School. Biopsy sections were stained with hematoxylin and eosin and also with Giemsa for identification of H. pylori. The grades of duodenitis and gastric metaplasia were classified from 0 to 3 and from 0 to 4, respectively. Results: The incidence of H. pylori infection was 54% in total patients. Amongst 163 children with duodenitis there was a lack of correlation between H. pylori infection and the grade of duodenitis. Amongst 11 patients with duodenal ucler, only 4 children were infected by H. pylori. And amongst 5 patients with gastric metaplasia, H. pylori and duodenal ulcer were detected in 2 and 3 children, respectively. The occurrence of duodenal ulcer and gastric metaplasia were increased significantly in proportion to the grade of duodenitis (p<0.0001 and p=0.0365, respectively). Conclusion: As opposed to the results of previously reported articles, there were lacks of correlation between H. pylori infection and duodenitis, duodenal ulcer, and gastric metaplasia. So further study hould be done to clarify the effect of H. pylori on the duodenal histopathology in children infected by H. pylori.

• Journal of Preventive Medicine and Public Health
• /
• v.41 no.6
• /
• pp.373-379
• /
• 2008

Objectives ; The objective of this study was to evaluate the prevalence of atrophic gastritis and intestinal metaplasia according to gender, age and Helicobacter pylori infection in a rural population in Korea. Methods: Between April 2003 and January 2007, 713 subjects (298 men and 415 women, age range: 18-85) among the 2,161 adults who participated in a population-based survey received gastrointestinal endoscopy. All the subjects provided informed consent. Multiple biopsy specimens were evaluated for the presence of atrophic gastritis and intestinal metaplasia. The presence of Helicobacter Pylori was determined using CLO and histology testing. Results ; The age-adjusted prevalence of atrophic gastritis was 42.7% for men and 38.1% for women and the prevalence of intestinal metaplasia was 42.5% for men and 32.7% for women. The prevalence of atrophic gastritis and intestinal metaplasia increased significantly with age for both men and women (p for trend<0.001). The age-adjusted prevalence of Helicobacter pylori was similar for men (59.0%) and women (56.7%). The subjects with Helicobacter pylori infection showed a significantly higher prevalence of intestinal metaplasia (44.3%) compared with that (26.8%) of the noninfected subjects (p<0.001). However, the prevalence of atrophic gastritis was not statistically different between the Helicobacter pylori-infected subjects and the noninfected individuals. Conclusions : Our findings suggest that the prevalence of atrophic gastritis and intestinal metaplasia is higher for a Korean rural population than that for a Western population; this may be related to the high incidence of gastric cancer in Koreans. Especially, the prevalence of intestinal metaplasia was high for the subjects with Helicobacter pylori infection. The multistep process of gastric carcinogenesis and the various factors contributing to each step of this process need to be determined by conducting future follow-up studies.

• Asian Pacific Journal of Cancer Prevention
• /
• v.13 no.1
• /
• pp.247-250
• /
• 2012

Objective: To determine whether CDX2 and villin protein expression are associated with intestinal metaplasia (IM) in gastric cardiac mucosa and to explore the relationship with evolution of gastric cardiac adenocarcinoma (GCA). Methods: We studied 143 gastric cardiac biopsy or resection specimens from Henan province China, including 25 cardiac gastritis specimens with IM, 65 dysplasia specimens with IM and 35 gastric cardiac adenocarcinoma specimens and stained them for CDX2 and villin by the immunohistochemical SP method. 15 normal gastric cardiac biopsy specimens were also collected as control. Results: (1) Normal gastric mucosa presented no CDX2 and villin expression. The positive rates of CDX2 protein in cardiac gastritis with IM, dysplasia with IM, and carcinoma tissues were 84.0% (21/25), 66.7% (32/48) and 36.4% (20/55), respectively. While the positive rates of villin protein in cardiac gastritis with IM, dysplasia with IM, and carcinoma tissues were 76.0% (19/25), 70.8% (34/48) and 45.5% (25/55), respectively. There were significant differences among the three groups for both CDX2 and villin (P<0.01). Spearman's rank correlation coefficient(rho) showed a close correlation between the two proteins (r=0.843, P<0.01) and both were positively related with tumor differentiation (both P<0.05), but not associated with age, sex, invasion and metastasis of lymph node (P>0.05). Conclusion: Our results suggest that ectopic expression of CDX2 and villin may be involved in early-stage IM and tumorigenesis in gastric cardia and the expression of villin may be regulated by CDX2.