An attempt at presymptomatic diagnosis of gastric carcinoma in pernicious anaemia

Systematic review: gastric cancer incidence in pernicious anaemia

“…These articles were screened on the basis of title and abstract and, after the application of our inclusion and exclusion criteria, 71 articles were retrieved for full‐paper evaluation. Of these 71 full‐papers, 27 met eligibility criteria and were subjected to data extraction …”

“…Of the six high‐quality studies, four reported large sample sizes, representative of communities which were American and North European. The majority of the studies which were considered of low and very low quality were not matched cohort studies and the Comparability category of the Newcastle‐Ottawa Quality Scale was not assessable …”

“…In particular, clinical criteria such as blood tests (macrocytic anaemia, low vitamin B 12 , iron, gastrin, pepsinogen I), positive Schilling test, gastric pH, megaloblastic bone marrow or neuropathy (subacute combined cord degeneration, peripheral neuropathy, dementia) were used in 17 studies; data were extracted on the basis of International Classification of Disease (ICD) in four studies and using hospital records in one study . Five studies included patients with PA without providing further details. The sources of the patients differed: 14 studies included patients hospitalised for PA and after followed‐up as out‐patients, 4 studies included hospitalised patients representative of general population, 2 studies included both inpatients and out‐patients and 3 studies included out‐patients referred to haematological or gastroenterological units for anaemia or gastrointestinal symptoms .…”

“…The sources of the patients differed: 14 studies included patients hospitalised for PA and after followed‐up as out‐patients, 4 studies included hospitalised patients representative of general population, 2 studies included both inpatients and out‐patients and 3 studies included out‐patients referred to haematological or gastroenterological units for anaemia or gastrointestinal symptoms . Three studies lacked information about the origin of participants, while in the Blackburn study, patients were recorded in the files of eight PA clinics, but it was not indicated whether the patients were hospitalised or not. The studies were very variable with regard to the follow‐up protocol.…”

“…The studies were very variable with regard to the follow‐up protocol. Only nine studies (33.3%) had an active follow‐up based on different diagnostic tools: EGD with biopsies ( n = 6), cytology ( n = 1), EGD or Xray ( n = 1), clinical/EGD ( n = 1) at regular intervals. In the majority of cases, patients were not actively followed‐up ( n = 18), but in three of these studies, diagnostic investigations were performed on the basis of new clinical symptoms …”