Outcome of Intestinal Metaplasia in Gastric Biopsy of Patients with Dyspepsia in Guilan Province, North Iran

Abstract

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.

A friable peristomal lesion

“…Incomplete IM shows transformed cells that contain goblet cells and rudimentary villi associated with the colon. 2 A report by Ono et al 3 described flat, ulcerated, peristomal IM as well as peristomal polypoid IM, as seen in our case. Both polypoid and flat IM lacked epidermis and exposed red macerated mucosa-like tissue.…”

Tobacco smoking and intestinal metaplasia: Systematic review and meta-analysis

“…Thirty-two articles were included in the systematic review (Supplementary Tables S1 and S2). Fifteen studies were conducted in Asia [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (five from Japan, four from China, three from Korea, two from Iran and one from Taiwan), eight in Europe [41][42][43][44][45][46][47][48] (a multicentre study and one each from England, Finland, Italy, Netherlands, Poland, Portugal and Spain), four in North America [49][50][51][52] (participants were Asian/Hawaiian in two of them), three in South America [53][54][55] [38,42] included participants referred due to gastrointestinal complaints as well as volunteers, and one study [34] recruited first-degree relatives of gastric cancer patients.…”

“…A total of 13 articles [26,27,31,[39][40][41][43][44][45][46][47]49,57] included in the systematic review were not included in the meta-analysis as they did not provide enough information to compute quantitative estimates regarding the exposure to tobacco, compared exposure or outcome categories not directly comparable with those presented in most of the other reports, or evaluated only H. pylori-infected subjects ( Supplementary Table S2).…”

“…Other articles [27,31,39,40,43,44,49,57] included participants which all had IM with different extents and severities. For example, Jedrychowski et al [44] compared participants with moderate or severe IM vs. those with nil or mild IM and found a significant association for ever vs. never smokers (OR = 1.42, 95% CI: 1.10-1.84).…”

Prevalence of gastric precancerous lesions among chronic dyspeptic patients and related common risk factors

“…This could be related to individual or environmental factors. Some studies also showed that H. pylori and gastric atrophy might be associated with gastric cancer in Iran (Malekzadeh et al, 2004(Malekzadeh et al, , 2009Mansour-Ghanaei et al, 2013). The progression of precancerous lesions to gastric adenocarcinoma takes a long period of time; therefore, early detection of these lesions will enable the management of these cases more efficiently.…”