Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy

Abstract

BackgroundIntestinal metaplasia (IM) is regarded as a premalignant lesion. However, endoscopic diagnosis of IM has been considered difficult. Using endoscopy, we found a unique pattern of erythema, “Mottled Patchy Erythema (MPE),” which includes severe IM. Helicobacter pylori (Hp) infection itself can cause erythema, which reflects histologic changes in the gastric mucosa. Therefore we enrolled Hp eradication patients to validate the relation between MPE and pathologic findings.MethodsWe enrolled patients with chronic gastritis who underwent successful Hp eradication at least 6 months before the study. We defined MPE as multiple flat or depressed erythematous lesions. When encountering MPE on endoscopy, we performed biopsy on both the MPE site and non-MPE site. The non-MPE site was defined as an adjacent mucosa located within 3 cm of the MPE site. All biopsy specimens were evaluated immunohistochemically for IM subtype using MUC2, MUC5AC, MUC6, CD10, and CDX2 stains. The degree of IM was defined according to the Updated Sydney System. The diagnostic accuracy of the MPE findings for pathologic IM was calculated. The relation between MPE and IM subtype was also assessed.ResultsA total of 102 patients were selected for the study. Of these, 55 (54%) patients had MPE. Biopsy specimens were taken from the MPE sites and non-MPE sites from these 55 patients. The IM percentages and median scores of IM were both significantly higher at the MPE sites (P < 0.001) than at the non-MPE sites. The sensitivity and specificity for MPE in the detection of histologic IM were 72.7% and 84.1%, respectively. No significant associations were observed in the expression of MUC2, MUC5AC, MUC6, CD10, and CDX2 between the MPE sites and non-MPE sites. There were no significant differences in the ratios (complete/incomplete) of IM subtypes between the two groups.ConclusionsMPE is a useful endoscopic finding to detect histologic IM without the use of chromoendoscopy and magnifying endoscopy. However, the IM subtype is difficult to identify. In the era of Hp eradication, MPE has the potential to become a predictive finding for the risk of gastric cancer.

Predictive findings forHelicobacter pylori-uninfected, -infected and -eradicated gastric mucosa: Validation study

“…Atrophic change, occurring as a result of H. pylori infection, is thought to remain after eradication therapy [26] . Moreover, in our previous study, MPE, which is recognized as a flat or slightly depressed reddish lesion that is distinguishable from the congested mucosa, emerged after H. pylori eradication therapy [12] . In the study too, atrophic change and MPE was highly predictive of H. pylori eradicated mucosa, suggesting that a combination of these findings is highly valuable in clinical practice.…”

“…The presence or absence of the following 11 distinctive endoscopic findings were evaluated (Figures 1 and 2): regular arrangement of collecting venules (RAC) [5] , linear erythema [9] , hemorrhage [9] , fundic gland polyp (FGP) [10] , atrophic change [6,7] , severity of atrophy (open/ closed) [6,7] , rugal hyperplasia [8] , edema [9] (which is visible as a thickened mucosal layer especially at the angulus and cardia), spotty erythema [9] , exudate [9] , xanthoma [11] , and mottled patchy erythema (MPE) [12] . A well-experienced endoscopist (Kobayakawa M) assessed the findings, and to determine inter-observer agreement, another experi- …”

“…The development of histological gastritis is regarded as rare in H. pylori-uninfected cases, but it is usually noted in H. pylori-infected cases and improved by eradication therapy. This difference is reflected in the appearance of the gastric mucosa, which has been reported in the form of endoscopic findings in several studies [5][6][7][8][9][10][11][12] . However, the predictive value of the findings has not yet been validated.…”

Clinical Significance of Reddish Depressed Lesions Observed in the Gastric Mucosa after <b><i>Helicobacter pylori</i></b> Eradication

“…Nagata et al [9] have demonstrated that mottled patch erythema, which may include RDLs, is a response to intestinal metaplasia. In the present study, we demonstrated that a variety of magnifying patterns were found in association with RDLs, and the histopathological features of RDLs were not identical.…”

“…Nagata et al [9] reported that endoscopic findings of mottled patchy erythema were characteristic of pathological intestinal metaplasia in patients who have received eradication therapy. In addition, Moribata et al [10] report that the presence of map-like redness observed after H. pylori eradication is a useful endoscopic marker to predict a diagnosis of metachronous gastric cancer following endoscopic submucosal dissection [10].…”