Relationship between the Degree of Endoscopic Atrophy of the Gastric Mucosa and Carcinogenic Risk

Abstract

Background: The relationship between Helicobacter pylori infection and gastric cancer has been demonstrated, and the risk of gastric cancer occurrence is known to increase with the progression of atrophic changes associated with chronic gastritis. Endoscopic evaluation of the degree and extent of atrophy of the gastric mucosa is a simple and very important means of identifying a group at high risk for gastric cancer. This study aimed to clarify the carcinogenic risk in relation to the degree of atrophy. Methods: A total of 27,777 patients (272 with early gastric cancer and 135 with advanced gastric cancer) were included in this study. Endoscopically evaluated atrophy of the gastric mucosa was classified as C-0 to O-3 according to the Kimura and Takemoto classification system. Results: The cancer detection rate in relation to the degree of gastric mucosal atrophy was 0.04% (2/4,183 patients) for C-0, 0% (0/4,506) for C-1, 0.25% (9/3,660) for C-2, 0.71% (21/2,960) for C-3, 1.32% (75/5,684) for O-1, 3.70% (140/3,780) for O-2 and 5.33% (160/3,004) for O-3. As to the proportions of differentiated and undifferentiated cancers, the latter were relatively frequent in the C-0 to C-2 groups, but differentiated cancers became predominant as atrophy progressed. On the other hand, the number of both differentiated and undifferentiated cancers detected increased as gastric mucosal atrophy progressed. In addition, open-type atrophy was found in 29 (96.7%) of 30 patients with synchronous multiple gastric cancers and in all 20 patients with metachronous multiple gastric cancers. Conclusion: Endoscopic evaluation of gastric mucosal atrophy can provide a simple and reliable predictive index for both current and future carcinogenic risk.

Natural Course of <b><i>Helicobacter pylori</i></b> Infection in Japanese Hemodialysis Patients

“…The percentage changes in the PG I/II ratio are useful as indices for distinguishing outcome in eradication therapy for H. pylori [36]. In Japan, recently, the combination of serum PG level and H. pylori -IgG level, namely, the ABC method, has been commonly used at health screenings as a useful marker of gastric cancer [37]. However, because of their elevated levels, it was considered difficult to use serum PG as a biomarker of gastric atrophy and gastric cancer, gastric acid secretion level, or determinant of outcome in eradication therapy in hemodialysis patients.…”

Comparative analysis of upper gastrointestinal endoscopy, double-contrast upper gastrointestinal barium X-ray radiography, and the titer of serum anti-Helicobacter pylori IgG focusing on the diagnosis of atrophic gastritis

“…Presently, detection of chronic H. pylori infection is thought to be important for predicting the risk of gastric cancer [32][33][34][35]. For endoscopic observation, atrophic gastritis is established as the most typical and frequent appearance of gastric mucosa with H. pylori infection [22,35,36].…”

“…For endoscopic observation, atrophic gastritis is established as the most typical and frequent appearance of gastric mucosa with H. pylori infection [22,35,36]. Therefore, a strong association between ''UGI-ESbased'' and ''UGI-XR-based'' diagnoses suggests that detection of UGI-XR-based atrophic gastritis can lead to evaluation of chronic H. pylori infection.…”

“…In either case, our results reveal that UGI-ES/UGI-XR-based atrophic gastritis can be overlooked Internationally standard risk stratification methods for gastric cancer are still histological evaluation of random biopsy specimens such as OLGA [37,38], OLIGM [39], etc. In contrast, endoscopic diagnosis of premalignant atrophic gastritis is widely conducted in Japan [35]. The KimuraTakemoto classification of atrophic gastritis by UGI-ES is the most widely used method, which has been validated by several reports showing the reliable association between endoscopic findings and histological appearances [18,19,22,40].…”

Antibiotic Resistance of &lt;i&gt;Helicobacter pylori&lt;/i&gt; and Eradication Rate in Japanese Pediatric Patients

“…On the other hand, eradication therapy does not prevent the development of metachronous gastric cancer completely [29]. Moreover, the risk of gastric cancer rises with the progress of atrophy [30] [31] [32], and Kato et al [33] showed that gastric atrophy could develop in Japanese children of an average age of 12 years with H. pylori infection. In addition, we have shown significant over expression of several years old (57.9%) comparing to the elder group of more than 50 years old (35.1%) [40].…”