Can neopterin be a useful immune biomarker for differentiating gastric intestinal metaplasia and gastric atrophy from non-atrophic non-metaplastic chronic gastritis?

Objectives: The aim of this study was to investigate the prevalence of intestinal metaplasia and its relation to H. Pylori infection, gastric atrophy, ulcer, age and gender in patients underwent esophagogastroduodenoscopy and gastric biopsy for upper gastrointestinal symptoms. Method: 200 gastric biopsy blocks examined for patients underwent esophagogastroduodenoscopy (EGD) and gastric biopsy, between January 2019 October 2020 at Gastroenterology and hepatology Hospital / Medical city / Baghdad / Iraq. Result: (67.5%) of patients examined in the study had H. pylori infection, while (20.5%) of the total number patients in the study had gastric intestinal metaplasia. There was significant association between Intestinal metaplasia with both active chronic inflammation and intestinal atrophy but there was no significant association between Intestinal metaplasia with both ulcer and H. pylori infection. Conclusion: gastric intestinal metaplasia encountered more in old age male patients with gastric atrophy and it is not solely related to h pylori, other risk factors could be responsible for it.

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Predictors for regression and progression of intestinal metaplasia (IM): A large population-based study from low prevalence area of gastric cancer (IM-predictor trial)

PLoS ONE ◽

10.1371/journal.pone.0255601 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255601

Author(s):

Natsuda Aumpan ◽

Ratha-korn Vilaichone ◽

Bubpha Pornthisarn ◽

Soonthorn Chonprasertsuk ◽

Sith Siramolpiwat ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gastric Cancer ◽

Intestinal Metaplasia ◽

Chronic Gastritis ◽

Large Population ◽

University Hospital ◽

Medical Database ◽

Gastric Intestinal Metaplasia ◽

Gastric Biopsies

Background Gastric intestinal metaplasia (IM) can lead to gastric cancer. Until now, there have been limited studies of predictors for regression and progression of IM. This study aimed to determine risk factors associated with regression or progression of IM for guiding proper management and prevention of gastric cancer. Methods 2,025 patients undergoing gastroscopy in Thammasat University Hospital, Thailand were enrolled during September 2017-August 2019. Patients’ data including baseline characteristics, laboratory results, and histopathology of gastric biopsies from University medical database were extensively reviewed. Results 2,025 patients had mean age of 61.3 years and 44.2% were males. Overall H. pylori prevalence was 47.5%. There were 1,551(76.6%) patients with chronic gastritis and 361(17.8%) with IM. Of 400 patients with chronic gastritis having follow-up endoscopy and repeated gastric biopsies, 104(26%) had persistent H. pylori infection and 27(26%) developed IM during mean follow-up time of 24 months. Persistent H. pylori infection was significantly associated with development of IM (OR 3.16, 95%CI 1.56–6.39, p = 0.001). Regression, persistence, and progression of IM were demonstrated in 57.3%, 39.2%, and 3.5% of patients, respectively. Age >65 years, persistent H. pylori infection, and diabetes mellitus were significantly associated with persistent IM or progression to dysplasia with OR 2.47(95%CI 1.33–4.61, p = 0.004), OR 2.64(95%CI 1.13–6.18, p = 0.025), and OR 2.54(95%CI 1.16–5.54, p = 0.019), respectively. Patients without H. pylori infection had more IM regression than patients with persistent infection (60.4%vs.39.4%, p = 0.035). Patients with persistent H. pylori infection significantly had higher IM progression to dysplasia (15.2%vs.2.1%; OR 11.15, 95%CI 1.18–105.24, p = 0.035) than noninfected. During 24 months of study, 30 patients (1.5%) were diagnosed with gastric cancer. Conclusion Regression of IM could be achieved by successful H. pylori eradication. Persistent H. pylori infection was significantly associated with development and progression of IM to dysplasia. Age >65 years and diabetes mellitus were also significant predictors for IM progression.

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Endoscopic Scoring System for Gastric Atrophy and Intestinal Metaplasia: Correlation with OLGA and OLGIM Staging: A Single Center Prospective Pilot Study

10.21203/rs.3.rs-948227/v1 ◽

2021 ◽

Author(s):

Hee Kyong Na ◽

Kee Don Choi ◽

Young Soo Park ◽

Hwa Jung Kim ◽

Ji Yong Ahn ◽

...

Keyword(s):

Intestinal Metaplasia ◽

Predictive Value ◽

Scoring System ◽

Narrow Band Imaging ◽

Gastric Atrophy ◽

Stage Iii ◽

Gastric Intestinal Metaplasia ◽

Endoscopic Score ◽

Greater Curvature ◽

Sensitivity Specificity

Abstract Background/Aims: We aimed to develop an endoscopic scoring system to evaluate atrophic and intestinal metaplasia using narrow-band imaging (NBI) and near focus mode (NFM) to compare endoscopic scores with the Operative link for gastritis assessment (OLGA) and the Operative link for gastric intestinal metaplasia assessment (OLGIM). Methods: A total of 51 patients who underwent diagnostic esophagogastroduodenoscopy were prospectively enrolled and endoscopic scoring using NBI and NFM was performed. Four areas (the lesser and greater curvatures of the antrum and the lesser and greater curvature side of the corpus) were observed and biopsies were taken. The degree of atrophy was scored from 0 to 2 according to the Kimura-Takemoto classification (0: C0-1, 1: C2-3, 2: O1-3). The degree of metaplasia was scored from 0 to 4 (0: no metaplasia, 1: presence of metaplasia at the antrum, 2: presence of metaplasia at the corpus, add score 1: presence of metaplasia for 1/2> observed field of the picture at the antrum, add score 2: 1/2 > observed field of the picture at the corpus). The endoscopic scores were compared to the OLGA and OLGIM staging. Results: The correlation coefficient for atrophy between the endoscopic and histologic scores was 0.70 (95% CI: 0.52–0.81 p <0.001) and for metaplasia, it was 0.75 (95% CI: 0.60–0.85; p <0.001). For atrophic gastritis, endoscopic score > 1 correlated with OLGA stage III and IV with a sensitivity, specificity, positive predictive value, negative predictive value, and agreement of 88%, 74%, 75%, 87%, and 80.4%, respectively, and for metaplasia, an endoscopic score > 1 correlated with high OLGIM stage III and IV with 100%, 59%, 69%, 100%, and 78.4%, respectively. Conclusions: Endoscopic scoring for gastric atrophy and metaplasia using NBI-NFM correlate well with histologic staging.

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Can Neutrophil-To-Lymphocyte Ratio (Nlr) be a simple predictive marker for differentiating gastric intestinal metaplasia and gastric atrophy from non-atrophic non-metaplastic chronic gastritis?

10.52768/jjgastro/1018 ◽

2021 ◽

Vol 1 (4) ◽

Author(s):

Ufuk Kutluana ◽

◽

Ecem Kutluana ◽

Ayse Kilciler ◽

◽

...

Keyword(s):

Intestinal Metaplasia ◽

Multiple Logistic Regression Analysis ◽

Predictive Marker ◽

Gastric Atrophy ◽

Neutrophil To Lymphocyte Ratio ◽

Roc Curve Analysis ◽

Distribution Width ◽

Gastric Intestinal Metaplasia ◽

Lymphocyte Ratio ◽

Independent Determinant

Background: Gastric İntestinal Metaplasia (GIM) and Gastric Atrophy (GA) are pre-neoplastic lesions that can lead to gastric cancer. Nowadays, there are no recognized good biomarkers of GIM and GA. The neutrophil-to-lymphocyte ratio (NLR) is an economical, effective, and repetitive indicator of inflammation. We aimed to comparatively evaluate Red Cell Distribution Width (RDW) and the NLR. Methods: 88 patients with GIM and 48 patients with GA and 64 patients with non-atrophic-non-metaplastic gastritis were included in the study. NLR and RDW levels were measured in patients and controls. Results: NLR levels were significantly higher in patients with GIM than in controls (p < 0.05). NLR level was correlated positively with presence of GIM (p < 0.05), H.pylori presence in GIM and GA (p < 0.05), and menopause (p < 0.05). A multiple logistic regression analysis showed the GIM was predictor for elevated NLR (p < 0.05). According to the ROC curve analysis, the best cut-off NLR value to differentiate between patients with GIM from GA and/or controls was >2.92 (p < 0.05). In this study, we mainly found a significant association between GIM and NLR. Conclusions: NLR is significantly higher in patients with GIM. NLR can be an independent determinant factor for GIM. Keywords: Intestinal metaplasia; gastric atrophy; biomarker.

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Advances in the Aetiology & Endoscopic Detection and Management of Early Gastric Cancer

Cancers ◽

10.3390/cancers13246242 ◽

2021 ◽

Vol 13 (24) ◽

pp. 6242

Author(s):

Darina Kohoutova ◽

Matthew Banks ◽

Jan Bures

Keyword(s):

Gastric Cancer ◽

Helicobacter Pylori ◽

Gastric Carcinoma ◽

Intestinal Metaplasia ◽

Precancerous Lesions ◽

Gastric Atrophy ◽

High Definition ◽

Gastric Intestinal Metaplasia ◽

White Light Endoscopy ◽

Magnification Endoscopy

The mortality rates of gastric carcinoma remain high, despite the progress in research and development in disease mechanisms and treatment. Therefore, recognition of gastric precancerous lesions and early neoplasia is crucial. Two subtypes of sporadic gastric cancer have been recognized: cardia subtype and non-cardia (distal) subtype, the latter being more frequent and largely associated with infection of Helicobacter pylori, a class I carcinogen. Helicobacter pylori initiates the widely accepted Correa cascade, describing a stepwise progression through precursor lesions from chronic inflammation to gastric atrophy, gastric intestinal metaplasia and neoplasia. Our knowledge on He-licobacter pylori is still limited, and multiple questions in the context of its contribution to the pathogenesis of gastric neoplasia are yet to be answered. Awareness and recognition of gastric atrophy and intestinal metaplasia on high-definition white-light endoscopy, image-enhanced endoscopy and magnification endoscopy, in combination with histology from the biopsies taken accurately according to the protocol, are crucial to guiding the management. Standard indications for endoscopic resections (endoscopic mucosal resection and endoscopic submucosal dissection) of gastric dysplasia and intestinal type of gastric carcinoma have been recommended by multiple societies. Endoscopic evaluation and surveillance should be offered to individuals with an inherited predisposition to gastric carcinoma.

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