Premalignant changes associated chronic gastritis in Karbala Province: multi institutional study
AbstractObjectives: The aim of this study was to investigate the prevalence of gastric premalignant changes as gastric atrophy, intestinal metaplasia and dysplastic changes in patients underwent esophagogastroduodenoscopy in three health institutions in Karbala province.
Methods: The data was collected from patients attended the endoscopy units during a period from January to September 2018 in three medical centers in holy Karbala/ Iraq, Al Hussein teaching hospital, Imam Zain Al Abedin hospital and Imam AL Hujjah hospital. It includes 215 males and 285 females who were subjected to esophagogastroduodenoscopy (EGD) from whom mucosal biopsies were taken. These biopsies were stained by Giemsa to detect H. pylori organisms.
Results: The mean age of patients was (40.9 +/- 15 years SD). H. Pylori infection was demonstrated in (71%) patients, (19.4%) were presented with glandular atrophy, (7.4%) out of 500 patients had intestinal metaplasia and only 6 (1.2%) patients had dysplastic changes. there was a significant statistical relation between gastric glandular atrophy and age, p value (0.03). there was a significant statistical relation between glandular atrophy and infection with H. Pylori, p value (0.001). there was a significant negative relation between H. Pylori infection and the existence of intestinal metaplasia, p value (0.0001). this study show a significant statistical relationship between the existence of intestinal metaplasia and the occurrence of dysplastic changes, P value (0.001).
Conclusion: the current study show a significant relation between aging and the existence of gastric glandular atrophy. There was a significant relation between each of gastric glandular atrophy and intestinal metaplastic changes with the H. pylori infection. there was a significant relation between gastric intestinal metaplasia and dysplastic changes.
2. Ferro A, Peleteiro B, Malvezzi M, Bosetti C, Bertuccio P, Levi F, Negri E, La Vecchia C, Lunet N. Worldwide trends in gastric cancer mortality (1980–2011), with predictions to 2015, and incidence by subtype. European journal of cancer. 2014 May 1;50(7):1330-44.
3. Olmez S, Aslan M, Erten R, Sayar S, Bayram I. The prevalence of gastric intestinal metaplasia and distribution of helicobacter pylori infection, atrophy, dysplasia, and cancer in its subtypes. Gastroenterology research and practice. 2015;2015.
4. Srivastava A, Kim GH, Mino-Kenudson M, Deshpande V, Zukerberg LR, Am Song G, Lauwers GY. CDX2 expression in the intestinal-type gastric epithelial neoplasia: frequency and significance. Modern Pathology. 2010 Jan;23(1):54.
5. Houghton J, Wang TC. Helicobacter pylori and gastric cancer: a new paradigm for inflammation-associated epithelial cancers. Gastroenterology. 2005 May 1;128(6):1567-78.
6. Catalano V, Labianca R, Beretta GD, Gatta G, De Braud F, Van Cutsem E. Gastric cancer. Critical reviews in oncology/hematology. 2009 Aug 1;71(2):127-64.
7. Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M, Taniyama K, Sasaki N, Schlemper RJ. Helicobacter pylori infection and the development of gastric cancer. New England Journal of Medicine. 2001 Sep 13;345(11):784-9.
8. Lee YC, Chen TH, Chiu HM, Shun CT, Chiang H, Liu TY, Wu MS, Lin JT. The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention. Gut. 2013 May 1;62(5):676-82.
9. Blaser MJ, Nomura A, Lee J, Stemmerman GN, Perez-Perez GI. Early-life family structure and microbially induced cancer risk. PLoS medicine. 2007 Jan 16;4(1):e7.
10. Dinis-Ribeiro M, Areia M, De Vries AC, Marcos-Pinto R, Monteiro-Soares M, O’connor A, Pereira C, Pimentel-Nunes P, Correia R, Ensari A, Dumonceau JM. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy. 2012 Jan;44(01):74-94.
11. Correa P, Piazuelo MB, Wilson KT. Pathology of gastric intestinal metaplasia: clinical implications. The American journal of gastroenterology. 2010 Mar;105(3):493.
12. GLOBOCAN IARC. Cancer Map: Male Stomach Cancer, Age-Standardized Incidence Rate per 100,000 in 2002. Available from: URL: http://www-dep.iarc.fr/. Accessed on May 30, 2007.
13. Hussein NR, Napaki SM, Atherton JC. A study of Helicobacter pylori-associated gastritis patterns in Iraq and their association with strain virulence. Saudi journal of gastroenterology: official journal of the Saudi Gastroenterology Association. 2009 Apr;15(2):125.
14. Fuccio L, Zagari RM, Minardi ME, Bazzoli F. Systematic review: Helicobacter pylori eradication for the prevention of gastric cancer. Alimentary pharmacology & therapeutics. 2007 Jan;25(2):133-41.
15. Yasir S, Moin F, Akhtar SM. Frequency of helicobacter pylori infection on histopathology in patients with dyspepsia. American Journal of Clinical Medicine Research. 2014;2(3):53-6.
16. Ahn HJ, Lee DS. Helicobacter pylori in gastric carcinogenesis. World journal of gastrointestinal oncology. 2015 Dec 15;7(12):455.
17. Eusebi LH, Zagari RM and Bazzoli F. Epidemiol¬ogy of helicobacter pylori infection. Helico¬bacter 2014; 19 Suppl 1: 1-5.
18. Ozakay A, Kınacı E, Bayrak S, Pasaoğlu E, Sevinc MM, Dursun N. Helicobacter pylori, intestinal metaplasia, and the accuracy of biopsies in metaplastic gastric mucosa. Int J Clin Exp Med. 2017 Jan 1;10(3):5332-7.
19. Sarkar C, Anim JT, Ibrahim BH. Atrophic gastritis and intestinal metaplasia in Helicobacter pylori-associated antral gastritis. Medical Principles and Practice. 1994;4(4):197-203.
20. Korstanje A, Hartog GD, Biemond I, Lamers CB. The serological gastric biopsy: a non-endoscopical diagnostic approach in management of the dyspeptic patient significance for primary care based on a survey of the literature. Scandinavian Journal of Gastroenterology. 2002 Jan 1;37(236):22-6.
21. Matalka II, Al-Omari FA, Al-Jarrah MA, Obeidat FN, Kanaan FM. Image-based discriminating morphological features for gastric atrophy assessment: a step to go further. Pathology-Research and Practice. 2008 Apr 14;204(4):235-40.
22. Kaklikkaya N, Cubukcu K, Aydin F, Bakir T, Erkul S, Tosun I, Topbas M, Yazici Y, Buruk CK, Erturk M. Significance of cagA status and vacA subtypes of Helicobacter pylori in determining gastric histopathology: virulence markers of H. pylori and histopathology. Journal of gastroenterology and hepatology. 2006 Jun;21(6):1042-7.
23. Sonnenberg A, Lash RH, Genta RM. A national study of Helicobactor pylori infection in gastric biopsy specimens. Gastroenterology. 2010 Dec 1;139(6):1894-901.
24. De Vries AC, Van Grieken NC, Looman CW, Casparie MK, de Vries E, Meijer GA, Kuipers EJ. Gastric cancer risk in patients with premalignant gastric lesions: a nationwide cohort study in the Netherlands. Gastroenterology. 2008 Apr 1;134(4):945-52.
25. Almouradi T, Hiatt T, Attar B. Gastric intestinal metaplasia in an underserved population in the USA: prevalence, epidemiologic and clinical features. Gastroenterology research and practice. 2013;2013.
26. Malekzadeh R, Sotoudeh M, Derakhshan MH, Mikaeli J, Yazdanbod A, Merat S, Yoonessi A, Tavangar M, Abedi BA, Sotoudehmanesh R, Pourshams A. Prevalence of gastric precancerous lesions in Ardabil, a high incidence province for gastric adenocarcinoma in the northwest of Iran. Journal of clinical pathology. 2004 Jan 1;57(1):37-42.
27. Den Hoed CM, Van Eijck BC, Capelle LG, van Dekken H, Biermann K, Siersema PD, Kuipers EJ. The prevalence of premalignant gastric lesions in asymptomatic patients: predicting the future incidence of gastric cancer. European Journal of Cancer. 2011 May 1;47(8):1211-8.
28. Çınar A, Sadıç M, Atılgan Hİ, Baskın A, Koca G, Demirel K, Korkmaz M. Prevalence of Helicobacter pylori infection in school and pre-school aged children with C-14 urea breath test and the association with familial and environmental factors. Molecular imaging and radionuclide therapy. 2015 Jun;24(2):66.
29. Fikret D, Kaya Ö, Suna E, Vahap O, Mustafa A, Şebnem A. Relationship between atrophic gastritis, intestinal metaplasia, dysplasia and Helicobacter pylori infection. Turkish J Gastroenterol. 2001;12(2):169-70.
30. Galiatsatos P, Wyse J, Szilagyi A. Accuracy of biopsies for Helicobacter pylori in the presence of intestinal metaplasia of the stomach. The Turkish Journal of Gastroenterology. 2014 Feb 1;25(1):19-23.
31. Almouradi T, Hiatt T, Attar B. Gastric intestinal metaplasia in an underserved population in the USA: prevalence, epidemiologic and clinical features. Gastroenterology research and practice. 2013;2013.
32. Lee YC, Chen TH, Chiu HM, Shun CT, Chiang H, Liu TY, Wu MS, Lin JT. The benefit of mass eradication of Helicobacter pylori infection: a community-based study of gastric cancer prevention. Gut. 2013 May 1;62(5):676-82.
33. Gomez JM, Patrie JT, Bleibel W, Frye JW, Sauer BG, Shami VM, Stelow EB, Moskaluk CA, Wang AY. Gastric intestinal metaplasia is associated with gastric dysplasia but is inversely correlated with esophageal dysplasia. World journal of gastrointestinal endoscopy. 2017 Feb 16;9(2):61.
34. Mohammad Amin Bozorgnia , Seyed Mohammad Hossein Kashfi , Mehdi Ariana , Foroozan Ghalkhani , Shahrokh Iravani , Mohammad Hossein Lashkari , Hasan Jalaeikhoo , Pedram Azimzadeh , Amir Shabdini Pashaki , Nastaran Saeedi, Mohsen Azizi. Prevalence and correlation of chronic atrophic gastritis, intestinal metaplasia and other precancerous lesions of stomach in Iran: a historical cohort study. Transl Gastrointest Cancer 2015;4(6):413-422.
35. Chon I, Choi C, Shin CM, Park YS, Kim N, Lee DH. Effect of Helicobacter pylori eradication on subsequent dysplasia development after endoscopic resection of gastric dysplasia. The Korean Journal of Gastroenterology. 2013 Jun 1;61(6):307-12.