Gastric cancer risk in relation to Helicobacter pylori infection and subtypes of intestinal metaplasia

Abstract

(Correa. 1992). In sequential changes from superficial gastritis to dysplasia and cancer. intestinal metaplasia (TM) plays a pivotal role. This is testified by a high frequency of IM in patients with GC and in their relatives. a similar topographic distribution of IM and GC. and a high IM occurrence in endemic areas with a high risk of GC (Dobrilla et al. 1994). Although most investigators agree with Stemmermann ( 1994) that the risk of GC is proportional to the extent of IM and although IM has been intensively explored as a possible premalignant lesion of GC. controversy exists because of many confounding factors in previous retrospective studies (Antonioli. 1994). Because of the heterogeneous nature of IM. a recent interest has been focused on the interrelationship between GC and different subtypes of IM (Jass et al. 1979: Turani et al. 1986: Filipe et al. 1994 patients were finally included in this study. Tumorous. adjacent and non-tumorous portions were resected from surgical specimens and stored for further examination. Controls matched one-to-one with cases on age (within 3 years). sex. ethnic group and residential area were also selected from subjects receiving endoscopic examinations that did not reveal any ulcer nor tumour in the stomach. During this procedure. five specimens were biopsied including two from the lesser curvature of the antrum. one from the incisura angularis and two from the lesser curvature of the corpus of the stomach. An aliquot of 5 ml of heparinized blood wvas collected from each study subject. and the serum was separated on the same day and stored at -70°C until further testing. The titre of serum IgG antibody against H. pylorn was determined using an enzyme-linked immunosorbent assay as previously described (Lin et al. 1993).Histopathological determination of intestinal metaplasia and its subtypes Specimens from patients and controls were fixed in 10% buffered formalin. embedded in paraffin. sectioned and stained with haematoxylin and eosin (H&E). If IM was present in H&E staining, a fther section was stained using the high iron diamine (HID)alcian Table 2. There were 57 patients with diffuse type GC and 78 with intestinal type GC. According to the depth of invasion. the frequency of early lesion in diffuse type GC (42 .1%) was higher than that of intestinal type GC (29.5%7. P = 0.18).Intestinal type GC had a significantly higher frequency of coexistent IM (91.0%) than diffuse type (33.3%. P = 0.0001).As shown in Table 3

Metallothionein in human gastrointestinal cancer

“…In gastric cancer, we found no association between the MT content and any clinicopathological parameter. However, our observation that MT is strongly expressed by foci of intestinal metaplasia, which have increased neoplastic potential42, indicates that MT might play a role in the growth and differentiation even of cells within normal‐appearing gastric mucosa. Similarly, although Monden et al 26.…”

Staging and grading of chronic gastritis

“…The stage of chronic gastritis is related to both its duration and to the host's response to the etiological agent(s) and may have implications for the prognosis and management of the patient. Some studies suggested that the histochemical phenotype of IM is associated with a cancer risk increasing progressively from type I to type III [43,44]. Because a greater extension of metaplasia is associated with a greater proportion of type III IM [40], we uphold the recommendation of the Updated Sydney System discouraging the use of histochemical phenotyping to determine the type of metaplasia.…”

Prospects for intervention in gastric carcinogenesis: reversibility of gastric atrophy and intestinal metaplasia

“…Interestingly, it is the latter type that harbours most genetic changes17 18 and the only IM phenotype that carries a higher risk for gastric cancer 19…”