Intestinal metaplasia is the probable common precursor of adenocarcinoma in Barrett esophagus and adenocarcinoma of the gastric cardia

Ruol, Alberto; Parenti, Anna; Zaninotto, Giovanni; Merigliano, Stefano; Costantini, Mario; Cagol, Matteo; Alfieri, Rita; Bonavina, Luigi; Peracchia, A.; Ancona, Ermanno

doi:10.1002/1097-0142(20000601)88:11<2520::aid-cncr13>3.0.co;2-l

Cited by 141 publications

(75 citation statements)

References 56 publications

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“…Likewise, most GCs arise from the distal part of the stomach and infrequently from the near part. It is believed that GC correlates with IM closely, particularly with the intestinal type of GC based on the fact that the risk for GC and IM shares the same epidemiological characteristics [14] . It was reported that the incomplete IM in which columnar cells secrete sulfuric acid mucous relates with GC [12,15,16] .…”

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confidence: 99%

Histochemical studies on intestinal metaplasia adjacent to gastric cardia adenocarcinoma in subjects at high-incidence area in Henan, north China

Gao¹,

Wang²,

Fan³

et al. 2005

WJG

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Abstract Abstract Abstract AIM:To characterize the histochemical type and pattern of intestinal metaplasia (IM) adjacent to gastric cardia adenocarcinoma (GCA) and distal gastric cancer (GC) in Linzhou, Henan Province, China. METHODS:Alcian-blue-periodic acid Schiff and high iron diamine-Alcian blue histochemical methods were performed on 142 cases of IM, including 49 cases of GCA and 93 cases of GC. All the patients were from Linzhou, Henan Province, China, the highest incidence area for both GCA and squamous cell carcinoma. Radio-or chemotherapy was not applied to these patients before surgery. RESULTS:The detection rate of IM in tissues adjacent to GCA tissues was 44.9%, which was significantly lower than that in GC tissues (80.64%, P<0.01). The rates of both incomplete small intestinal and colonic IM types identified by histochemistry in GCA tissues (31.82% and 63.64%, respectively) were significantly higher than those in GC (5.33% and 21.33%, respectively, P<0.01). CONCLUSION:IM in GCA and GC should be considered as a separate entity. Further research is needed to evaluate whether neoplastic progression of IM is related to its mucin profile in GCA.

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Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Histochemical studies on intestinal metaplasia adjacent to gastric cardia adenocarcinoma in subjects at high-incidence area in Henan, north China

Gao¹,

Wang²,

Fan³

et al. 2005

WJG

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“…8 Other studies have suggested that the presence of intestinal metaplasia of the esophagus, that is, Barrett esophagus, has a greater impact on prognosis. Barrett esophagus is a preneoplastic precursor lesion of adenocarcinomas of the distal esophagus and esophagogastric junction 9,10 and is found in association with approximately 60% of esophageal adenocarcinomas. 11 Like Barrett esophagus, adenocarcinomas of the esophagus and esophagogastric junction are more frequently found in men over the age of 65 years, many of whom have a history of gastroesophageal reflux disease.…”

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The dichotomy in carcinogenesis of the distal esophagus and esophagogastric junction: intestinal-type vs cardiac-type mucosa-associated adenocarcinoma

et al. 2011

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Adenocarcinoma of the distal esophagus and esophagogastric junction continues to rise in incidence. An intestinal metaplasia (Barrett esophagus)-dysplasia-carcinoma sequence induced by gastroesophageal reflux disease is well established. However, a significant number of adenocarcinomas in the vicinity of the esophagogastric junction are seen in the background of gastric/cardiac-type mucosa without intestinal metaplasia. Thus, the aim of this study was to investigate the role of Barrett esophagus (intestinal-type mucosa) in the classification and prognosis of tumors of the distal esophagus and esophagogastric junction. Clinicopathological and molecular characteristics were examined in 157 consecutively resected adenocarcinomas of the distal esophagus and esophagogastric junction and were compared between tumors arising in association with intestinal-type and cardiac-type mucosa. Intestinal-type mucosa-associated adenocarcinomas were more likely to be associated with younger age (P ¼ 0.0057), reflux symptoms (Po0.0001), proximal location (P ¼ 0.0009), lower T stage (Po0.0001), fewer nodal metastases (P ¼ 0.0001), absence of lymphatic (Po0.0001), venous (P ¼ 0.0060) or perineural (Po0.0001) invasion. Histologically, intestinal-type mucosa-associated tumors were more likely to be low-grade glandular tumors (P ¼ 0.0095) of intestinal or mixed immunophenotype (P ¼ 0.015) and express nuclear b-catenin (P ¼ 0.0080), whereas tumors arising in a background of cardiac-type mucosa were more frequently associated with EGFR amplification (P ¼ 0.0051). Five-year overall survival rate was significantly higher in patients with intestinal-type mucosa-associated tumors (28 vs 9%, P ¼ 0.0015), although no survival benefit was seen after adjusting for potential confounders. Our findings support the theory that multiple distinct pathways of tumorigenesis exist in the vicinity of the esophagogastric junction, including one in which tumors arise from dysplastic intestinal metaplasia (intestinal pathway), and one potentially involving dysplasia of the cardiac-type mucosa (non-intestinal pathway). Additional studies are warranted to further clarify their pathogenesis and the molecular mechanisms involved.

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“…These tumors share epidemiologic similarities. 4 The incidence of these 2 types of cancers has progressively risen in the Western world. 2,[5][6][7][8] However, at the present time, it is impossible to predict which patients are at risk of neoplastic progression and all patients are advised to undergo a regular endoscopic followup.…”

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Risk factors for Barrett's esophagus: A case‐control study

Conio¹,

Filiberti²,

Blanchi³

et al. 2001

Intl Journal of Cancer

138

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Barrett's esophagus (BE) is an acquired disorder due to chronic gastroesophageal reflux. Environmental factors seem to play an important role in the pathogenesis of BE, especially in Western society. A multicenter case-control study was carried out between February 1995 and April 1999 in 8 Italian Departments of Gastroenterology gathered in a study group (GOSPE), in order to analyze the influence of some individual characteristics and life-style habits on the occurrence of BE. Three groups of patients were studied: 149 patients with BE, 143 patients with esophagitis (E) and 308 hospital controls (C) with acute, non-neoplastic, non-gastroenterological conditions. The diagnosis of BE was based on endoscopy and histology. E was defined by the Savary classification (grade I-III). Data collection was performed by using a questionnaire that focused on smoking, coffee and alcohol consumption, medical history, drugs history, gastroesophageal reflux disease (GERD) symptoms (heartburn, regurgitation) and socio-economic status. Multivariate analysis showed that the frequency of weekly GERD symptoms was significantly associated with both BE and E (p<0.0001), such as the presence of hiatal hernia (p<0.001). Ulcer was significantly associated with BE (p‫.)100.0؍‬ Among patients with E, the risk was directly related to spirits consumption (p‫.)30.0؍‬ Patients with GERD symptoms that lasted more than 13 years were more likely to have BE than E (p‫.)10.0؍‬ In conclusion, results from our study point out that long-standing GERD symptoms, hiatal hernia and possibly alcohol consumption are risk factors in the development of the BE and E.

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Intestinal metaplasia is the probable common precursor of adenocarcinoma in Barrett esophagus and adenocarcinoma of the gastric cardia

Cited by 141 publications

References 56 publications

Histochemical studies on intestinal metaplasia adjacent to gastric cardia adenocarcinoma in subjects at high-incidence area in Henan, north China

Histochemical studies on intestinal metaplasia adjacent to gastric cardia adenocarcinoma in subjects at high-incidence area in Henan, north China

The dichotomy in carcinogenesis of the distal esophagus and esophagogastric junction: intestinal-type vs cardiac-type mucosa-associated adenocarcinoma

Risk factors for Barrett's esophagus: A case‐control study

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