Nodular Gastritis as a Precursor Lesion of Atrophic and Metaplastic Gastritis

Abstract

Background/Aims: Chronic atrophic gastritis (CAG) and metaplastic gastritis (MG) are precancerous conditions of Helicobacter pylori (H. pylori)-related gastric cancer. This study aimed to identify the characteristics of nodular gastritis (NG) showing CAG or MG after nodule regression. Methods: H. pylori-infected patients with NG were included after upper gastrointestinal endoscopy. Patients were excluded if their latest endoscopy had been performed ≤36 months after the initial diagnosis of NG. Small-granular-type NG was defined as the condition with 1-2 mm regular subepithelial nodules. Large-nodular-type NG was defined as those with 3-4 mm, irregular subepithelial nodules. The endoscopic findings after nodule regression were recorded. Results: Among the 97 H. pylori-infected patients with NG, 61 showed nodule regression after a mean follow-up of 73.0±22.0 months. After nodule regression, 16 patients showed a salt-and-pepper appearance and/or transparent submucosal vessels, indicating CAG. Twenty-nine patients showed diffuse irregular elevations and/or whitish plaques, indicating MG. Sixteen patients with other endoscopic findings (14 normal, one erosive gastritis, and one chronic superficial gastritis) showed a higher proportion of H. pylori eradication (12/16, 75.0%) than those in the CAG group (5/16, 31.3%) and MG group (6/29, 20.7%; p=0.001). Patients with small-granular-type NG tended to progress toward CAG (14/27, 51.9%), whereas those with large-nodular-type NG tended to progress toward MG (25/34, 73.5%; p<0.001). Conclusions: In patients with a persistent H. pylori infection, NG tended to progress to CAG or MG when the nodules regressed. Small-granular-type NG tended to progress to CAG, whereas large-nodular-type NG tended to progress to MG.

Gastric epithelial histology and precancerous conditions

“…According to the updated Sydney system classification of CG, CG can be divided into atrophic and non-atrophic gastritis (chronic superficial gastritis)[ 57 ]. H. pylori -induced chronic non-atrophic gastritis can progress to atrophic gastritis[ 58 , 59 ]. Atrophy of the gastric mucosa is defined as the decrease or disappearance of the original gastric glands, which may be replaced by SPEM/pseudopyloric metaplasia (PPM), pyloric metaplasia, IM or fibrosis[ 60 ].…”

Ultrasound criteria for predicting pre-cancer changes of the gastric mucosa in patients with chronic atrophic gastritis combined with thyroid pathology

“…More than half of the people worldwide suffer from chronic gastritis accompanied by the prolonged inflammation that results in the destruction of the gastric mucosa (GM) with the loss of gastric glands -the formation of atrophic gastritis [1,2]. In atrophic gastritis, in its turn, there is a high risk of restructuring changes in the form of replacement of the lost glands with new immature ones, similar in their structure to small or large intestinal glands -the so-called elements of intestinal metaplasia, and the risk of losing the cell architecture, i. e. dysplastic changes, and as a consequence, the emergence of gastric cancer [3,4]. It is known that such processes last quite long, but the severe socio-economic consequences of such a disease as gastric cancer necessitate search for markers of timely detection and prediction of precancerous structural changes in the stomach [5].…”

Prognosis of Seronegative Subjects with a Helicobacter pylori-infected Spouse

“…황 색종(xanthoma)은 노란색 반점이 국소적으로 보일 때 진단했으 며, 화생성 위염(metaplastic gastritis)은 울퉁불퉁한 흰색 융기 나 붉은 함몰 또는 융모상 변화(villous change)가 불규칙하게 관찰될 때 진단했다. 위축성 위염(chronic atrophic gastritis, CAG)은 점막이 얇아져서 점막하층이 salt-and-pepper 모양으 로 투영되거나, 15 점막하층의 혈관상이 보라색의 긴 나뭇가지 모 양으로 관찰되면 진단했다. CAG의 분류는 최근에 보고한 연구 처럼 폐쇄형(closed-type 0, 1, 2, 3)부터 개방형(open-type 1, 2, 3, pangastritis)까지 8단계로 분류했다.…”