Genta Robert M, Sonnenberg Amnon
*Miraca Life Sciences Research Institute, Irving, TX †Departments of Pathology and Medicine (Gastroenterology), VA Medical Center, University of Southwestern Medical Center, Dallas, TX ‡Department of Medicine (Gastroenterology), VA Medical Center, Oregon Health & Science University, Portland, OR.
Am J Surg Pathol. 2015 May;39(5):700-4. doi: 10.1097/PAS.0000000000000384.
Gastric intestinal metaplasia (IM) occurs in response to different injuries, some of which involve increased risk for gastric cancer, whereas others may not. The background in which IM arises has not been systematically investigated. This study was designed to determine the relative prevalence of the histopathologic conditions of the gastric mucosa associated with IM in a large cohort. We extracted from a database patients who had undergone esophagogastroduodenoscopy with gastric biopsies between January 2008 and December 2013 in endoscopy centers throughout the United States. For each subject we recorded demographic, clinical, and histopathologic information. We stratified patients according to the presence of IM and compared the prevalence of Helicobacter pylori infection, reactive gastropathy, minimal inflammatory and gastropathy changes, mucosal atrophy, gastric polyps, cancer, and lymphoma in the 2 groups. IM, present in 8.4% of the 810,821 unique patients, increased with age and was more common in male than in female individuals. Compared with other Americans, East Asian ancestry was associated with a 5-fold risk for IM. Helicobacter gastritis and its sequelae were present in 42.2% of patients with IM, and reactive gastropathy in 17.3%. In >50% of patients under the age of 30 and in 26% of older adults, foci of IM occurred in an almost normal gastric mucosa. Thus, approximately half of the patients with IM had no histopathologic evidence of current or previous Helicobacter gastritis, whereas almost one fifth had a background of reactive gastropathy. Longitudinal studies are needed to determine the relative risk for gastric cancer in patients with IM associated and not with Helicobacter infection.
胃肠化生（IM）是对不同损伤的反应，其中一些损伤会增加患胃癌的风险，而另一些则可能不会。IM发生的背景尚未得到系统研究。本研究旨在确定一大群队列中与IM相关的胃黏膜组织病理学状况的相对患病率。我们从一个数据库中提取了2008年1月至2013年12月期间在美国各地内镜中心接受过食管胃十二指肠镜检查并进行胃活检的患者。对于每个受试者，我们记录了人口统计学、临床和组织病理学信息。我们根据IM的存在对患者进行分层，并比较两组中幽门螺杆菌感染、反应性胃病、轻微炎症和胃病改变、黏膜萎缩、胃息肉、癌症和淋巴瘤的患病率。在810,821名独特患者中，8.4%存在IM，其患病率随年龄增加，男性比女性更常见。与其他美国人相比，东亚血统与IM的风险增加5倍有关。IM患者中42.2%存在幽门螺杆菌胃炎及其后遗症，17.3%存在反应性胃病。在30岁以下的患者中，超过50%以及在老年人中26%的IM病灶出现在几乎正常的胃黏膜中。因此，大约一半的IM患者没有当前或既往幽门螺杆菌胃炎的组织病理学证据，而近五分之一有反应性胃病背景。需要进行纵向研究以确定与幽门螺杆菌感染相关和不相关的IM患者患胃癌的相对风险。
