Nagata Naoyoshi, Shimbo Takuro, Akiyama Junichi, Nakashima Ryo, Kim Hyung Hun, Yoshida Takeichi, Hoshimoto Kazufusa, Uemura Naomi
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine (NCGM), Tokyo, Japan.
Department of Clinical Research and Informatics International Clinical Research Center Research Institute, NCGM, Tokyo, Japan.
Gastroenterology Res. 2011 Oct;4(5):203-209. doi: 10.4021/gr357w. Epub 2011 Sep 20.
Intestinal metaplasia (IM) is regarded as a premalignant lesion. However, endoscopic diagnosis of IM has been considered difficult. Using endoscopy, we found a unique pattern of erythema, "Mottled Patchy Erythema (MPE)," which includes severe IM. () infection itself can cause erythema, which reflects histologic changes in the gastric mucosa. Therefore we enrolled eradication patients to validate the relation between MPE and pathologic findings.
We enrolled patients with chronic gastritis who underwent successful eradication at least 6 months before the study. We defined MPE as multiple flat or depressed erythematous lesions. When encountering MPE on endoscopy, we performed biopsy on both the MPE site and non-MPE site. The non-MPE site was defined as an adjacent mucosa located within 3 cm of the MPE site. All biopsy specimens were evaluated immunohistochemically for IM subtype using MUC2, MUC5AC, MUC6, CD10, and CDX2 stains. The degree of IM was defined according to the Updated Sydney System. The diagnostic accuracy of the MPE findings for pathologic IM was calculated. The relation between MPE and IM subtype was also assessed.
A total of 102 patients were selected for the study. Of these, 55 (54%) patients had MPE. Biopsy specimens were taken from the MPE sites and non-MPE sites from these 55 patients. The IM percentages and median scores of IM were both significantly higher at the MPE sites (P < 0.001) than at the non-MPE sites. The sensitivity and specificity for MPE in the detection of histologic IM were 72.7% and 84.1%, respectively. No significant associations were observed in the expression of MUC2, MUC5AC, MUC6, CD10, and CDX2 between the MPE sites and non-MPE sites. There were no significant differences in the ratios (complete/incomplete) of IM subtypes between the two groups.
MPE is a useful endoscopic finding to detect histologic IM without the use of chromoendoscopy and magnifying endoscopy. However, the IM subtype is difficult to identify. In the era of eradication, MPE has the potential to become a predictive finding for the risk of gastric cancer.
肠化生（IM）被视为一种癌前病变。然而，内镜诊断IM一直被认为具有难度。通过内镜检查，我们发现了一种独特的红斑模式，即“斑点状红斑（MPE）”，其中包括重度IM。（）感染本身可导致红斑，这反映了胃黏膜的组织学变化。因此，我们纳入根除治疗的患者以验证MPE与病理结果之间的关系。
我们纳入了在研究前至少6个月成功进行根除治疗的慢性胃炎患者。我们将MPE定义为多个扁平或凹陷的红斑性病变。在内镜检查中遇到MPE时，我们在MPE部位和非MPE部位均进行活检。非MPE部位定义为位于MPE部位3厘米内的相邻黏膜。所有活检标本均使用MUC2、MUC5AC、MUC6、CD10和CDX2染色进行免疫组织化学评估以确定IM亚型。IM的程度根据更新的悉尼系统进行定义。计算MPE发现对于病理IM的诊断准确性。还评估了MPE与IM亚型之间的关系。
共102例患者被选入本研究。其中，55例（54%）患者有MPE。从这55例患者的MPE部位和非MPE部位获取活检标本。MPE部位的IM百分比和IM中位评分均显著高于非MPE部位（P < 0.001）。MPE检测组织学IM的敏感性和特异性分别为72.7%和84.1%。在MPE部位和非MPE部位之间，未观察到MUC2、MUC5AC、MUC6、CD10和CDX2表达的显著关联。两组之间IM亚型的比例（完全/不完全）无显著差异。
MPE是一种无需使用色素内镜和放大内镜即可检测组织学IM的有用内镜表现。然而，IM亚型难以识别。在根除治疗时代，MPE有可能成为胃癌风险的预测性表现。
