Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia.
Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia.
J Clin Immunol. 2018 Oct;38(7):768-777. doi: 10.1007/s10875-018-0546-3. Epub 2018 Sep 15.
Individuals with common variable immunodeficiency (CVID) have an increased risk of gastric cancer, and gastrointestinal lymphoma, yet screening for premalignant gastric lesions is rarely offered routinely to these patients. Proposed screening protocols are not widely accepted and are based on gastric cancer risk factors that are not applicable to all CVID patients. Fifty-two CVID patients were recruited for screening gastroscopy irrespective of symptoms or blood results and were compared to 40 controls presenting for gastroscopy for other clinical indications. Overall, 34% of CVID patients had intestinal metaplasia (IM), atrophic gastritis or moderate to severe non-atrophic gastritis, which can increase the risk of gastric cancer, compared to 7.5% of controls (p < 0.01). Focal nodular lymphoid hyperplasia, a precursor lesion for gastrointestinal lymphoma, was seen in eight CVID patients (16%), one of whom was diagnosed with gastrointestinal lymphoma on the same endoscopy. High-risk gastric pathology was associated with increased time since diagnosis of CVID, smoking, Helicobacter pylori, a low-serum pepsinogen I concentration, and diarrhea, but not pepsinogen I/II ratio, iron studies, vitamin B12 levels or upper gastrointestinal symptoms. There was a lower rate of detection of IM when fewer biopsies were taken, and IM and gastric atrophy were rarely predicted by the endoscopist macroscopically, highlighting the need for standardized biopsy protocols. The prevalence of premalignant gastric lesions in patients with CVID highlights the need for routine gastric screening. We propose a novel gastric screening protocol to detect early premalignant lesions and reduce the risk of gastric cancer and gastric lymphoma in these patients.
普通变异性免疫缺陷（CVID）患者患胃癌和胃肠道淋巴瘤的风险增加，但这些患者很少接受常规的癌前胃病变筛查。提出的筛查方案并未得到广泛接受，并且基于不适用于所有 CVID 患者的胃癌危险因素。招募了 52 名 CVID 患者进行筛查性胃镜检查，不论症状或血液检查结果如何，并与 40 名因其他临床指征进行胃镜检查的对照组进行了比较。总体而言，与对照组的 7.5%相比，34%的 CVID 患者存在肠上皮化生（IM）、萎缩性胃炎或中重度非萎缩性胃炎，这些病变会增加胃癌的风险（p<0.01）。8 名 CVID 患者（16%）出现局灶性结节性淋巴组织增生，这是胃肠道淋巴瘤的前期病变，其中 1 名患者在同一次内镜检查中被诊断为胃肠道淋巴瘤。高危胃病理与 CVID 诊断后时间延长、吸烟、幽门螺杆菌、低血清胃蛋白酶原 I 浓度和腹泻有关，但与胃蛋白酶原 I/II 比值、铁研究、维生素 B12 水平或上消化道症状无关。活检次数较少时，IM 的检出率较低，且内镜医生宏观上很少预测出 IM 和胃萎缩，这突出了标准化活检方案的必要性。CVID 患者癌前胃病变的发生率较高，强调了常规胃筛查的必要性。我们提出了一种新的胃筛查方案，以检测早期癌前病变，并降低这些患者患胃癌和胃肠道淋巴瘤的风险。
