Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014, Helsinki, Finland.
Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 66, 00014, Helsinki, Finland.
Acta Vet Scand. 2021 Feb 9;63(1):7. doi: 10.1186/s13028-021-00570-6.
Gastric carcinoma (GC) is uncommon in dogs, except in predisposed breeds such as Belgian Shepherd dogs (BSD) of the Tervuren and Groenendael varieties. When GC is diagnosed in dogs it is often late in the disease, resulting in a poorer prognosis. The aim of this prospective clinical study was to investigate possible associations of gastric mucosal pathologies with clinical signs, laboratory test results and GC in BSD. An online survey gathered epidemiological data to generate potential risk factors for vomiting as the predominant gastric clinical sign, and supported patient recruitment for endoscopy. Canine Chronic Enteropathy Clinical Activity Index (CCECAI) score and signs of gastroesophageal reflux (GER) were used to allocate BSD older than five years to either Group A, with signs of gastric disease, or Group B, without signs. Findings in the clinical history, laboratory tests and gastric histopathology of endoscopic biopsies were statistically analysed in search of associations.
The online survey included 232 responses. Logistic regression analysis recognized an association of vomiting with gagging, poor appetite and change in attitude. Recruitment for endoscopy included 16 BSD in Group A (mean age 9.1 ± 1.8 years, mean CCECAI = 3.1 ± 2.2 and signs of GER); and 11 in Group B (mean age 9.8 ± 1.4 years, CCECAI = 0, no signs of GER). Seven (25.9%) of the 27 BSD (Group A 4/16, Group B 3/11) had leukopenia. Serum C-reactive protein tended to be increased with more advanced GC (P = 0.063). Frequency of GC, mucosal atrophy, mucous metaplasia, or glandular dysplasia did not differ between groups. GC was frequently diagnosed (6/27), even without clinical signs (2/11). The odds ratio for vomiting (OR = 9.9; P = 0.016) was increased only when glandular dysplasia was present. GC was associated with mucous metaplasia (P = 0.024) and glandular dysplasia (P = 0.006), but not with mucosal atrophy (P = 1).
GC can develop as an occult disease, associated with metaplasia and dysplasia of the gastric mucosa. Suggestive clinical signs, notably vomiting, should warrant timely endoscopy in BSD. Extensive endoscopic screening of asymptomatic dogs remains, however, unrealistic. Therefore, biomarkers of mucosal pathology preceding clinical illness are needed to support an indication for endoscopy and enable early diagnosis of GC.
胃癌（GC）在犬中不常见，除了在易感品种中，如 Tervuren 和 Groenendael 品种的比利时牧羊犬（BSD）。当犬被诊断出患有 GC 时，通常已经处于疾病晚期，预后较差。本前瞻性临床研究的目的是探讨犬胃黏膜病变与临床症状、实验室检查结果和 GC 之间的可能关联。一项在线调查收集了流行病学数据，以确定以呕吐为主要胃临床症状的潜在危险因素，并支持招募接受内镜检查的患者。犬慢性肠病临床活动指数（CCECAI）评分和胃食管反流（GER）的迹象用于将五岁以上的 BSD 分配到 A 组，有胃疾病迹象，或 B 组，无胃疾病迹象。对内镜活检的临床病史、实验室检查和组织病理学结果进行了统计学分析，以寻找关联。
在线调查包括 232 份回复。逻辑回归分析发现，呕吐与呛咳、食欲不振和态度改变有关。内镜检查共招募了 16 只 A 组 BSD（平均年龄 9.1±1.8 岁，平均 CCECAI=3.1±2.2，有 GER 迹象）和 11 只 B 组 BSD（平均年龄 9.8±1.4 岁，CCECAI=0，无 GER 迹象）。27 只 BSD 中有 7 只（25.9%）出现白细胞减少症（Group A 4/16，Group B 3/11）。随着 GC 更晚期，血清 C 反应蛋白有升高趋势（P=0.063）。两组间 GC、黏膜萎缩、黏液化生或腺体发育不良的频率无差异。即使没有临床症状（2/11），也经常诊断出 GC（6/27）。当存在腺体发育不良时，呕吐的优势比（OR=9.9；P=0.016）增加。GC 与黏液化生（P=0.024）和腺体发育不良（P=0.006）有关，但与黏膜萎缩无关（P=1）。
GC 可作为隐匿性疾病发展，与胃黏膜化生和发育不良有关。有提示性的临床症状，特别是呕吐，应及时在内镜检查中对 BSD 进行检查。然而，对无症状犬进行广泛的内镜筛查仍然不现实。因此，需要有黏膜病理的生物标志物来支持内镜检查的适应证，并能够早期诊断 GC。
