Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy.
Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy.
Am J Gastroenterol. 2021 Sep 1;116(9):1859-1867. doi: 10.14309/ajg.0000000000001390.
Corpus atrophic gastritis (CAG) is associated with intestinal metaplasia (IM) and pseudopyloric metaplasia (PPM). Prospective data on corpus mucosa PPM and its link to the development of gastric cancer (GC) are lacking. This study aimed to investigate the relationship between the presence of corpus mucosa PPM at baseline and the development of GC at follow-up in patients with CAG.
A longitudinal cohort study was conducted on patients with consecutive CAG adhering to endoscopic-histological surveillance. Patients were stratified for the presence/absence of corpus PPM without concomitant corpus IM at baseline, and the occurrence of gastric neoplastic lesions at the longest available follow-up was assessed.
A total of 292 patients with CAG with a follow-up of 4.2 (3-17) years were included. At baseline, corpus PPM without corpus IM was diagnosed in 62 patients (21.2%). At the follow-up, GC was detected in 5 patients (1.7%) and gastric dysplasia (GD) in 4 patients (1.4%). In all these 9 patients with GC/GD at the follow-up, corpus IM was present at baseline and follow-up. Age <50 years (odds ratio [OR] 2.5), absence of pernicious anemia (OR 4.3), and absence of severe corpus atrophy (OR 2.3) were associated with corpus PPM without corpus IM.
At the 4.2-year follow-up, in patients with CAG characterized at baseline with corpus PPM without corpus IM, GC or GD was not observed because these lesions were consistently associated with corpus IM. Corpus PPM without corpus IM was associated with younger age, absence of pernicious anemia, and severe corpus atrophy, suggesting a lower stage of disease progression. Corpus PPM alone seems not to be associated with GC, whose development seems to require the presence of corpus IM as a necessary step.
萎缩性胃炎（CAG）与肠上皮化生（IM）和假幽门化生（PPM）有关。缺乏关于 CAG 患者胃底黏膜 PPM 及其与胃癌（GC）发展之间关系的前瞻性数据。本研究旨在探讨 CAG 患者基线时胃底黏膜 PPM 的存在与随访时 GC 发展之间的关系。
对连续接受内镜-组织学监测的 CAG 患者进行了一项纵向队列研究。根据基线时胃底黏膜 PPM 是否存在且无胃底黏膜 IM 进行分层，并评估最长随访时胃内肿瘤性病变的发生情况。
共纳入 292 例 CAG 患者，随访时间为 4.2（3-17）年。基线时，62 例（21.2%）患者诊断为胃底黏膜 PPM 而无胃底黏膜 IM。在随访期间，5 例（1.7%）患者诊断为 GC，4 例（1.4%）患者诊断为胃异型增生（GD）。在所有这些 9 例随访时 GC/GD 的患者中，基线和随访时均存在胃底黏膜 IM。<50 岁（比值比 [OR] 2.5）、无恶性贫血（OR 4.3）和无严重胃底萎缩（OR 2.3）与胃底黏膜无胃底黏膜 IM 相关。
在 4.2 年的随访中，在基线时胃底黏膜 PPM 而无胃底黏膜 IM 的 CAG 患者中，未观察到 GC 或 GD，因为这些病变始终与胃底黏膜 IM 相关。胃底黏膜 PPM 而无胃底黏膜 IM 与年龄较小、无恶性贫血和严重胃底萎缩相关，提示疾病进展程度较低。单纯的胃底黏膜 PPM 似乎与 GC 无关，GC 的发展似乎需要胃底黏膜 IM 的存在作为必要步骤。
