Testoni P A, Masci E, Marchi R, Guslandi M, Ronchi G, Tittobello A
J Clin Gastroenterol. 1987 Jun;9(3):298-302.
Atrophic gastritis with intestinal metaplasia is generally considered a precancerous lesion. We followed 261 patients with chronic atrophic gastritis and intestinal metaplasia, with and without gastric ulcer, every 12 months for 9 +/- 2 years by means of endoscopic and histological examination. In the presence of dysplasia, however, studies were carried out every 6 months in moderate cases, or every 3 months in severe cases. Patients with gastric ulcer received medical therapy for 8 weeks; if healing did not occur, treatment was continued. Only subjects with healed ulcers were admitted to the follow-up. To date, 205 subjects have been included in the study. Over a 10-year period, 16 patients with recurrent gastric ulcer and 12 patients with cancer in situ or in an early stage, were subjected to surgery. One case of advanced cancer was observed. Cancer has been found in five of 95 cases of atrophic gastritis with gastric ulcer (5.2%), and in 7 of 166 cases of atrophic gastritis without gastric ulcer (4.2%). The difference was not statistically significant. Our results confirm that gastric ulcer per se is not a high-risk condition, but it must be considered as an epiphenomenon on a background of epithelial atrophy.
萎缩性胃炎伴肠化生一般被认为是一种癌前病变。我们对261例患有慢性萎缩性胃炎伴肠化生的患者进行了随访，这些患者中有胃溃疡和无胃溃疡的情况均存在，通过内镜和组织学检查，每12个月进行一次，持续9±2年。然而，在存在发育异常的情况下，中度病例每6个月进行一次检查，重度病例每3个月进行一次检查。患有胃溃疡的患者接受了8周的药物治疗；如果溃疡未愈合，则继续治疗。只有溃疡愈合的受试者才被纳入随访。迄今为止，205名受试者已被纳入该研究。在10年期间，16例复发性胃溃疡患者和12例原位癌或早期癌患者接受了手术治疗。观察到1例进展期癌。在95例伴有胃溃疡的萎缩性胃炎病例中有5例发现癌症（5.2%），在166例无胃溃疡的萎缩性胃炎病例中有7例发现癌症（4.2%）。差异无统计学意义。我们的结果证实，胃溃疡本身并非高危情况，但必须将其视为上皮萎缩背景下的一种附带现象。
