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Review of atrophic gastritis and intestinal metaplasia as a premalignant lesion of gastric cancer.

Park YH, Kim N - J Cancer Prev (2015)

Bottom Line: The prevalence of AG and IM vary depending on countries, even it represents diverse results in the same nation.Helicobacter pylori infection has been proved as the most important cause of AG and IM.However, the reversibility of AG and IM by eradication of H. pylori which was assumed to be certain by meta-analysis is; however, controversial now.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam.

ABSTRACT
Atrophic gastritis (AG) and intestinal metaplasia (IM) are the main precursor lesions of gastric cancer as the incidence of gastric cancer increases in the gastric mucosa involved with AG and IM. The prevalence of AG and IM vary depending on countries, even it represents diverse results in the same nation. Usually AG is antecedent of IM but the etiologies of AG and IM are not always the same. The sensitivity and specificity of diagnostic methods to detect AG and IM are different. Furthermore, the management strategy of AG and IM has not been established, yet. Helicobacter pylori infection has been proved as the most important cause of AG and IM. Thus the eradication of H. pylori is very important to prevent the progression to gastric cancer which is still placed in the high rank in morbidity and mortality among cancers. However, the reversibility of AG and IM by eradication of H. pylori which was assumed to be certain by meta-analysis is; however, controversial now. Therefore, the understanding and early diagnosis of AG and IM are very important, especially, in high incidence area of gastric cancer such as Republic of Korea.

No MeSH data available.


Related in: MedlinePlus

Grading of gastritis by Sydney System: acute inflammation, chronic inflammation, atrophic gastritis, intestinal metaplasia, and Helicobacter pylori densitiy. Adapted from Dixon et al.63
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f3-jcp-20-25: Grading of gastritis by Sydney System: acute inflammation, chronic inflammation, atrophic gastritis, intestinal metaplasia, and Helicobacter pylori densitiy. Adapted from Dixon et al.63

Mentions: There is no universally accepted classification of gastritis, although several classifications of gastritis have been proposed. The first classification based on histopathological examination of gastric mucosa collected by so-called blind biopsies and samples collected during surgical procedures was created by Schindler.61 Schindler61 described that gastritis was divided into a superficial gastritis (Fig. 2B) that may progress to AG (Fig. 2C) and IM (Fig. 2D) with time, which is different from normal (Fig. 2A). Additionally, Schindler61 proposed that there were different courses and prognoses of disease by the type of the gastritis. And a novel classification and grading of gastritis was devised by a group of experts at the 9th World Congress of Gastroenterology in Sydney, Australia in 1990.62 The histological division of Sydney System is a practical guideline upon which the morphological features of gastritis in endoscopic biopsy samples should be documented. Type, severity and extent of gastric inflammation composed to possible etiology should be detailed depending on the chart. The Sydney System asserted the routine gastric biopsy sampling protocol (two from antrum and two from corpus, both from anterior and posterior walls) and sample fixation in adequately labelled separate containers.62 Now the updated Sydney system in 1996 is most widely used as the classification of gastritis.63 The original Sydney classification of gastritis dividing into gastritis acute, chronic and special forms, and grading of chronic inflammation, neutrophil activity, atrophy, IM and H. pylori density into mild, moderate and marked categories were kept.62 The updated Sydney system introduced a visual analogue scale for evaluating the severity of histological grading (Fig. 3).63 The histological features of the gastric mucosa were recorded using updated Sydney system scores, that is, 0 = none, 1 = mild, 2 = moderate, and 3 = marked.63 It changed the routine of endoscopic biopsy sampling by the introduction of biopsy sampling from the incisura angularis and modified corpus and antrum biopsy locations from the two opposite walls in lesser and greater curvature of both parts (Fig. 4).63 Endoscopic description of acute gastritis by Sydney system are divided into edema, exudates, erosions and hemorrhage. In contrast, endoscopic diagnosis and classification of chronic gastritis are reliable depending on the inter-observer.63


Review of atrophic gastritis and intestinal metaplasia as a premalignant lesion of gastric cancer.

Park YH, Kim N - J Cancer Prev (2015)

Grading of gastritis by Sydney System: acute inflammation, chronic inflammation, atrophic gastritis, intestinal metaplasia, and Helicobacter pylori densitiy. Adapted from Dixon et al.63
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384712&req=5

f3-jcp-20-25: Grading of gastritis by Sydney System: acute inflammation, chronic inflammation, atrophic gastritis, intestinal metaplasia, and Helicobacter pylori densitiy. Adapted from Dixon et al.63
Mentions: There is no universally accepted classification of gastritis, although several classifications of gastritis have been proposed. The first classification based on histopathological examination of gastric mucosa collected by so-called blind biopsies and samples collected during surgical procedures was created by Schindler.61 Schindler61 described that gastritis was divided into a superficial gastritis (Fig. 2B) that may progress to AG (Fig. 2C) and IM (Fig. 2D) with time, which is different from normal (Fig. 2A). Additionally, Schindler61 proposed that there were different courses and prognoses of disease by the type of the gastritis. And a novel classification and grading of gastritis was devised by a group of experts at the 9th World Congress of Gastroenterology in Sydney, Australia in 1990.62 The histological division of Sydney System is a practical guideline upon which the morphological features of gastritis in endoscopic biopsy samples should be documented. Type, severity and extent of gastric inflammation composed to possible etiology should be detailed depending on the chart. The Sydney System asserted the routine gastric biopsy sampling protocol (two from antrum and two from corpus, both from anterior and posterior walls) and sample fixation in adequately labelled separate containers.62 Now the updated Sydney system in 1996 is most widely used as the classification of gastritis.63 The original Sydney classification of gastritis dividing into gastritis acute, chronic and special forms, and grading of chronic inflammation, neutrophil activity, atrophy, IM and H. pylori density into mild, moderate and marked categories were kept.62 The updated Sydney system introduced a visual analogue scale for evaluating the severity of histological grading (Fig. 3).63 The histological features of the gastric mucosa were recorded using updated Sydney system scores, that is, 0 = none, 1 = mild, 2 = moderate, and 3 = marked.63 It changed the routine of endoscopic biopsy sampling by the introduction of biopsy sampling from the incisura angularis and modified corpus and antrum biopsy locations from the two opposite walls in lesser and greater curvature of both parts (Fig. 4).63 Endoscopic description of acute gastritis by Sydney system are divided into edema, exudates, erosions and hemorrhage. In contrast, endoscopic diagnosis and classification of chronic gastritis are reliable depending on the inter-observer.63

Bottom Line: The prevalence of AG and IM vary depending on countries, even it represents diverse results in the same nation.Helicobacter pylori infection has been proved as the most important cause of AG and IM.However, the reversibility of AG and IM by eradication of H. pylori which was assumed to be certain by meta-analysis is; however, controversial now.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam.

ABSTRACT
Atrophic gastritis (AG) and intestinal metaplasia (IM) are the main precursor lesions of gastric cancer as the incidence of gastric cancer increases in the gastric mucosa involved with AG and IM. The prevalence of AG and IM vary depending on countries, even it represents diverse results in the same nation. Usually AG is antecedent of IM but the etiologies of AG and IM are not always the same. The sensitivity and specificity of diagnostic methods to detect AG and IM are different. Furthermore, the management strategy of AG and IM has not been established, yet. Helicobacter pylori infection has been proved as the most important cause of AG and IM. Thus the eradication of H. pylori is very important to prevent the progression to gastric cancer which is still placed in the high rank in morbidity and mortality among cancers. However, the reversibility of AG and IM by eradication of H. pylori which was assumed to be certain by meta-analysis is; however, controversial now. Therefore, the understanding and early diagnosis of AG and IM are very important, especially, in high incidence area of gastric cancer such as Republic of Korea.

No MeSH data available.


Related in: MedlinePlus