Enzyme cytochemistry of the abraded gastric surface epithelium. An aid in the diagnosis of early atrophic gastritis and focal intestinal metaplasia.

Abstract

Enzyme cytochemistry of the abraded gastric mucosa was here developed as a new procedure and applied to the study of atrophic gastritis. This new technic consists of determining 5 enzymes in the superficial epithelium of the gastric mucosa, abraded by conventional cytologic brush technic—namely, alkaline phosphatase, acid phosphatase, leucine amino peptidase, lactic acid dehydrogenase and diphosphopyridine nucleotide diaphorase. Enzyme cytochemistry of the abraded surface epithelial cells was correlated, in 49 individuals, with the histology and cytology of the gastric mucosa, as obtained by gastric suction biopsy and conventional cytologic technic. In addition, in 31 of these patients, enzyme histochemistry of the gastric surface epithelium, obtained by gastric suction biopsy, was studied and correlated with enzyme cytochemistry of the smears of the abraded surface epithelium of the stomach. The results obtained indicate similar yields of cytochemical and histochemical methods in individuals with normal gastric mucosa and chronic superficial gastritis. However, enzyme cytochemical study of the abraded mucosa appears to be superior to histologic and enzyme histochemical examination of the gastric suction biopsy specimens in recognizing the early atrophic lesions of the gastric mucous membrane. These manifest themselves by positive reactions of the abraded surface epithelium for acid phosphatase, lactic acid dehydrogenase and diphosphopyridine nucleotide diaphorase. Enzyme cytochemistry is especially important in diagnosing the focally distributed intestinal metaplasia, which is often missed in gastric suction biopsy. This can be easily recognized by strongly positive reactions of the abraded surface epithelium for alkaline phosphatase and leucine amino polypeptidase. In view of the relation existing between the foci of intestinal metaplasia and development of gastric cancer in this area such a recognition may be significant in the followup of patients presenting this type of lesion.