Abstract
Background and Aim: Chronic atrophic gastritis is a known precancerous lesion for gastric cancer, with an overall 5-year survival less than 20%. However, there is few new data describing the progression rate from atrophic gastritis (AG) to gastric cancer in China. We retrospectively analyzed the risk of gastric cancer among patients with AG and aimed to determine the accuracy of endoscopy diagnosis of AG in China. Methods: Clinical features and endoscopic profiles of chronic atrophic gastritis patients from Wenzhou People’s Hospital between January 2006 and December 2016 were analyzed retrospectively. Results: There were 61,810 cases analyzed retrospectively. 3641 cases of atopic gastritis were diagnosed by endoscopy, in which 1704 cases were confirmed by pathological biopsy; the diagnostic coincidence rate was 46.80%; 2631 cases were diagnosed as atrophic gastritis by pathological biopsy, in which 927 cases were ignored by endoscopy; the miss diagnosis rate was 35.23%. The progression rate from chronic atrophic gastritis and non-atrophic gastritis to gastric cancer respectively was 0.79% and 0.43%. The rate of intestinal metaplasia in mild AG, moderate AG and severe AG respectively was 75.63%, 86.18% and 90.32%, 3.42%, 6.27% and 5.16% about dysplasia in three different degree atrophic gastritis. Conclusions: Endoscopy diagnosis and pathology diagnosis of AG were statistically different. Patients with atrophic gastritis have higher risk of developing into gastric cancer, but it needs further investigation. Different degrees of atrophic gastritis have the different proportions of intestinal metaplasia and dysplasia.
Highlights
Chronic atrophic gastritis (CAG) is a chronic inflammation characterized by the reduction or disappearance of the inherent gland of the gastric mucosa
There were 61,810 cases analyzed retrospectively. 3641 cases of atopic gastritis were diagnosed by endoscopy, in which 1704 cases were confirmed by pathological biopsy; the diagnostic coincidence rate was 46.80%; 2631 cases were diagnosed as atrophic gastritis by pathological biopsy, in which 927 cases were ignored by endoscopy; the miss diagnosis rate was 35.23%
The link between CAG and intestinal type gastric carcinoma was illuminated by Corra P in 1988, who deemed that human gastric carcinogenesis was an multistep and multifactorial process and proposed a classical model about the progress: normal gastric mucosa → superficial gastritis → atrophic gastritis → small intestinal metaplasia → colonic intestinal metaplasia → mild dysplasia → severe dysplasia → adenocarcinoma [1] [2]
Summary
Chronic atrophic gastritis (CAG) is a chronic inflammation characterized by the reduction or disappearance of the inherent gland of the gastric mucosa. The fare of malignancy strongly guides clinical practices and decision-making, whereby an immediate endoscopy is recommended in elderly people (more than 45 - 55 years of age) with dyspeptic symptoms by most of international and local consensus statement [7]. This will certainly bring patients additional psychological and economic burden. Methods: Clinical features and endoscopic profiles of chronic atrophic gastritis patients from Wenzhou People’s Hospital between January 2006 and December 2016 were analyzed retrospectively. Different degrees of atrophic gastritis have the different proportions of intestinal metaplasia and dysplasia
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