Extensive Gastric Metaplasia Research Articles

Diagnosis and Management of Epithelial Precancerous Conditions and Lesions in the Stomach

Chronic atrophic gastritis and intestinal metaplasia are associated with higher gastric cancer risk and guidelines recommend endoscopic surveillance, as diagnosis of early gastric neoplasia allows endoscopic resection. This review summarizes the current approach to the diagnosis and surveillance of pre-malignant gastric conditions and endoscopic treatment of early gastric cancer. Virtual chromoendoscopy can diagnose extensive gastric metaplasia with great accuracy compared with histopathology and higher endoscopic staging is a risk factor for gastric cancer. Poorly differentiated and superficially invasive cancers have higher (up to 3%) lymph node metastasis risk even after curative resection, which should influence post-resection management. After non-curative resection, a histopathological score (eCura system) can predict LNM and survival without gastrectomy. Extensive pre-malignant gastric conditions should be surveilled with high-definition chromoendoscopy, which allows intestinal metaplasia staging and improves dysplasia diagnosis. Endoscopic submucosal dissection is well-established as the first-line treatment of early gastric cancer.

Extensive Gastric Metaplasia Presenting as a Duodenal Mass

A 56-year-old woman was referred for EGD due to abdominal pain, nausea, and emesis for one month. This revealed a 3 cm semi-pedunculated mass in the third portion of the duodenum (FIGURE A arrows), biopsies of which showed only gastric metaplasia. Given concern for a more sinister nature, she underwent endoscopic submucosal dissection of the mass with microscopic evaluation. FIGURE B (H&E x 40) and FIGURE C (H&E x 100) depict normal duodenal mucosa (left, thin arrow) with the lesional tissue on the right, highlighting hyperplastic and reactive changes including villous blunting and extensive gastric metaplasia with mucinous epithelium (thick arrow) with gastric heterotopia characterized by the presence of parietal and chief cells (star). FIGURE B also depicts neutrophilic inflammation and plasma cell infiltrates (top inset, arrow) (H&E x 200) and prolapse-type changes (bottom inset, arrow) (H&E X 100). Duodenal gastric heterotopia and foveolar gastric metaplasia are long-recognized but poorly understood phenomena. They may exist on a spectrum of a purely congenital lesion to one associated with significant peptic duodenitis or mucosal injury(1), and rarely present as a mass(2, 3) that is excised. NBI and EUS may help characterize these masses(2, 4). In follow-up, the patient reported symptomatic improvement.2517_A Figure 1. Endoscopic view of 3 cm semi-pedunculated mass in the third portion of the duodenum2517_B Figure 2. H&E stain of excised mass under low power2517_C Figure 3. H&E stain of excised mass under high power

Intussusception caused by heterotopic gastric mucosa in small intestine: a case report

BackgroundIntestinal intussusception is the most frequent cause of small bowel obstruction in children between the ages of 2 months and 5 years and often remains idiopathic in etiology, even after surgery. On microscopic examination, in intussusception normal mucosa is noted but in a few cases heterotopic tissue can be seen. Heterotopic gastric mucosa in the small intestine is extremely rare except for its occurrence in remnants of Meckel’s diverticulum. In view of the rarity of this condition, we report a case of ectopic gastric mucosa in the small intestine that was not associated with remnants of vitelline duct.Case presentationA 6-year-old boy of Indo-Aryan ethnicity from India presented with episodes of acute abdominal pain and distension with vomiting and non-passage of stools. On ultrasonography intussusception was suspected. A laparotomy was done and the ileal segment (tip of intussusception) was sent for histopathological examination. On histopathology, sections from the tip of intussusception showed extensive gastric metaplasia of the mucosa.ConclusionsA definitive diagnosis of heterotopic gastric mucosa is established by histopathological examination and it is important to differentiate heterotopia, which is a developmental anomaly, from metaplasia, which is an acquired condition. Heterotopic gastric mucosa is usually clinically silent and surgical intervention can be considered in patients with complications such as gastrointestinal hemorrhage and intestinal obstruction.

Gastric Metaplasia and Small Bowel Ulcerogenesis in a Case of Ulcerative Jejunitis Not Related to Celiac Disease

The possible relationship between gastric metaplasia and ulcerative lesions in an unusual case of ulcerative jejunitis not related to celiac disease and with extensive gastric metaplasia is discussed. Previous studies have described gastric metaplasia in duodenal ulcers on the basis of endoscopic data, and some authors maintain that acid secretion in metaplastic mucosa could represent a pathogenetic factor of ulcerogenesis, with a self-amplifying mechanism. In the absence of functional evidence, we could provide data, in a case of ulcerative jejunitis, about morphologic signs of acid secretion in gastric metaplastic epithelium using an antibody against HMFG-1, a good marker of acid-secreting fundic cells. Metaplastic areas demonstrated a focal positivity for HMFG-1, and these finding are suggestive of local acid secretion.

Immunofluorescence Studies of Gastric Heterotopia of the Small Intestine in Crohn's Disease

A patient with long-standing Crohn's disease of the large and small intestine was found to have extensive gastric metaplasia of the ileum. Most metaplastic glands were of the pyloric type, but numerous oxyntic glands with parietal and chief cells were also seen. By immunofluorescence the chief cells contained both the group I and group II pepsinogens, while the pyloric gland cells contained only the group II pepsinogens. Gastric-containing or other endocrine cells were not detected in the metaplastic pyloric and oxyntic glands. The latter findings are consistent with the concept expressed by Pearse that the endocrine and exocrine cells of the gastrointestinal mucosa may originate from different precursor elements during embryogenesis.