Prevalence Of Intestinal Metaplasia Research Articles

The first study appraising colonic diverticulosis and Helicobacter pylori diagnosed by histopathology.

Colonic diverticulosis might be caused by low-fiber dietary habits, gastrointestinal motility disorders, and colonic wall resistance changes, which might also affect the upper gastrointestinal system mucosa. Therefore, the present study aims to answer whether the gastric histopathological findings of the cases with diverge from those without. This retrospective cross-sectional study included 184 cases who underwent both upper and lower gastrointestinal endoscopy procedures between January 2020 and December 2022. Notably, 84 cases were colonic diverticulosis, while the rest of the study group was control. Their demographic, laboratory, and histopathological findings were compared meticulously. The median ages for the colonic diverticulosis and control were 67.07±8.14 and 66.29±15.83 years, respectively, and no statistical difference concerning the age and gender distribution between them was recognized. The median levels of white blood cells, neutrophils, glucose, creatinine, and aspartate aminotransferase in colonic diverticulosis were significantly increased compared to control. As for pathological comparison, colonic diverticulosis had a higher prevalence of Helicobacter pylori (45.2 vs. 38%), while atrophy and intestinal metaplasia prevalence were nearly the same in the groups, without significance regarding Helicobacter pylori. Consequently, colonic diverticulosis should not be overlooked, particularly when the abovementioned laboratory parameters are augmented in a dyspeptic patient. A correlation might be raised between Helicobacter pylori and colonic diverticulosis. Eradication therapy might help attenuate the risk of colonic diverticulosis when Helicobacter pylori has emerged in a patient.

Prevalence and temporal trend of gastric preneoplastic lesions in Asia: A systematic review with meta-analysis.

Gastric cancer is the fifth most common cancer globally, with about 75% of cases occurring in Asia. While chronic atrophic gastritis (CAG) and intestinal metaplasia (IM) are well-recognized preneoplastic gastric lesions, we determined the prevalence and temporal trend of CAG and IM in Asia over the past 50years. In this systematic review and meta-analysis, we searched PubMed, Embase, MEDLINE, Scopus, and Web of Science for studies reporting the prevalence of CAG and IM in Asia (according to the United Nations geoscheme) published between 1970 and 2022. Heterogeneity was assessed by the I2 index and Cochran Q test. We adopted the random effects model to estimate the pooled prevalence and 95% confidence interval (CI). The slope of prevalence was estimated as a function of time in simple linear regression and weighted meta-regression models to demonstrate the temporal trend. Studies that reported the odds ratio (OR) of Helicobacter pylori infection and CAG/IM were analyzed separately to compile a pooled OR with a 95% CI. This study was registered in INPLASY2022120028. Of the 81 studies from 19 Asian countries identified, the pooled prevalence for CAG and IM in Asia was 26.1% (95%CI: 22.7-30.0) and 22.9% (95%CI: 19.7-26.6), respectively. Over the past 5decades, there was a significant decline in the prevalence of IM (slope in adjusted meta-regression models: -0.79 [95%CI: -1.28 to -0.26], P=0.003), but there was no significant change in the pooled prevalence of CAG. Within Asia, the prevalence varied significantly among different regions. Southern Asia reported the highest pooled prevalence of CAG (42.9%, 95%CI: 27.5%-67.1%), while Western Asia reported the lowest level (12.7%, 95%CI: 5.0%-32.3%). For IM, Eastern Asia reported the highest prevalence (27.1%, 95%CI: 21.1-34.9), with the lowest prevalence reported in Western Asia (3.1%; 95% CI1.2%-8.0%). H. pylori infection was linked to CAG and IM with OR of 2.16 (95%CI: 2.09-2.22) and 1.64 (95%CI: 1.57-1.72), respectively. This updated meta-analysis showed that up to 26% of study individuals in Asia harbored preneoplastic gastric lesions. There was a declining temporal trend in the prevalence of IM, but not for CAG, in Asia.

Pancreatic acinar metaplasia at the gastroesophageal junction is associated with protective effect against intestinal metaplasia in patients with gastroesophageal reflux disease

Anecdotal evidence suggests that pancreatic acinar metaplasia (PAM) and intestinal metaplasia (IM) overlap infrequently at the gastroesophageal junction/distal esophagus (GEJ/DE). The goal of this study was to evaluate the significance of PAM at GEJ/DE in relation to IM in patients with gastroesophageal reflux disease (GERD). Group 1 comprised 230 consecutive patients with GEJ/DE biopsies (80.6% with GERD symptoms). Group 2 comprised 151 patients with established GERD and GEJ/DE biopsies taken before Nissen fundoplication. Group 3 comprised 540 consecutive patients used for a follow-up study of PAM. PAM was present in 15.7%-15.9% and IM in 24.8%-31.1% of patients in groups 1 and 2, respectively. PAM-IM overlap was present in 2.2%-3.3%, respectively. Patients with PAM were, on average, 6-12 years younger than patients with IM, and were predominantly female (72.2%-75%), in contrast to patients with IM (47.3%-32%). In the unadjusted logistic regression model, patients with PAM were 69%-65% less likely to also have IM, as compared to patients without PAM. In the fully adjusted model, patients with PAM were 35%-61% less likely to also have IM, although the P-value was not significant. Follow-up analysis of patients with PAM from group 3 (n=28) demonstrated the prevalence of IM and PAM in subsequent biopsies at 7.1% and 60.7%, respectively. No cases showed PAM-IM overlap on follow-up. The data suggests that PAM at the GEJ/DE is associated with protective effect against IM and thus could be useful as a marker of decreased susceptibility to IM.

Xanthomas and precancerous changes of the stomach: an accidental combination or an important prognostic endoscopic marker?

Background. The article deals with the study of gastric xanthomas, benign accidental formations with an unknown etiopathogenesis, which, according to the literature, are associated with a number of pathological conditions (atrophic gastritis, intestinal metaplasia, dysplasia, gastric cancer, dyslipidemia, etc.). The purpose was to study the prevalence of gastric xanthomas in patients with atrophic gastritis and to analyze their relationship with endoscopic changes in the stomach, including precancerous conditions. Materials and methods. Esophagogastroduodenoscopy was performed using the EVIS EXERA III video endoscopy system with the Olympus 190 gastroscope (Japan) in 120 patients with atrophic gastritis undergoing examination and treatment at the Institute of Gastroenterology of the National Academy of Sciences of Ukraine. The presence of duodenogastric reflux, the prevalence and severity of mucosal atrophy, changes in the relief of the gastric mucosa (including nodules and bumps), the presence of hyperplasia, polyps, hemorrhages, erosions, ulcers, xanthomas in the stomach were assessed. When using the narrow-band imaging and close focus, the presence and prevalence of intestinal metaplasia, the presence of gastric dysplasia were evaluated. Comparative and statistical analysis of endoscopic data was conducted depending on the presence of gastric xanthomas. Results. The heterogeneity of endoscopic changes in atrophic gastritis was revealed (prevalence and severity of atrophy, intestinal metaplasia, changes in the mucosal relief, presence of hyperplasia, polyps, ulcers, etc.). Gastric xanthomas were found in more than a third of patients with atrophic gastritis (36.7 % of cases), with predominant localization in the antral region (90.9 %). As a rule (95.5 %), they were single. In patients with atrophic gastritis associated with xanthomas, diffuse atrophic changes in gastric mucosa were detected significantly more often, as well as mucosal nodules and bumps, mucosal hyperplasia, intestinal metaplasia and the mucosal dysplasia, which was confirmed morphologically (p < 0.05). Rare cases of gastric ulcers and gastric cancer were diagnosed only in patients with xanthomas (p > 0.05). Conclusions. The obtained results indicate that gastric xanthoma is an important diagnostic marker of precancerous changes in the gastric mucosa: widespread atrophy, intestinal metaplasia, dysplasia, and can be used as an important prognostic marker for the development of gastric cancer. Patients with xanthoma-associated atrophic gastritis require a thorough examination using modern endoscopic equipment and dynamic observation, with a focus on changes in the gastric relief by the type of nodules and bumps.

Impact of improved upper endoscopy quality on detection of gastric precancerous lesions.

Intestinal metaplasia (IM) is the point of no return in gastric carcinogenesis, and patients with extensive (antrum plus corpus) IM are at high risk of developing gastric cancer. We evaluated the impact of improved gastroscopy quality on the detection of gastric IM in an Italian area at high risk for gastric cancer. Data of consecutive patients with gastric biopsies according to the updated Sydney System observed in 2013, 2016 and 2019 resulting in IM diagnosis were retrieved. In the first period, endoscopy was performed with standard white light instruments. In the second period, preendoscopic gastric preparation was administered, and the examinations lasting at least 7 min with standard endoscopes were performed. In the third period, the latter procedure was followed, with virtual chromoendoscopy equipped instruments. The prevalence of IM in any gastric site and that of extensive IM were compared among the three periods. Data of 3485 patients were available. The detection of IM in at least one gastric site increased from 29.9 to 33.6% and 34.5% (95% CI, 32.1-36.8) in the first, second and third period, respectively. The difference was statistically significant between the first and last (P = 0.02; OR, 1.24; 95% CI, 1.04-1.48) period. When considering extensive IM, the detection increased from 4.28 to 6.1% and 5.44%, although the difference failed to reach statistical significance (P = 0.076). Our data showed that implementation of a quality protocol increased the probability to detect IM in the stomach, allowing us to select patients deserving stricter follow-up.

Characteristics of gastric precancerous conditions and Helicobacter pylori infection among dyspeptic patients in north-eastern Iran: is endoscopic biopsy and histopathological assessment necessary?

BackgroundEarly detection and appropriate treatment of precancerous, mucosal changes could significantly decrease the prevalence of life-threatening gastric cancer. Biopsy of the normal-appearing mucosa to detect Helicobacter pylori and these conditions is not routinely obtained. This study assesses the prevalence and characteristics of H. pylori infection and precancerous conditions in a group of patients suffering from chronic dyspepsia who were subjected to gastric endoscopy and biopsy mapping.MethodsThis cross-sectional study included dyspeptic patients, not previously treated for H. pylori, undergoing esophagogastroduodenoscopy (EGD) with their gastric endoscopic biopsies obtained for examination for evidence of H. pylori infection and precancerous conditions. Demographic and clinical data on the gender, smoking, opium addiction, alcohol consumption, medication with aspirin, corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) and family history of cancer were collected by interviewing the patients and evaluating their health records. The cohort examined consisted of 585 patients with a mean (SD) age of 48.0 (14.46) years, 397 (67.9%) of whom were women.ResultsH. pylori infection was identified in 469 patients (80.2%) with the highest prevalence (84.2%) in those aged 40–60 years. Opium addiction correlated with a higher a H. pylori infection rate, while alcohol consumption was associated with a lower rate by Odds Ratio 1.98 (95% CI 1.11–3.52) and 0.49 (95% CI 0.26–0.92), respectively. The prevalence of intestinal metaplasia, gastric atrophy and gastric dysplasia was 15.2, 12.6 and 7.9%, respectively. Increased age, positive H. pylori infection, endoscopic abnormal findings and opium addiction showed a statistically significant association with all precancerous conditions, while NSAID consumption was negatively associated with precancerous conditions. For 121 patients (20.7% of all), the EGD examination revealed normal gastric mucosa, however, for more than half (68/121, 56.2%) of these patients, the histological evaluation showed H. pylori infection, and also signs of atrophic mucosa, intestinal metaplasia and dysplasia in 1.7, 4.1 and 1.7%, respectively.ConclusionEGD with gastric biopsy mapping should be performed even in the presence of normal-appearing mucosa, especially in dyspeptic patients older than 40 years with opium addiction in north-eastern Iran. Owing to the high prevalence of precancerous conditions and H. pylori infection among patients with dyspepsia in parts of Iran, large-scale national screening in this country should be beneficial.

Effectiveness of esophagogastroduodenoscopy in changing treatment outcome in refractory gastro-esophageal reflux disease

Background/aims The effectiveness of screening esophagogastroduodenoscopy (EGD) for refractory gastroesophageal reflux disease (GERD) symptoms alone has not been validated. Methods We performed an observational study of patients with refractory GERD who underwent EGD from 2013 to 2016 at a tertiary hospital. Among 928 patients with GERD, we excluded patients with other alarm features, other indications for EGD, history of gastroesophageal surgery, or EGD done for other diagnostic procedures, and identified 301 patients who underwent EGD solely for persistent reflux symptoms such as heartburn or regurgitation. Results Among 301 patients with refractory GERD, 81.4% of patients were taking PPIs. 49.8% of patients had completely normal EGD findings and 33.6% of patients had benign or incidental findings. Two patients (0.6%) had LA grade C or D esophagitis, and 16.3% of patients had irregular Z line or salmon-colored mucosa. 91.0% (122/134) who had a biopsy had normal or benign findings. 4.0% (12/301) of patients had biopsy-proven intestinal metaplasia which is similar to the previously known prevalence of intestinal metaplasia in patients without heartburn (5.6%) and none had dysplasia or malignancy. Male sex was associated with endoscopic intestinal metaplasia suspected lesions in multivariate analysis (OR: 1.96, 95% CI: 1.04–3.70, p = .036) but not biopsy-proven intestinal metaplasia. Elderly age, obesity, alcohol or cigarette consumption, PPI use, GERD duration >3–5 years did not predict endoscopically suspected or biopsy-proven intestinal metaplasia. Only 5% of patients had a pH-impedance study for refractory reflux symptoms. Conclusions Most patients who underwent EGD for refractory GERD symptoms alone did not have pathological findings requiring a change in management. Screening EGD for patients only with persistent reflux symptoms should not be routinely recommended.

The prevalence of intestinal metaplasia in APCA positive patients with Graves’ disease

The prevalence of intestinal metaplasia in APCA positive patients with Graves’ disease

Prevalence of intestinal metaplasia and its relation to Helicobacter pylori infection in Iraq

Objectives: The aim of this study was to investigate the prevalence of intestinal metaplasia and its relation to H. Pylori infection, gastric atrophy, ulcer, age and gender in patients underwent esophagogastroduodenoscopy and gastric biopsy for upper gastrointestinal symptoms. Method: 200 gastric biopsy blocks examined for patients underwent esophagogastroduodenoscopy (EGD) and gastric biopsy, between January 2019 October 2020 at Gastroenterology and hepatology Hospital / Medical city / Baghdad / Iraq. Result: (67.5%) of patients examined in the study had H. pylori infection, while (20.5%) of the total number patients in the study had gastric intestinal metaplasia. There was significant association between Intestinal metaplasia with both active chronic inflammation and intestinal atrophy but there was no significant association between Intestinal metaplasia with both ulcer and H. pylori infection. Conclusion: gastric intestinal metaplasia encountered more in old age male patients with gastric atrophy and it is not solely related to h pylori, other risk factors could be responsible for it.

Is gastric mapping needed in the endoscopy of dyspeptic patients?

Our study aimed to determine the prevalence of intestinal metaplasia in dyspeptic patients who underwent upper GI endoscopy. Intestinal metaplasia, which is defined as the replacement of normal gastric mucosa by metaplastic intestinal epithelium, has been described as a premalignant gastric lesion. Six hundred two consecutive patients with dyspeptic symptoms who had undergone upper GI endoscopy were included in the study. For all patients, gastric mapping was performed to determine the presence of intestinal metaplasia. All histologic samples were reported according to the updated Sydney classification. Total of 61.3% of the patients were female. The mean age of the patients was 46±15 years. The overall prevalence of intestinal metaplasia was 22%. The distribution of intestinal metaplasia in the stomach was 15.1% in the antrum, 4.3% in the body, and 2.6% in the antrum and body together. Also, the prevalence of intestinal metaplasia in the age group of under 40 years was 9.5% and in patients over 40 years it was 29.5%.. The results of this study have shown that more than one-fifth of the patients with dyspepsia have intestinal metaplasia. This indicates that gastric mapping in patients with dyspepsia may lead to the detection of precancerous lesions especially after the age of 40.

Histo-epidemiological aspect of Helicobacter pylori chronic gastritis in a Moroccan population

Helicobacter pylori(H. Pylori) is the best example of the implication of chronical infection in carcinogenesis. The World Health Organization recognized it as a class I carcinogen since it triggers the progression of premalignant gastric lesions. The aim of this study is to define the prevalence ofH. Pyloriinfection, related risk factors, and explore the histological features of the chronic gastritis. This is a retrospective study of 248 gastric specimens, examinated and evaluated according Sydney to system. The prevalence ofH. Pyloriis 67 %, chronic gastritis is observed in all the biopsies (100%). Age and gender were not a risk factors for the H. Pylori infection. Prevalence ofH. Pyloriwas 71.93% in low socio-economic class. The severity of the chronic gastritis increases if the colonization ofH. Pyloriincreases. In 74, 58% of cases chronic gastritis was active. Glandular atrophy presented 10.37% and in 80% was related toH. Pyloriinfection (p=0,004) and 12 % related to autoimmune diseases. The prevalence of Intestinal metaplasia is 10.53%, andH. Pyloriwas observed in 42.31% of cases (p=0.001). The dysplasia is detected in one case, in a 72 years old patient. We also observed one case of gastric adenocarcinoma, of an 80 years. Follicular gastritis are in 32% of cases, and they were more frequent inH. Pyloriinfected slides (82% of subjects) (p< 0.005).According to this study,H. PyloriChronic Gastritis is very common in our population, and a coherent relationship exists betweenH. Pyloricolonization and pre-cancerous lesions. An early eradicating should be considered as a health goal.

Community-driven research in the canadian arctic: dietary exposure to methylmercury and gastric health outcomes

ABSTRACT Indigenous Arctic Canadians have a higher prevalence of gastric neoplasms relative to North Americans of European ancestry. We investigated the hypothesis that low-dose methylmercury exposure from eating fish/whale increases the risk of gastric cancer in Arctic communities. We used intermediate endpoints from an established model of gastric carcinogenesis: intestinal metaplasia, atrophy, and severe chronic gastritis. During 2008–2012, we obtained gastric biopsies from participants of community-driven projects in 3 communities. In 2016, we collected hair samples to measure methylmercury levels and interviewed them about diet. In cross-sectional analysis, logistic regression estimated odds ratios for the estimated effect of hair-methylmercury concentration on the prevalence of each pathology outcome stratified by selenium intake. Among 80 participants, prevalence of intestinal metaplasia, atrophy and severe chronic gastritis was 17, 29 and 38%, respectively. Adjusted Odds of severe chronic gastritis and atrophy were highest at hair-methylmercury concentrations ≥1μg/g when estimated selenium intake was 0, and approached 0 for all methylmercury levels as estimated selenium intake increased. Gastric pathology increased with methylmercury exposure when selenium intake was low. Though limited by small numbers, these findings suggest selenium ingested by eating fish/whale may counter harmful effects of methylmercury exposure in Arctic populations.

Helicobacter pylori and Upper Endoscopy in Systemic Sclerosis: A Cross-sectional Study in the Real World.

A role for Helicobacter pylori in triggering systemic sclerosis (SSc) has been proposed, but data are conflicting. In previous studies, infection has been generally searched for by using serology. We designed this study to assess H. pylori prevalence in SSc patients with histology of gastric mucosa, considered the criterion standard for infection diagnosis. This cross-sectional study enrolled 30 SSc patients who complained of upper gastrointestinal symptoms. All underwent upper endoscopy with gastric biopsies. Endoscopic alterations were recorded, and gastric mucosa biopsies were used for both histological examination and searching for H. pylori. The role for proton-pump inhibitor (PPI) therapy was considered. Fisher exact test was used for statistical analysis. Data of 28 SSc patients were available, 14 with ongoing PPI therapy. Helicobacter pylori infection at histology was detected in 14.3% patients, and it equally occurred in patients with or without PPI therapy. Erosive esophagitis/Barrett esophagus was detected in 26.6% of cases. Among patients with PPI therapy, 30% received half dose only. The prevalence of intestinal metaplasia was low (14.3%). Endoscopic esophageal alterations were significantly more frequent in those patients showing anti-Scl70 antibody positivity. This study showed that prevalence of H. pylori is very low in SSc patients, so that it seems not having a role in triggering SSc. Management of gastroesophageal diseases in SSc patients needs to be improved, and looking to the autoimmune profile may be of help. Thus, collaboration between rheumatologist and gastroenterologist is highly recommended.

Tu1508 PREDICTORS FOR DEVELOPMENT OF COMPLETE AND INCOMPLETE INTESTINAL METAPLASIA (IM) ASSOCIATED WITH HELICOBACTER PYLORI INFECTION: A LARGE-SCALE STUDY FROM LOW PREVALENCE AREA OF GASTRIC CANCER (IM-HP TRIAL)

Gastric intestinal metaplasia (IM) is a precancerous lesion of gastric cancer related to Helicobacter pylori (H. pylori) infection. Until now, there has been limited data about IM prevalence and associated risk factors in Thai people. This study aimed to determine risk factors related to the development of IM to guide proper management in Thailand. 1,117 dyspeptic patients undergoing upper gastrointestinal endoscopy in Thammasat University Hospital, Thailand were enrolled between April 2018 and August 2019. Patients’ data including baseline characteristics, laboratory results, and histopathology of gastric biopsies from medical database were extensively reviewed. 1,117 patients had overall H. pylori prevalence of 44.8% and the mean age was 60.6 years and 44.7% of whom were males. 862 (77.2%) patients demonstrated chronic gastritis, while 209 (18.7%) had IM. There were 180 (16.1%) patients with complete IM and 29 (2.6%) with incomplete IM. In groups of complete and incomplete IM, current H. pylori infection rates were 66.1%, and 58.6%, respectively (OR 0.73; 95% CI 0.33-1.62, p = 0.434). The mean body mass index (BMI) of incomplete IM group (27.3) was significantly higher than BMI of complete IM group (23.7) (OR 1.13; 95% CI 1.04-1.23, p = 0.003). Age >45 years, current H. pylori infection, and family history of gastric cancer were significantly higher in IM than chronic gastritis group with OR 1.90 (95% CI 1.04-3.45, p = 0.036), OR 2.94 (95% CI 2.10-4.11, p <0.001), and OR 5.36 (95% CI 1.11-26.01, p = 0.037), respectively, as demonstrated in table 1 and 2. There was no difference of laboratory result including complete blood count, plasma glucose, tumor markers (CEA and CA19-9) between complete and incomplete IM groups. During 16 months of study, there were 12 patients (1.1%) diagnosed with gastric cancer and 2 of them had history of prior IM along with adenocarcinoma on their gastric pathology. The 1-year survival rate of 12 gastric cancer patients was as low as 50%. Age >45 years, current H. pylori infection, and family history of gastric cancer are significant predictors for the presence of intestinal metaplasia. Body mass index might be beneficial for using as a predictive risk factor to reduce the development of incomplete intestinal metaplasia. H. pylori eradication could be an effective way to prevent the development of gastric precancerous lesions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prevalence of subtypes of gastric intestinal metaplasia and its relationship with Helicobacter pylori infection

Background: Gastric intestinal metaplasia is seen chronic gastritis associated with Helicobacter pylori. The objective of this study was to determine the prevalence of subtypes of intestinal metaplasia and presence of Helicobacter pylori infection.&#x0D; Materials and Methods: This was a cross sectional study done at Kathmandu Medical College teaching Hospital in Pathology department from December 2018 to August 2019. The endoscopic biopsies were evaluated for intestinal metaplasia and Helicobacter pylori with the help of Hematoxylin and Eosin stains as well as Giemsa stain. Subtypes of intestinal metaplasia were classified with the help of periodic acid- Schiff/Alcian Blue stain combination and High Iron Diamine- Alcian Blue stain at pH 2.5. The relationship between Helicobacter pylori and subtypes of intestinal metaplasia were compared. Fisher’s exact test was used for statistical evaluation. A p value of ˂0.05 was considered as statistically significant.&#x0D; Results: The prevalence of intestinal metaplasia was found in 57 (12.2%) biopsies. Type I intestinal metaplasia was found in 23 (40.4%) biopsies, type II in 10 (17.5%) biopsies and type III in 24 (42.1%) biopsies. Helicobacter pylori was positive in 28(49.1%) and it was negative in 29(50.9%) biopsies. No statistical significant correlation was seen in the subtypes of intestinal metaplasia with Helicobacter pylori status (p˃0.05).&#x0D; Conclusion: Intestinal metaplasia is frequently observed in endoscopic biopsies, most common being type III subtype.

Comparación de prevalencia de infección por Helicobacter pylori en pacientes con dispepsia entre dos instituciones de diferentes estratos socioeconómicos en el periodo 2017-2018

Helicobacter pylori (Hp) infection is associated with multiple digestive problems from gastroduodenal ulcers to gastric adenocarcinoma and/or MALT lymphoma. Peru is considered a place of high prevalence of Hp. In the world, significant differences have been described in the prevalence of Hp infection associated with the socioeconomic characteristics of the population. Objective: To compare the prevalence of Hp infection in dyspeptic patients between 2 institutional centers of different socio-economic strata during 2017-2018. Materials and methods: A sample of 633 patients with dyspepsia was collected retrospectively and randomly, without previous endoscopic study, or a history of Hp eradication therapy that came to the gastroenterology services of the Hospital Cayetano Heredia (HCH) in San Martin de Porres, and of the Anglo American Clinic (CAA) in San Isidro, during the period of June 2017 - July 2018 (CAA: 300 and HCH: 333). Proceeding then to review the clinical history, endoscopy report and pathological anatomy of each of them, for further statistical analysis using the SPSS program. Results: A prevalence of Hp was found in the HCH of 54.1%, while in the CAA it was only 29.3% (p<0.05), this relationship being maintained in the different age groups. Likewise, the prevalence of intestinal metaplasia (MI) in the total of patients with dyspepsia in the HCH was 33.9% (MI + in Hp + was 34.4%) and in the CAA the presence of MI without considering the Hp status was only 6.7% (MI + in HP + was 6.8%) (p<0.05). Finally, the presence of gastric atrophy in the HCH was 26.7% and in the CAA it was 1.3% (p<0.05). Conclusion: There is a clear relationship between the low socioeconomic stratum and the presence of Hp, gastric atrophy and intestinal metaplasia (the latter relationship remaining independent of Hp status).

HELICOBACTER PYLORI INFECTION AND GASTRIC CANCER PRECURSOR LESIONS: PREVALENCE AND ASSOCIATED FACTORS IN A REFERENCE LABORATORY IN SOUTHEASTERN BRAZIL

Helicobacter pylori infection is the most important risk factor for gastric atrophy and intestinal metaplasia, both considered gastric cancer precursor lesions. Therefore, the investigation of the occurrence of H. pylori infection, precursor lesions and associated factors guides the adoption of specific strategies for the control this type of cancer. To evaluate the prevalence of H. pylori infection in patients undergoing upper digestive endoscopy, as well as the prevalence of intestinal metaplasia, atrophy and chronic inflammation and their association with H. pylori infection. A retrospective study was performed based on reports of gastric endoscopic biopsies performed in a private laboratory affiliated to the Brazilian Public Health System (SUS). Patients were evaluated for age, gender and type of health service. The samples were evaluated for the presence of H. pylori, and also of chronic inflammation, intestinal metaplasia and glandular atrophy. Of a total of 4,604 patients (mean age 51±16.6), 63.9% were female and 63.1% coming from private health care service. The prevalence of H. pylori infection was 31.7% (n=1,459), and the percentage of infection was significantly higher in patients from public health service (42.0%) in relation to patients from private health service (25.6%). Among H. pylori (+) patients, a higher percentage of intestinal metaplasia (17.7% vs 13.3%) and glandular atrophy (17.6% vs 6.9%) were observed when compared to those H. pylori (-) (P<0.01). From the patients H. pylori (+) with at least one type of precursor lesion (n=418), 161 (38.5%) had metaplasia and chronic inflammation, 160 (38.3%) had atrophy and chronic inflammation and finally 97 (23.2%) presented metaplasia, atrophy and chronic inflammation simultaneously. The present study reinforces the association of H. pylori infection with gastric cancer precursor lesions in a Brazilian population, emphasizing the importance of infection prevention measures, as well as the treatment of infected patients, especially in regions with lower socioeconomic levels that show a higher prevalence of infection by H. pylori.

Topographic study of H. pylori and gastric intestinal metaplasia in patients with dyspepsia in a tertiary health care setting

Background & Objectives: Dyspepsia is a relatively common clinical condition characterized by chronic / recurrent upper abdominal pain or discomfort and is often associated with one or more of following symptoms at any given time - upper abdominal pain, burning sensation in the chest or upper abdomen, regurgitation, anorexia and early satiety. The present study was done to estimate the prevalence of Intestinal Metaplasia (IM) in the stomach in unselected patients with dyspepsia and to correlate these changes with symptoms, risk factors and endoscopic findings. Methods: We evaluated 102 patients who presented with symptoms of dyspepsia. Relevant clinical details were noted. A minimum of 9 endoscopic mucosal biopsies were taken from all subjects and in addition, biopsies were also taken from endoscopically abnormal areas. Rapid Urease Test (Standard in-house method) was done. All gastric biopsies were graded according to the Updated Sydney System. Statistical analysis was done using Chi-square test. Results: Intestinal metaplasia (IM) was seen in 16.7% of the patients, predominantly in the antrum (10.8%) and all of them showed Type II IM. Atrophic gastritis was again seen predominantly (65.2%) in the gastric antrum and these patients had significantly less (P=0.0065) H. pylori infection. Reflux symptoms were significantly less in patients with IM. Conclusion: We found a prevalence rate of 16.7% of Type II Intestinal Metaplasia of the stomach, which was topographically preponderant in the antrum.

Novel endoscopic findings as visualized by non-magnification endoscopy with linked color imaging are indicative of gastric intestinal metaplasia.

Background:Gastric intestinal metaplasia (GIM) is generally considered to be the main mucosal background for the development of gastric adenocarcinomas. Using linked color imaging (LCI), we noticed that the color pattern in areas of GIM was purple mixed with white on the epithelium with signs of mist that were detected by the non-magnifying LCI observation. We have termed this endoscopic finding “Purple in Mist” (PIM). The aim of this study was to investigate whether PIM could be a useful optical sign for predicting GIM.Methods:We prospectively evaluated consecutive patients undergoing endoscopy for various indications. The endoscopist used the LCI system to carefully observe the gastric antrum, body and angulus. When a PIM was identified in the surface layer, targeted biopsies were subsequently taken from this part. If the suspected area had no PIM on the surface, targeted biopsies were also taken.Results:Sixty-three consecutive patients were included in this study. The prevalence of intestinal metaplasia (IM) was 29/63 (46%). In PIM-positive patients, the prevalence of IM was 23/26 (89%). Of these patients, 146 biopsy specimens were included in this study. For the diagnosis of IM, compared to histological assessment, the LCI finding had an accuracy of 91.1% (95%CI: 86.5%–95.7%), a sensitivity of 89.8% (95%CI: 81.3%–98.3%), a specificity of 91.8% (95%CI: 86.3%–97.2%), a positive predictive value of 84.6% (95%CI: 74.8%–94.4%), and a negative predictive value of 94.7% (95%CI: 90.1%–99.2%).Conclusions:A positive PIM finding in a suspicious lesion on LCI would complement LCI diagnosis of possible IM because of the positive predictive value of PIM. PIM could be a novel endoscopic marker for IM.Trial registration:ClinicalTrials.gov, No. NCT03092414; https://clinicaltrials.gov/ct2/show/NCT03092414?id=NCT03092414&rank=1

Modern endoscopic criteria for stratifiation of patients with atrophic gastritis in the development of precancerous changes of the stomach

Purpose: to identify the most signifiant endoscopic diagnostic criteria for the development of precancerous changes of theof the stomach mucosa (SM).Material and methods. 80 patients with atrophic gastritis were examined (34 (42.5 %) men and 46 (57.5 %) women, the average age (57.7 ± 2.1) years. The diagnosis was set during endoscopic examinations and was morphologically confimed in all cases. Esophagogastroduodenoscopy was performed using EVIS EXERA III video endoscopic system with Olympus 190 gastroscope (Japan). Examination of the stomach was carried out in white light regimen, magnifiation (near focus) and NBI regimen. All examined patients were divided into groups according to the presence and prevalence of intestinal metaplasia(IM) and the presence of SM dysplasia: group I – SM atrophy without IM (10 patients), II – SM atrophy with IM, limited of the antral part (20 patients), III – SM atrophy with diffse (multifocal) IM (39 patients), IV – SM dysplasia (11 patients).Results. For the formation of group of patients with high risk of developing gastric cancer, diagnostic criteria of structural changes of gastric mucosa with pre-cancerous potential were identifid. In white light upper endoscopy, the knotted / tuberous relief of the stomach mucosa can be considered as a diagnostic criterion for sensitivity (81.4 %) and specifiity (60.0 %) indicators.The xanthomatosis of the stomach mucosa increases by 5 times the risk of IM or dysplasia in patients with atrophic gastritis (sensitivity – 47.1 %, specifiity – 90.0 %). Magnifiation endoscopy and endoscopy with narrow-band imaging allowed us to establish another diagnostic criterion for the formation of the group with high risk of developing gastric cancer: pyloric metaplasia(pseudopylorisation) of the gastric corpus. Pyloric metaplasia increases the frequency of detection of structural precancerous changes in a patient with atrophic gastritis by almost 7 times (sensitivity – 71.4 %, specifiity – 70.0 %).Conclusion. The established endoscopic criteria (nodular relief of the stomach (OR = 4.96), xanthomatosis of the stomach (OR = 4.94), pyloric metaplasia of the stomach body (OR = 6.72)) can be applied in the formation of a group of patients with atrophic gastritis who have high potential for the development of gastric cancer and require careful examination using modernendoscopic equipment and dynamic surveillance.