Chronic gastritis and precancerous diseases of the stomach: Is there a chance of a correct diagnosis?

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Abstract

AIM: The purpose of the study is to investigate the occurrence of the main forms of chronic gastritis, metaplastic and dysplastic changes in the gastric mucosa, the degree of their severity, and to assess their potential risk for the development of gastric cancer.

MATERIALS AND METHODS: The study involved 2982 patients who underwent esophagogastroduodenoscopy with a standard biopsy of the gastric mucosa for morphological assessment and bacterioscopy. If autoimmune gastritis was suspected, an additional serological diagnosis was performed. When detecting intestinal metaplasia of the gastric mucosa as well as neoplastic changes according to the histological report, the description of this report was analyzed in order to identify possible equivalents in the macroscopic description of the mucous membrane.

RESULTS: Out of 2982 histological studies of gastric mucosa biopsies, 1273 cases (42.7%) were found to contain H. pylori contamination. In 726 cases (24.3%), intestinal metaplasia. 66 biopsies (2.21%) showed the presence of low-grade intraepithelial neoplasia of the mucosa, 2 biopsies showed indeterminate neoplasia and 4 biopsies showed high-grade neoplasia. In 3 out of the total number of the samples, intravascular gastric adenocarcinoma was detected. In 168 cases (5.6%), gastritis was detected with predominant inflammation of the fundal region characteristic of autoimmune gastritis. In 286 biopsies (10.6%), inflammatory and/or atrophic changes and/or metaplastic changes were preserved, which, as a rule, did not have high activity and pronounced inflammation. In the remaining 1279 cases (42.9%), there was no significant inflammation or atrophic changes. The analysis of endoscopic findings showed that the detectability of intestinal metaplasia of the gastric mucosa without a biopsy study was 13.3%.

DISCUSSION OF THE RESULTS: According to the results of the conducted research and analysis, it can be stated that at present, the correct diagnosis of chronic gastritis with the establishment of the etiological factor, prognosis and risks of stomach cancer development is practically not feasible within the modern health care system. This not only deprives a doctor of the opportunity to make a correct diagnosis and prescribe adequate treatment to a patient, but also makes almost all cascades of carcinogenesis, including early cancer, “invisible”.

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About the authors

Aleksandr V. Tryapitsyn

Saint Petersburg State University Hospital

Author for correspondence.
Email: tryapitsin@gmail.com

MD, Cand. Sci. (Med.)

Russian Federation, 154 Fontanka River Embankment, Saint Petersburg, 190103

Vladimir A. Malkov

Saint Petersburg State University Hospital

Email: wladimir.malkow@gmail.com

MD

Russian Federation, 154 Fontanka River Embankment, Saint Petersburg, 190103

Emil M. Gasanov

Saint Petersburg State University Hospital

Email: gasanov-emil15@mail.ru

MD

Russian Federation, 154 Fontanka River Embankment, Saint Petersburg, 190103

Ilya Belyakov

National Center for Clinical Morphological Diagnostics

Email: zavpao@ncmd.ru

MD

Russian Federation, Saint Petersburg

References

  1. Bakulin IG, Pirogov SS, Bakulina NV, et al. Prophylaxis and early diagnosis of stomach cancer. Russian journal of evidence-based gastroenterology. 2018;7(2):44–58. (In Russ.). doi: 10.17116/dokgastro201872244
  2. Baranskaya EK, Ivashkin VT. Klinicheskii spektr predrakovoi patologii zheludka. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2002;(3):7–14. (In Russ.)
  3. German SV, Bobrovnitsky IP. Helicobacter pylori infection and hepatobiliary pathology. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(4):15–22. (In Russ.). doi: 10.22416/1382-4376- 2018-28-4-15-22
  4. German SV, Zykova IYe, Modestova AV, Yermakov NV. Prevalence of H. pylori infection in the Moscow population. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2010;20(2):25–30. (In Russ.)
  5. Zakharova NV, Simanenkov VI, Bakulin IG, et al. Prevalence of Helicobacter pylori infection in gastroenterological patients in Saint Petersburg. Farmateka. 2016;(S5):33–39. (In Russ.)
  6. Ivashkin VT, Mayev IV, Lapina TL, et al. Treatment of Helicobacter pylori infection: mainstream and innovations (Review of literature and resolution of Advisory council of the Russian gastroenterological association, May 19, 2017). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(4):4–21. (In Russ.)
  7. Gastroehnterologiya. Natsional’noe rukovodstvo. Ed. by V.T. Ivashkin, T.L. Lapina. Moscow: GEOTAR-Media; 2008. (In Russ.)
  8. Ivashkin VT, Mayev IV, Lapina TL, et al. Diagnostics and treatment of Helicobacter pylori infection in adults: Clinical guidelines of the Russian gastroenterological association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(1):55–70. (In Russ.). doi: 10.22416/1382-4376-2018-28-1-55-70
  9. Ivashkin VT, Sheptulin AA, Mayev IV, et al. Diagnostics and treatment of peptic ulcer: clinical guidelines of the Russian gastroenterological Association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016;26(6):40–54. (In Russ.) doi: 10.22416/1382-4376-2016-26-6-40-54
  10. Maev IV, Samsonov AA, Andreev DN. Infektsiya Helicobacter pylori. Moscow: GEOTAR-Media; 2016. (In Russ.)
  11. Mikhaleva LM, Birukov AE, Polyanko NI. Precancerous lesions and early gastric cancer: modern clinical-morphological data. Klinicheskaya Meditsina. 2017;95(10):881–887. (In Russ.). doi: 10.18821/0023-2149-2017-95-10-881-887
  12. Nadeev AP, Kozaev MA, Porotnikova EV, Sadykov AM. Nosological structure of the gastro-intestinal tract diseases according to biopsy studies. Experimental and clinical gastroenterology journal. 2017;(9(145)):60–64. (In Russ.)
  13. Bordin DS, Plavnik RG, Nevmerzhitskiy VI, et al. Prevalence of Helicobacter pylori among medical workers in Moscow and Kazan according to ¹³С-urease breathe test. Almanac of Clinical Medicine. 2018;46(1):40–49. (In Russ.). doi: 10.18786/2072-0505-2018-46-1-40-49
  14. Rakhmanin YuA, Zykova IYe, Fedichkina TP, et al. Regional distribution of Helicobacter pylori infection of able-bodied population of Moscow at medical examination of the production staff. Hygiene and Sanitation. 2013;92(5):79–82. (In Russ.)
  15. Reshetnikov OV, Kurilovich SA, Krotov SA, Krotova VA. Helicobacter pylori infection in Siberian populations. The Siberian Scientific Medical Journal. 2010;30(2):88–93. (In Russ.)
  16. Svarval AV, Ferman RS, Zhebrun AB. Study of the dynamic of Helicobacter pylori infection prevalence in different age groups of St. Petersburg population in 2007–2011. Russian Journal of Infection and Immunity. 2012;2(4):741–746. (In Russ.)
  17. Tryapitsyn AV, Mal’kov VA. The role and diagnostic value of the most common methods for diagnosing Helicobacter pylori infection. Herald of North-Western State Medical University named after I.I. Mechnikov. 2019;11(4):59–66. (In Russ.). doi: 10.17816/mechnikov201911459-66
  18. Tryapitsyn AV, Mal’kov VA, Gasanov EhM. Sovremennye vozmozhnosti mul’tifokal’nogo gistologicheskogo issledovaniya zheludka, znachenie v pravil’noi postanovke diagnoza. Proceedings of Vserossiiskii terapevticheskii kongress s mezhdunarodnym uchastiem «Botkinskie chteniYA»; 2019 Apr 23–24; Saint Petersburg. Ed. by V.I. Mazurov, E.A. Trofimov. Saint Petersburg; 2020. P. 279–281. (In Russ.)
  19. Tsukanov VV, Tretyakova OV, Amelchugova OS, et al. Prevalence of atrophic corpus gastritis at Krasnoyarsk over 45 year-old population. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2012;22(4):27–31. (In Russ.)
  20. Tsimmerman YaS, Zakharova YuA, Vedernikov VE. Microflora of gastric mucosa, its properties and role in the development of acute and chronic gastritis. Klinicheskaya Meditsina. 2012;90(11):39–44. (In Russ.)
  21. Tsimmerman YaS, Zakharova YuA. Kyoto consensus — the new etiological classification of chronic gastritis and its discussion. Klinicheskaya Meditsina. 2017;95(2):181–188. (In Russ.). doi: 10.18821/0023-2149-2017-95-2-181-188
  22. Sheptulin AA, Lapina TL, Kaybysheva VO. Update on Helicobacter pylori infection study and key points of “Maastricht-V” consensus conference (2016). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(1):35–43. (In Russ.). doi: 10.22416/1382-4376-2017-27-1-35-43
  23. Shtygasheva OV, Tsukanov VV. Prevalence of Helicobacter pylori infection and frequency of dispeptic symptoms in Khakasia population. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2004;14(1):33–36. (In Russ.)
  24. Cardaropoli S, Roltb A, Piazzese A, et al. Helicobacter pylori’s virulence and infection peisistence define pre-eclampsia complicated by fetal growth retardation. World J Gastroenterol. 2011;17(47):5156–5165. doi: 10.3748/wjg.v17.i47.5156
  25. Di Gregorio C, Morandi P, Fante R, De Gaetani C. Gastric dysplasia. A follow-up study. Am J Gastroenterol. 1993;88(10):1714–1719.
  26. Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revisited. Gut. 2002;51(1):130–131. doi: 10.1136/gut.51.1.130
  27. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20(10):1161–1181. doi: 10.1097/00000478-199610000-00001
  28. Farinati F, Rugge M, Di Mario F, et al. Early and advanced gastric cancer in the follow-up of moderate and severe gastric dysplasia patients. A prospective study. I.G.G.E.D. — Interdisciplinary Group on Gastric Epithelial Dysplasia. Endoscopy. 1993;25(4):261–264. doi: 10.1055/s-2007-1010310
  29. Fertitta AM, Comin U, Terruzzi V, et al. Clinical significance of gastric dysplasia: a multicenter follow-up study. Gastrointestinal Endoscopic Pathology Study Group. Endoscopy. 1993;25(4):265–268. doi: 10.1055/s-2007-1010311
  30. Franceschi F, Di Simone N, D’Ippolito S, et al. Antibodies anti-CagA cross-react with trophoblast cells: a risk factor for pre-eclampsia? Helicobacter. 2012;17(6):426–434. doi: 10.1111/j.1523-5378.2012.00966.x
  31. Pathology and genetics of tumours of the digestive system. Ed. by S.R. Hamilton, L.A. Aaltonen. Lyon: ARC Press; 2000. doi: 10.1046/j.1365-2559.2001.01219.x
  32. Nagtegaal ID, Odze RD, Klimstra D. The 2019 WHO classification of tumors of the digestive system. Histopathology. 2020;76(2):182–188. doi: 10.1111/his.13975
  33. Logan RPH, Walker MM. ABC of the upper gastrointestinal tract: Epidemiology and diagnosis or Helicobacter pylori infection. BMJ. 2001;323(7318):920–922. doi: 10.1136/bmj.323.7318.920
  34. Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection — the Maastricht V/ Florence Consensus Report. Gut. 2017;66(1):6–30. doi: 10.1136/gutjnl-2016-312288
  35. Rugge M, Correa P, Di Mario F, et al. OLGA staging for gastritis: A tutorial. Dig Liver Dis. 2008;40(8):650–658. doi: 10.1016/j.dld.2008.02.030
  36. Rugge M, Fassan M, Pizzi M, et al. Operative link for gastritis assessment gastritis staging incorporates intestinal metaplasia subtyping. Hum Pathol. 2011;42(10):1539–1544. doi: 10.1016/j.humpath.2010.12.017
  37. Rugge M, Farinati F, Di Mario F, et al Gastric epithelial dysplasia: a prospective multicenter follow-up study from the Interdisciplinary Group on Gastric Epithelial Dysplasia. Hum Pathol. 1991;22(10):1002–1008. doi: 10.1016/0046-8177(91)90008-d
  38. Rugge M, de Boni M, Pennelli G, et al. Gastritis OLGA-staging and gastric cancer risk: a twelve-year clinico-pathological follow-up study. Aliment Pharmacol Ther. 2010;31(10):1104–1111. doi: 10.1111/j.1365-2036.2010.04277.x
  39. Saraga EP, Gardiol D, Costa J. Gastric dysplasia. A histologic follow-up study. Am J Surg. Pathol. 1987;11(10):788–796.
  40. Schlemper RJ, Itabashi M, Kato Y, et al. Differences in diagnostic criteria for gastric carcinoma between Japanese and western pathologists. Lancet. 1997;349(9067):1725–1729. doi: 10.1016/S0140-6736(96)12249-2
  41. Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353–1367. doi: 10.1136/gutjnl-2015-309252

Supplementary files

Supplementary Files
Action
1. Fig. 1. Cascade of gastric carcinogenesis (Correa P., 1988, 1990)

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2. Fig. 2. The pyramid of carcinogenesis. АИ — autoimmune gastritis; Low-grade dysplasia — low-grade intraepithelial neoplasia; High-grade dysplasia — high-grade inrtaepithelial neoplasia, including indeterminate neoplasia; ИННВС — high-grade intraepithelial neoplasia

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3. Fig. 3. Tactics of diagnosis, treatment and observation in relation to the patients who do not need endoscopy

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4. Fig. 4. Tactics of diagnosis, treatment and observation in relation to the patients who do not need endoscopy. * Here and further steps, according to the pyramid of carcinogenesis

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Copyright (c) 2021 Tryapitsyn A.V., Malkov V.A., Gasanov E.M., Belyakov I.

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