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

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Supplementary files

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2. Fig. 1. Cascade of gastric carcinogenesis (Correa P., 1988, 1990)

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

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5. 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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