Prevalence of gastric cancer precursor lesions in patients with dyspepsia

Abstract

Objectives: In Southeastern cities of Turkey, high preva­lences of Helicobacter pylori infection and gastric cancer are seen. The aim of this study was to evaluate the fre­quency of the precancerous gastric lesions in patients with dyspeptic symptoms who underwent upper gastroin­testinal endoscopy in Adıyaman State Hospital. Materials and methods: We analyzed gastric biopsies taken from corpus and antrum of 234 consecutive pa­tients who underwent upper gastrointestinal endoscopy between January 2009 and May 2009. According to Syd­ney system, chronic gastritis, gastric atrophy, intestinal metaplasia and dysplasia were diagnosed by histological examination. Results: The mean age of patients was 46±15 (16- 82) years. Helicobacter pylori infection was seen in 66.7% of patients. Normal mucosa, chronic gastritis, gastric atro­phy, intestinal metaplasia and dysplasia were diagnosed in 2.7%, 78.6%, 3.4%, 11.5% and 3.8% of gastric biopsy specimens, respectively. Helicobacter pylori infected pa­tients showed a significantly higher prevalence of intes­tinal metaplasia compared with that of the non infected subjects (9.8% vs 1.7% p=0.021). Although prevalence of gastric atrophy and dysplasia were higher among He­licobacter pylori infected patients, the difference did not reached to a statistically significant level (3.0% vs 0.4% p=0.19 and 3.0% vs 0.8% p=0.37 respectively). Conclusion: Our findings suggested that the prevalence of gastric precancerous lesions such as gastric atrophy, intestinal metaplasia, dysplasia and Helicobacter pylori infection were high in dyspeptic patients. This may be re­lated to actual high incidence of gastric cancer in south­eastern region of Turkey.

Keywords

• Dyspepsia, atrophic gastritis, intestinal meta­plasia, dysplasia, Helicobacter pylori.

Dispeptik yakınmalar ile başvuran hastalarda mide kanseri öncü lezyonlarının görülme sıklığı

Abstract

Amaç: Türkiye\'nin güneydoğusundaki illerde Helicobac­ter pylori enfeksiyonu ve mide kanseri oldukça sık görül­mektedir. Bu çalışma ile Adıyaman Devlet Hastanesinde dispeptik yakınmalar sebebiyle başvuran hastalarda mide kanseri öncü lezyonlarının görülme sıklığını değerlendir­mek amaçlanmıştır. Gereç ve yöntem: Ocak 2009 ile Mayıs 2009 tarihleri arasında dispeptik yakınmalar nedeni ile başvuran ardışık 234 hasta çalışmaya alınmıştır. Yapılan üst gastrointesti­nal sistem endoskopisi sırasında mide antrum ve korpus­dan biyopsiler alınarak, histopatolojik inceleme (Sydney sınıflaması) ile kronik gastrit, gastrik atrofi, intestinal me­taplazi ve displazi tanıları konulmuştur. Bulgular: İncelenen hastaların yaş ortalaması 46±15 (16-82) yıl idi. Alınan biyopsi örneklerinden, hastaların %66.7\'sinde Helicobacter pylori enfeksiyonu teşhis edildi. Histopatolojik incelemede; normal mukoza %2.7, kronik gastrit %78.6, gastrik atrofi %3.4, intestinal metaplazi %11.5 ve displazi %3.8 oranlarında görüldü. Helicobac­ter pylori enfeksiyonu olan hastalarda intestinal metaplazi görülme sıklığı Helicobacter pylori enfeksiyonu olmayan hastalara göre anlamlı oranlarda yüksekti (sırasıyla, %9.8 ile %1.7, p=0.021). Gastrik atrofi sıklığı (sırasıyla %3.0 ile %0.4 p=0.19) ve displazi sıklığı (sırasıyla, %3.0 ile %0.8 p=0.37) ise Helicobacter pylori enfeksiyonu olan hastalarda olmayanlardan daha yüksek olmakla beraber aradaki fark istatistiksel anlamlı düzeye ulaşmamaktaydı (p>0.05). Sonuç: Mide kanseri öncü lezyonları olan gastrik atrofi, intestinal metaplazi, displazi ile Helicobacter pylori en­feksiyonu dispeptik yakınmalar ile başvuran hastalarda sıklıkla görülmektedir. Bu durum Türkiye\'nin güneydoğu­sunda yüksek insidansda görülen mide kanseri ile ilgili olabilir.

Keywords

• Dispepsi, atrofik gastrit, intestinal metaplazi, displazi, Helicobacter pylori.

References

1. Correa P. Human gastric carcinogenesis: A multistep and multifactorial process- the first American Cancer Society award lecture on cancer epidemiology and prevention. Can- cer Res 1992;52: 635-674.
2. Kato I, Tomigana S, Ito Y, et al. A prospective study of atro- phic gastritis and stomach cancer risk. Jpn J Cancer Res 1992; 83:1137-1142.
3. Tatsuta M, Iishi H, Nazaizumi A et al. Fundal atrophic gas- tritis as a risk factor for gastric cancer. Int J Cancer 1993; 53: 70-74.
4. You W, Chang Y. Epidemiology of precancerous gastric le- sions. J Gastroenterol Hepatol 1993; 8: 375-382.
5. Filipe M, Jass M . İntestinal metaplasia subtypes and cancer risk. In Filipe M, Jass J (eds): Gastric Carcinomas. Edin- burgh, Churchill Livingstone, 1986, p87.
6. Rokkas T, Filipe MI, Sladen GE. Detection of an increased incidence of early gastric cancer in patients with intestinal metaplasia type III who are closely followed up. Gut 1991; 32: 1110-1113.
7. Kokkola A, Haapiainen R, Laxen F, et al. Risk of gastric car- cinoma in patients with mucosal dysplasia associated with atrophic gastritis: A follow-up study. J Clin Pathol 1996; 49: 979-984.
8. Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. In- ternational Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996; 20: 1161-1181.

9. Türkdogan MK, Akman N, Tuncer I, et al. Epidemiolgical aspects of endemic upper gastrointestinal cancers in eastern Turkey. Hepatogastroenterology 2005; 52: 496-500.
10. Bor S, Vardar R, Ormeci N, et al. Prevalence patterns of Gastric cancers in Turkey: Model of a developing country with high occurence of Helicobacter pylori. J Gastroenterol Hepatol 2007; 22: 2242-2245.
11. Meining A, Morgner A, Miehlke S, Bayerdorffer E, Stolte M. Atrophy-metaplasia-dysplasia-carcinoma sequence in the stomach: a reality or merely an hypothesis? Best Pract Res Clin Gastroenterol 2001; 15: 983-998.
12. Özden A, Bozdayı G, Özkan M, Köse KS. Changes in the seroepidemiological pattern of Helicobacter pylori infec- tion over the last 10 years in Turkey. Turk J Gastroenterol 2004; 15: 156-158.
13. Saruç M, Ozden N, Turkel N, et al. Functional dyspepsia: relationship between clinical subgroups and Helicobacter pylori status in Western Turkey. Brazilian J Med Biol Res 2003; 36: 747-751.
14. Sari YS, Sander E, Erkan E, Tunali V. Endoscopic diagno- ses and CLO test results in 9239 cases, prevalence of Heli- cobacter pylori in Istanbul, Turkey. J Gastroenterol Hepatol 2007; 22: 1706-11.
15. Tsujii M, Kawano S, Tsuji S, et al. Ammonia: a possible promoter in Helicobacter pylori-related gastric carcinogen- esis. Cancer Lett 1992; 65: 15-18.
16. Tsujii M, Kawano S, Tsuji S, et al. Mechanism for ammo- nia-induced promotion of gastric carcinogenesis in rats. Carcinogenesis 1995;16:563-566.
17. Davies GR, Banatvala N, Collins CE, et al. Relationship between infective load of Helicobacter pylori and reactive oxygen metabolite production in antral mucosa. Scand J Gastroenterol 1994;29:419-424.
18. Kimura K. Chronological transition of the fundic-pyloric boder determined by stepwise biopsy of the lesser and greater curvatures of the stomach. Gastroenterology 1972;63:584-592.
19. Katelaris PH, Seow F, Lin BP, Napoli J, Ngu MC, Jones DB. Effect of age, Helicobacter pylori infection, and gastri- tis with atrophy on serum gastrin and gastric acid secretion in healthy men. Gut 1993;34:1032-1037.