INTRODUCTION: Helicobacter pylori (Hp)-related atrophic gastritis (AG) affects corpus and antral mucosa, resulting in multifocal AG (MF-AG); autoimmunity-driven AG is corpus-restricted (CR-AG). AG carries increased gastric dysplasia (GD) and gastric cancer (GC) risk, well established in MF-AG, but debated in CR-AG. This study aimed to assess clinical, endoscopic-histological characteristics of GD-GC in patients with MF-AG and CR-AG. METHODS: This was the multicenter cross-sectional study across 11 Italian gastroenterology centers on data of non-cardia GD-GC in adult patients with MF-AG or CR-AG based on clinical, endoscopic, and histological charts. RESULTS: Eighty-four patients were included with MF-AG and CR-AG in 45 (53.6%) and 39 (46.4%), respectively. Low-grade GD, high-grade GD, and GC were diagnosed in 31 (36.9%), 6 (7.1%), and 47 (56.0%), respectively. GD-GC similarly occurred in patients with MF-AG and CR-AG: high-grade GD in 4 (8.9%) vs 2 (5.1%), low-grade GD in 17 (37.8%) vs 14 (35.9%), and GC in 24 (53.5%) vs 23 (59.0%) (P > 0.05). Compared with MF-AG, in patients with CR-AG, GD-GC were more commonly polypoid (51.6% vs 27.3%, P 5 0.048) and more frequent in the corpus (55.3% vs 28.6%, P 5 0.02), but occurred also in the antrum (34.2%) and incisura (10.5%). Surgery was more frequent in CR-AG than in MF-AG (48.6% vs 23.1%, P 5 0.02). Corpus atrophy severity and intestinal metaplasia were not different (P > 0.05), histological Hp positivity was low in both (2.3% vs 2.9%, P 5 0.87), but in Hp negatives, active inflammation was present in the antrum in 26.7% and 7.7% (P 5 0.02), and in the corpus in 31.1% and 21.5% (P 5 0.27). DISCUSSION: Non-cardia GC and GD may occur in both MF-AG and CR-AG, displaying differences in topography and endoscopic presentation but similarities in nonlesional mucosa, differentiation, and staging. Surveillance should be considered in corpus AG, regardless of extension and supposed etiology. BACKGROUND: La gastrite atrofica (AG) Helicobacter pylori (Hp)-relata interessa la mucosa dell’antro e del corpo-fondo dando luogo alla gastrite atrofica multifocale (MF-AG); la gastrite atrofica autoimmune invece è limitata al corpo-fondo risparmiando l’antro (CR-AG). L’AG è ad aumentato rischio per displasia (GD) e cancro gastrico (GC). Questo rischio è ben stabilito nella MF-AG, ma ancor adibattuto nella CR-AG. Questo studio ha come scopo di valutare le caratteristiche cliniche e endoscopico-istologiche di pazienti affetti da GD o GC in MF-AG e CR-AG.
Clinical and Endoscopic-Histological Features of Multifocal and Corpus-Restricted Atrophic Gastritis Patients With Non-Cardia Gastric Cancer or Dysplasia: A Multicenter, Cross-Sectional Study
Losurdo, Giuseppe;Borraccino, Antonia Valeria;Contaldo, Antonella;Giannelli, Gianluigi;
2025-01-01
Abstract
INTRODUCTION: Helicobacter pylori (Hp)-related atrophic gastritis (AG) affects corpus and antral mucosa, resulting in multifocal AG (MF-AG); autoimmunity-driven AG is corpus-restricted (CR-AG). AG carries increased gastric dysplasia (GD) and gastric cancer (GC) risk, well established in MF-AG, but debated in CR-AG. This study aimed to assess clinical, endoscopic-histological characteristics of GD-GC in patients with MF-AG and CR-AG. METHODS: This was the multicenter cross-sectional study across 11 Italian gastroenterology centers on data of non-cardia GD-GC in adult patients with MF-AG or CR-AG based on clinical, endoscopic, and histological charts. RESULTS: Eighty-four patients were included with MF-AG and CR-AG in 45 (53.6%) and 39 (46.4%), respectively. Low-grade GD, high-grade GD, and GC were diagnosed in 31 (36.9%), 6 (7.1%), and 47 (56.0%), respectively. GD-GC similarly occurred in patients with MF-AG and CR-AG: high-grade GD in 4 (8.9%) vs 2 (5.1%), low-grade GD in 17 (37.8%) vs 14 (35.9%), and GC in 24 (53.5%) vs 23 (59.0%) (P > 0.05). Compared with MF-AG, in patients with CR-AG, GD-GC were more commonly polypoid (51.6% vs 27.3%, P 5 0.048) and more frequent in the corpus (55.3% vs 28.6%, P 5 0.02), but occurred also in the antrum (34.2%) and incisura (10.5%). Surgery was more frequent in CR-AG than in MF-AG (48.6% vs 23.1%, P 5 0.02). Corpus atrophy severity and intestinal metaplasia were not different (P > 0.05), histological Hp positivity was low in both (2.3% vs 2.9%, P 5 0.87), but in Hp negatives, active inflammation was present in the antrum in 26.7% and 7.7% (P 5 0.02), and in the corpus in 31.1% and 21.5% (P 5 0.27). DISCUSSION: Non-cardia GC and GD may occur in both MF-AG and CR-AG, displaying differences in topography and endoscopic presentation but similarities in nonlesional mucosa, differentiation, and staging. Surveillance should be considered in corpus AG, regardless of extension and supposed etiology. BACKGROUND: La gastrite atrofica (AG) Helicobacter pylori (Hp)-relata interessa la mucosa dell’antro e del corpo-fondo dando luogo alla gastrite atrofica multifocale (MF-AG); la gastrite atrofica autoimmune invece è limitata al corpo-fondo risparmiando l’antro (CR-AG). L’AG è ad aumentato rischio per displasia (GD) e cancro gastrico (GC). Questo rischio è ben stabilito nella MF-AG, ma ancor adibattuto nella CR-AG. Questo studio ha come scopo di valutare le caratteristiche cliniche e endoscopico-istologiche di pazienti affetti da GD o GC in MF-AG e CR-AG.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
