Abstract
A prospective gastroscopic-bioptic study of 533 patients was performed to assess the prevalence and distribution of intestinal metaplasia (IM) and its subtypes in the antral mucosa of patients with various upper intestinal disorders and to assess whether the presence of certain IM subtypes might be of help in selecting patients for careful endoscopic-bioptic surveillance in the screening for gastric carcinoma. IM was found in 135 patients (25.3%). Its prevalence increased with age (P<0.001) and was strongly associated with intestinal-type carcinoma as compared to diffuse-type carcinoma (P<0.001), gastritis (P<0.001), and gastric ulcer (P<0.05). Type I IM was predominant (98.5%), whereas types II and III IM, respectively, were found in 77.8% and 15.6% of the patients with IM. No difference in the prevalence of type I and II IM was found among the various gastric disease states. Type III IM was strongly associated with intestinal-type carcinoma as compared to either benign lesions (P<0.01) or diffuse-type carcinoma. These results suggest that type III IM may play a special role in the histogenesis of intestinal-type carcinoma and suggest that the finding of this IM subtype in gastric biopsies may possibly be of help in identifying patients at greater risk of developing carcinoma.
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Davessar K, Pezzulo JC, Kessimian N, Hale JH, Jauregui HO: Gastric adenocarcinoma: Prognostic significance of several pathologic parameters and histologic classification. Hum Pathol 21:325–332, 1990
Faivre J, Justrabo E, Hillon P, Milan C, Klepping C: Gastric carcinoma in Cote d'Or (France)—a population-based study. Gastroenterology 88:1874–1879, 1985
Allum WH, Powell DJ, McConkey CC, Fielding JWL: Gastric cancer: A 25-year review. Br J Surg 76:535–540, 1989
Buchholtz TW, Welch CE, Malt RA: Clinical correlates of resectability and survival in gastric carcinoma. Ann Surg 188:711–715, 1978
McBride CM, Boddie AW Jr: Adenocarcinoma of the stomach: are we making any progress? South Med J 80:283–286, 1987
Kidokoro T: Frequency of resection, metastasis and 5-year survival rate of early gastric carcinoma in a surgical clinic. Gann Monogr Cancer Res 11:45–49, 1971
Craanen ME, Dekker W, Ferwerda J, Blok P, Tytgat GNJ: Early gastric cancer: a clinicopathologic study. J Clin Gastroenterol 13:274–283, 1991
Sowa M, Ohkita H, Nitta M, Yoshimoto T, Matsuzawa H, Miki A, Sugano S, Aoki T, Kamino K, Umeyama K: Evaluation of clinicopathological analysis of the early gastric cancer. World J Surg 5:717–720, 1981
Editorial: Screening for gastric cancer in the West. Lancet 1:1023–1024, 1978
Kaibara N, Kawaguchi H, Nishidoi H, Kimura O, Okamoto T, Koga S, Fukumoto S: Significance of mass survey for gastric cancer from the standpoint of surgery. Am J Surg 142:543–545, 1981
Correa P: Precursors of gastric and esophageal cancer. Cancer 50:2554–2565, 1982
Morson BC, Sobin LH, Grundmann E, Johansen A, Nagayo T, Serck-Hansen A: Precancerous conditions and epithelial dysplasia in the stomach. J Clin Pathol 33:711–721, 1980
Sipponen P, Kekki M, Haapakoski J: Gastric cancer risk in chronic atrophic gastritis: Statistical calculations of cross sectional data. Int J Cancer 35:173–177, 1985
Imai T, Maruyama H: Time trend in the prevalence of intestinal metaplasia. Cancer 52:353–361, 1983
Stemmermann GN, Hayashi T: Intestinal metaplasia of the gastric mucosa: a gross and microscopic study of its distribution in various disease states. J Natl Cancer Inst 41:627–634, 1968
Meister H, Holubarsch CH, Haferkamp O, Schlag P: Gastritis, intestinal metaplasia and dysplasia versus benign ulcer in stomach and duodenum and gastric carcinoma: A histotopographical study. Pathol Res Pract 164:256–269, 1979
Goldman H, Ming SC: Fine structure of intestinal metaplasia and adenocarcinoma of the human stomach. Lab Invest 18:203–210, 1968
Ming SC, Goldman H, Freiman DG: Intestinal metaplasia and histogenesis of carcinoma in human stomach. Light and electron microscopic study. Cancer 20:1418–1429, 1969
Matsukura N, Suzuki K, Kawachi T, Aoyagi M, Sugimura T, Kitaoka H, Numajiri H, Shirota A, Itabashi M, Hirota T: Distribution of marker enzymes and mucin in intestinal metaplasia in human stomach and relation of complete and incomplete types of intestinal metaplasia to minute gastric carcinomas. J Natl Cancer Inst 65:231–240, 1980
Matsukura N, Kawachi T, Sugimura T, Ohnuki T, Higo M, Itabashi M, Hirota T, Kitaoka H: Variety of phenotypical expression of intestinal marker enzymes and mucin in human stomach intestinal metaplasia. Acta Histochem Cytochem 13:499–507, 1980
Filipe MI: Mucins in the human gastrointestinal epithelium: A review. Invest Cell Pathol 2:195–216, 1979
Jass JR, Filipe MI: The mucin profiles of normal gastric mucosa, intestinal metaplasia and its variants and gastric carcinoma. Histochem J 13:931–939, 1981
Segura DI, Montero C: Histochemical characterization of different types of intestinal metaplasia in gastric mucosa. Cancer 52:498–503, 1983
Teglbjaerg PS, Nielsen HO: Small intestinal type and colonic type intestinal metaplasia of the human stomach. Acta Pathol Microbiol Scand 86:351–355, 1978
Huang CB, Xu J, Huang JF, Meng XY: Sulphomucin colonic type intestinal metaplasia and carcinoma in the stomach. Cancer 57:1370–1375, 1986
Jass JR, Filipe MI: A variant of intestinal metaplasia associated with gastric carcinoma: a histochemical study. Histopathology 3:191–199, 1979
Jass JR: Role of intestinal metaplasia in the histogenesis of gastric carcinoma. J Clin Pathol 33:801–810, 1980
Heilmann KL, Hopker WW: Loss of differentiation in intestinal metaplasia in cancerous stomachs. A comparative morphologic study. Pathol Res Pract 164:249–258, 1979
Duarte I, Fonk ML, Lanos O, Guzman S: Intestinal metaplasia of the gastric mucosa in autopsies of Chilean adults. Pathol Res Pract 178:538–542, 1984
Lauren P: The two histological main types of gastric carcinoma: Diffuse and so-called intestinal-type carcinoma. Acta Pathol Microbiol Scand 64:31–49, 1965
Mowry RW: The special value of methods that color both acidic and vicinal hydroxyl groups in the histochemical study of mucins: With revised directions for the colloidal iron stain, the use of Alcian blue 8GX and their combinations with the PAS reaction. Ann NY Acad Sci 106:402–423, 1963
Spicer SS: Diamine methods for differentiating mucosubstances histochemically. J Histochem Cytochem 13:211–234, 1965
Filipe MI: Histochemistry of intestinal mucins.In Gastrointestinal and Oesophageal pathology, 1st ed. R Whitehead (ed). Edinburgh, Churchill Livingstone, 1989, p 71
Taki K, Kuwabara N: Studies on histogenesis of the gastric carcinoma using minute cancers. Pathol Res Pract 172:176–190, 1981
Nakamura K, Sugano H, Takagi K: Carcinoma of the stomach in incipient phase: its histogenesis and histological appearances. Gann 59:251–258, 1968
Hirota T, Itabashi M, Suzuki K, Yoshida S: Clinicopathologic study of minute and small early gastric cancer. Pathol Annu 15:1–19, 1980
Hattori T: Development of adenocarcinoma in the stomach. Cancer 57:1528–1534, 1986
Kawachi K, Matsukura N, Sasajima K, Kurisu M, Sano T, Sugimura T: Molecular aspects of gastrocarcinogenesis, experimental and clinical.In Pathophysiology of Carcinogenesis in Digestive Organs. E Farber, T Kawachi, T Nagayo, H Sugano, T Sugimura, JH Weisburger (eds). Baltimore, University Park Press, 1977, pp 95–105
Filipe MI, Potet F, Bogomoletz WV, Dawson PA, Fabiani B, Chauveinc P, Fenzy A, Gazzard B, Goldfain D, Zeegen R: Incomplete sulphomucin-secreting intestinal metaplasia. Preliminary data from a prospective study from three centres. Gut 26:1319–1326, 1985
Sipponen P: Intestinal metaplasia and gastric carcinoma. Ann Clin Res 52:139–143, 1981
Correa P: The epidemiology and pathogenesis of chronic gastritis. Three aetiological entities.In Frontiers of Gastrointestinal Research. L Van Der Reis (ed). Basel, Karger, 1980, pp 98–108
Sipponen P, Kekki M, Siurala M: Atrophic chronic gastritis and intestinal metaplasia in gastric carcinoma. Cancer 52:1062–1068, 1983
Jass JR, Filipe MI: Sulphomucins and precancerous lesions of the human stomach. Histopathology 4:271–279, 1980
Sipponen P, Seppala K, Varis K, Hjelt L, Ihamaki T, Kekki M, Siurala M: Intestinal metaplasia with colonic-type sulphomucins in the gastric mucosa; its association with gastric carcinoma. Acta Pathol Microbiol Scand 88:217–224, 1980
Craanen ME, Blok P, Dekker W, Ferwerda J, Tytgat GNJ: Early gastric cancer and intestinal metaplasia (submitted)
Hirota T, Okada T, Itabashi M, Yoshida H, Matsukura N, Kitaoka H, Hirayama T: Significance of intestinal metaplasia as a precancerous condition of the stomach.In Precursors of Gastric Cancer. S-C Ming (ed). New York, Praeger, 1984, pp 179–193
Rhodes JM: Colonic mucus and mucosal glycoproteins: The key to colitis and cancer? Gut 30:1660–1666, 1989
de Silva HJ, Millard PR, Kettlewell M, Mortensen NJ, Prince C, Jewell DP: Mucosal characteristics of pelvic ileal pouches. Gut 32:61–65, 1991
Shepherd NA, Jass JR, Duval I, Moskowitz RL, Nicholls RJ, Morson BC: Restorative proctocolectomy with ileal reservoir: Pathological and histochemical study of mucosal biopsy specimens. J Clin Pathol 40:601–607, 1987
Silva S, Filipe MI, Pinho A: Variants of intestinal metaplasia in the evolution of chronic atrophic gastritis and gastric ulcer. A follow up study. Gut 31:1097–1105, 1990
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Craanen, M.E., Blok, P., Dekker, W. et al. Prevalence of subtypes of intestinal metaplasia in gastric antral mucosa. Digest Dis Sci 36, 1529–1536 (1991). https://doi.org/10.1007/BF01296393
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DOI: https://doi.org/10.1007/BF01296393