Papel da biópsia da incisura angular no estadiamento da gastrite e na avaliação de risco do câncer gástrico / Role of incisura angularis biopsy in gastritis staging and risk assessment of gastric câncer

ABSTRACT Background: Gastric atrophy (GA) and intestinal metaplasia (IM) are early stages in the development of gastric cancer. Evaluations are based on the Updated Sydney System, which includes a biopsy of the incisura angularis (IA), and the Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis Assessment using Intestinal Metaplasia (OLGIM) gastric cancer risk staging systems. Objective: To compare the OLGA and OLGIM classifications with and without IA biopsy. In addition, to determine the prevalence of Helicobacter pylori (HP) and pre-neoplastic changes (GA and IM) in different biopsied regions and to identify the exclusive findings of IA. Methods: Observational, prospective, descriptive, unicentric study with 350 patients without a diagnosis of gastric cancer, who underwent upper digestive endoscopy with biopsies at Gastroclínica Itajaí, from March 2020 to May 2022. The histopathological classification of gastritis followed the Updated Sydney System, and the gastric cancer risk assessment followed the OLGA and OLGIM systems. The methodology applied evaluated the scores of the OLGA and OLGIM systems with and without the assessment of the IA biopsy. Statistical analysis was performed using descriptive measures (frequencies, percentages, mean, standard deviation, 95% confidence interval). Ranks were compared using the Kruskal-Wallis or Wilcoxon tests. To analyze the relationship between the frequencies, the bilateral Fisher's exact test was used. Wilson's score with continuity correction was applied to the confidence interval. Results: The median age was 54.7 years, with 52.57% female and 47.43% male patients. The comparison between the used biopsies protocol (corpus + antrum [CA] vs corpus + antrum + incisura angularis [CAI]) and the OLGA and OLGIM stages showed a significant decrease in both staging systems when the biopsy protocol restricted to the corpus and antrum was applied (OLGA CAI vs CA; P=0.008 / OLGIM CAI vs CA; P=0.002). The prevalence of pre-malignant lesions (GA, IM and dysplasia) of the gastric mucosa was (33.4%, 34% and 1.1%, respectively) in the total sample. The antrum region exhibited significantly higher numbers of alteration (P<0.001), except for HP infection, which was present in 24.8% of the patients. Conclusion: Incisura angularis biopsy is important because it increased the number of cases diagnosed in more advanced stages of intestinal metaplasia and atrophy. The study had limitations, with the main one being the relatively small sample size, consisting mostly of healthy individuals, although mostly elderly.

RESUMO Contexto: A atrofia gástrica (AG) e a metaplasia intestinal (MI) são estágios iniciais do desenvolvimento do câncer gástrico. As avaliações são baseadas no Sistema de Sydney Atualizado, que inclui uma biópsia da incisura angular (IA), e nos sistemas de estadiamento de risco de câncer gástrico Operative Link on Gastritis Assessment (OLGA) e Operative Link on Gastritis Assessment using Intestinal Metaplasia (OLGIM). Objetivo: Comparar as classificações OLGA e OLGIM com e sem biópsia da IA. Além disso, determinar a prevalência de Helicobacter pylori (HP) e alterações pré-neoplásicas (AG e MI) em diferentes regiões biopsiadas e identificar os achados exclusivos da IA. Métodos: Estudo observacional, prospectivo, descritivo, unicêntrico, com 350 pacientes sem diagnóstico de câncer gástrico, submetidos à endoscopia digestiva alta com biópsias na Gastroclínica Itajaí, no período de março de 2020 a maio de 2022. A classificação histopatológica da gastrite seguiu o Sistema de Sydney Atualizado, e a avaliação do risco de câncer gástrico seguiu os sistemas OLGA e OLGIM. A metodologia aplicada avaliou os escores dos sistemas OLGA e OLGIM com e sem a avaliação da biópsia da IA. A análise estatística foi realizada por meio de medidas descritivas (frequências, porcentagens, média, desvio padrão, intervalo de confiança de 95%). As classificações foram comparadas usando os testes de Kruskal-Wallis ou Wilcoxon. Para analisar a relação entre as frequências, foi usado o teste exato de Fisher bilateral. O escore de Wilson com correção de continuidade foi aplicado ao intervalo de confiança. Resultados: A idade média foi de 54.7 anos, com 52.57% de pacientes do sexo feminino e 47.43% do sexo masculino. A comparação entre o protocolo de biópsias utilizado (corpo + antro [CA] vs corpo + antro + incisura angular [CAI]) e os estágios OLGA e OLGIM mostrou uma diminuição significativa em ambos os sistemas de estadiamento quando o protocolo de biópsia restrito ao corpo e ao antro foi aplicado (OLGA CAI vs CA; P=0.008 / OLGIM CAI vs CA; P=0.002). A prevalência de lesões pré-malignas (GA, MI e displasia) da mucosa gástrica foi de (33.4%, 34% e 1.1%, respectivamente) na amostra total. A região do antro exibiu um número significativamente maior de alterações (P<0.001), com exceção da infecção por HP, que estava presente em 24.8% dos pacientes. Conclusão: A biópsia de IA é importante porque aumentou o número de casos diagnosticados em estágios mais avançados de MI e AG. O estudo teve limitações, sendo a principal delas o tamanho relativamente pequeno da amostra, composta principalmente por indivíduos saudáveis, embora em sua maioria idosos.

Evaluation of trefoil factor 3 as a non-invasive biomarker of gastric intestinal metaplasia and gastric cancer in a high-risk population / Evaluación de Trefoil factor 3 como un biomarcador no invasivo para la detección de metaplasia intestinal y cáncer gástrico en una población de alto riesgo

Background: Adenocarcinoma is preceded by chronic atrophic gastritis, gastric intestinal metaplasia and dysplasia. Trefoil factor 3 (TFF3) is a peptide secreted by goblet cells, which is abundantly present in intestinal metaplasia. Aim: To evaluate the utility of serum TFF3 as a non-invasive biomarker for the diagnosis of intestinal metaplasia and gastric cancer. Methods: Single-center, cross-sectional study of 274 patients who consecutively underwent upper gastrointestinal endoscopy with gastric biopsies (updated Sydney system). TFF3 levels were measured in serum by a commercial ELISA kit. Patients with normal histology or chronic atrophic gastritis without intestinal metaplasia comprised the control group. In addition, 14 patients with invasive gastric cancer were included as a reference group. The association between TFF3 levels and intestinal metaplasia was assessed by logistic regression. Results: Patients with intestinal metaplasia (n=110) had a higher median TFF3 level as compared to controls (n=164), 13.1 vs. 11.9ng/mL, respectively (p=0.024). Multivariable logistic regression showed a no significant association between TFF3 levels and intestinal metaplasia (OR=1.20; 95%CI: 0.87–1.65; p-trend=0.273). The gastric cancer group had a median TFF3 level of 20.5ng/mL, and a significant association was found (OR=3.26; 95%CI: 1.29–8.27; p-trend=0.013). Conclusion: Serum levels of TFF3 do not discriminate intestinal metaplasia in this high-risk Latin American population. Nevertheless, we confirmed an association between TFF3 levels and invasive gastric cancer.(AU)

Introducción: El adenocarcinoma gástrico es precedido por la gastritis crónica atrófica, metaplasia intestinal y displasia gástrica. Trefoil factor 3 (TFF3) es un péptido secretado por las células caliciformes, que están abundantemente presentes en la metaplasia intestinal. Objetivo: Evaluar la utilidad de TFF3 sérico como biomarcador no invasivo para el diagnóstico de metaplasia intestinal y cáncer gástrico. Métodos: Estudio transversal, de 274 pacientes a los que se les realizó endoscopia digestiva alta consecutivamente con biopsias gástricas (sistema Sydney actualizado). Los niveles de TFF3 se midieron en suero mediante un kit de ELISA comercial. Los pacientes con histología normal o gastritis crónica atrófica sin metaplasia intestinal formaron el grupo control. Además, se incluyeron como grupo de referencia 14 pacientes con cáncer gástrico avanzado. La asociación entre los niveles de TFF3 y la metaplasia intestinal se evaluó mediante una regresión logística. Resultados: Los pacientes con metaplasia intestinal (n=110) presentaron una mediana de TFF3 más alta en comparación con el grupo control (n=164), 13,1 vs. 11,9ng/ml, respectivamente (p=0,024). Sin embargo, la regresión logística multivariable no mostró una asociación significativa entre los niveles de TFF3 y la metaplasia intestinal (OR=1,20; IC95%: 0,87-1,65; p-trend=0,273). El grupo de cáncer gástrico tuvo una mediana significativamente mayor de TFF3 de 20,5ng/ml (OR=3,26; IC95%: 1,29-8,27; p-trend=0,013). Conclusión: Los niveles séricos de TFF3 no permiten el diagnóstico no invasivo de metaplasia intestinal en esta población latinoamericana de alto riesgo. La asociación entre los niveles de TFF3 y el cáncer gástrico avanzado fue confirmada.(AU)

Técnicas de imagen avanzada en la detección y caracterización de las lesiones precursoras del cáncer gástrico y del cáncer gástrico precoz / Image-enhanced endoscopy in the diagnosis of gastric premalignant conditions and gastric cancer

La detección del cáncer gástrico precoz y de sus lesiones precursoras constituye un desafío para gran parte de los endoscopistas occidentales. Los cambios morfológicos que se producen en la mucosa gástrica generalmente son sutiles y, por tanto, difíciles de visualizar. En esta revisión se analiza la utilidad de la cromoendoscopia convencional, así como de sus modalidades digitales, y de la endoscopia con magnificación para reconocer y caracterizar estas lesiones.(AU)

Diagnosis of early gastric cancer and its precancerous lesions remains a challenge for great part of western endoscopists. Changes seen in the mucosal pattern are generally subtle and hence difficult to identify. In this article, we will review the usefulness of conventional and virtual chromoendoscopy and magnification endoscopy in the recognition and classification of these lesions.(AU)

Helicobacter pylori infection: A balance between bacteria and host / Helicobacter pylori: un balance entre bacterias y huésped

Abstract In Argentina, despite the important studies conducted on the prevalence of infection and the antibiotic resistance of Helicobacter pylori, there are no reports simultaneously analyzing a profile of virulence factors of the bacterium and polymorphisms in cytokine genes in patients with different alterations in the gastric mucosa (including intestinal metaplasia, IM). Our aim was to evaluate H. pylori genotypes in 132 adult patients with chronic gastritis presenting three different histological findings (inactive chronic gastritis, active chronic gastritis IM( and active chronic gastritis IM+) along with SNP-174 G>C in the IL-6 gene. cagA, vacA and babA2 genes were analyzed by multiplex PCR. The -174 G>C SNP IL-6 gene was analyzed by PCR-RFLP. Patients with active chronic gastritis IM+ showed the highest proportion of the cagA(+)/IL-6GG, cagA(+)/vacAm1s1/IL-6GG and cagA(+)/vacAm1s1/babA2(+)/IL-6GG combinations (p<0.05). There was 4-5 times greater probability of finding patients presenting the GG genotype for SNP-174 G>C IL-6, which in turn were infected with the most virulent H. pylori genotypes -cagA(+), cagA(+)/vacAm1s1 and cagA(+)/vacAm1s1/babA2- in the ACGIM+ group in comparison to the ICG group. Our results provide regional data to the idea that the transition towards severe alterations in the gastric mucosa would be the result of a balance between specific factors of H. pylori and inherent host factors. This fact can be useful to identify patients at greater risk and to select those individuals requiring appropriate eradication treatment to prevent progression to gastric cancer.

Resumen En Argentina, a pesar de los importantes estudios realizados sobre la prevalencia de infección y la resistencia a antibióticos de Helicobacter pylori, no existen reportes que analicen simultáneamente un perfil de factores de virulencia de la bacteria y polimorfismos en genes de citoquinas en pacientes con diferentes alteraciones en la mucosa gástrica (incluida la metaplasia intestinal [MI]). Nuestro objetivo fue evaluar genotipos de H. pylori en 132 pacientes adultos con gastritis crónica, con tres diferentes hallazgos histológicos (gastritis crónica inactiva [GCI], gastritis crónica activa [MI(] y gastritis crónica activa [MI+]), junto con el SNP-174 G>C en el gen de IL- 6. Los genes cagA, vacA y babA2 se analizaron mediante PCR multiplex. El SNP-174 G>C IL-6 se analizó mediante PCR-RFLP. Los pacientes con gastritis crónica activa MI+ mostraron la mayor proporción de combinaciones cagA(+)/IL-6GG, cagA(+)/vacAm1s1/IL-6GG y cagA(+)/vacAm1s1/babA2(+)/IL-6GG (p<0,05). Hubo 4-5 veces mayor probabilidad de encontrar pacientes con el genotipo GG en SNP-174 G>C IL-6 y a su vez infectados con los genotipos más virulentos de H. pylori-cagA(+), cagA(+)/vacAm1s1 y cagA(+)/vacAm1s1/babA2-en el grupo gastritis crónica activa MI+ en comparación con el grupo GCI. Nuestros resultados aportan datos regionales a la idea de que la transición hacia alteraciones más graves en la mucosa gástrica resultaría de un equilibrio entre factores específicos de H. pylori y factores inherentes al huésped. Esto puede ser útil para identificar pacientes con mayor riesgo y seleccionar aquellos individuos que requieran un apropiado tratamiento de erradicación para prevenir la progresión al cáncer gástrico.

The relationship between bile reflux and common bile duct diameter after cholecystectomy: a clinical case-control study.

OBJECTIVE: The present study aims to investigate the relationship between bile reflux (BR) and diameter of the common bile duct (CBD) in patients after cholecystectomy. MATERIALS AND METHODS: In our case series analysis, according to the endoscopy results, the patients who underwent cholecystectomy were divided into two groups as those with BR and those non-BR. Age, sex, CBD diameter measured on ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic biopsy results of the patients were statistically analyzed. RESULTS: In a total of 188 patients included in the study, BR was detected in 93 patients, it was not observed in 95 patients. The CBD diameter of the patients was observed to be 7 mm or less in 70.9% (n = 66) in the BR group, and 23% (n = 22) in the non-BR group. The statistical analysis revealed that while there was a significant difference between the two groups in terms of CBD diameter and intestinal metaplasia, the results were similar in both groups in terms of inflammation, activity, atrophy, and Helicobacter pylori. CONCLUSION: We believe that CBD diameter may be a predictive factor in the detection of BR after cholecystectomy.

OBJETIVO: Investigar la relación entre el reflujo biliar y el diámetro del colédoco después de la colecistectomía. MÉTODO: Estudio retrospectivo en el que, de acuerdo con los resultados de la endoscopia, los pacientes que se sometieron a colecistectomía se dividieron en dos grupos: con reflujo biliar y sin reflujo biliar. Se analizaron estadísticamente la edad, el sexo, el diámetro del conducto biliar común medido por ultrasonografía, tomografía computarizada y colangiopancreatografía por resonancia magnética, y los resultados de la biopsia endoscópica. RESULTADOS: En un total de 188 pacientes incluidos en el estudio, se detectó reflujo biliar en 93 pacientes y no se observó en 95 pacientes. Se vio que el diámetro del conducto biliar común de los pacientes era de 7 mm o menos en el 70.9% (n = 66) del grupo con reflujo biliar y en el 23% (n = 22) del grupo sin reflujo biliar. El análisis estadístico reveló que, si bien hubo una diferencia significativa entre los dos grupos en términos de diámetro del conducto biliar común y metaplasia intestinal, los resultados fueron similares en ambos grupos en términos de inflamación, actividad, atrofia y presencia de Helicobacter pylori. CONCLUSIONES: Creemos que el diámetro del colédoco puede ser un factor predictivo en la detección de reflujo biliar después de la colecistectomía.

Evaluation of trefoil factor 3 as a non-invasive biomarker of gastric intestinal metaplasia and gastric cancer in a high-risk population.

BACKGROUND: Adenocarcinoma is preceded by chronic atrophic gastritis, gastric intestinal metaplasia and dysplasia. Trefoil factor 3 (TFF3) is a peptide secreted by goblet cells, which is abundantly present in intestinal metaplasia. AIM: To evaluate the utility of serum TFF3 as a non-invasive biomarker for the diagnosis of intestinal metaplasia and gastric cancer. METHODS: Single-center, cross-sectional study of 274 patients who consecutively underwent upper gastrointestinal endoscopy with gastric biopsies (updated Sydney system). TFF3 levels were measured in serum by a commercial ELISA kit. Patients with normal histology or chronic atrophic gastritis without intestinal metaplasia comprised the control group. In addition, 14 patients with invasive gastric cancer were included as a reference group. The association between TFF3 levels and intestinal metaplasia was assessed by logistic regression. RESULTS: Patients with intestinal metaplasia (n=110) had a higher median TFF3 level as compared to controls (n=164), 13.1 vs. 11.9ng/mL, respectively (p=0.024). Multivariable logistic regression showed a no significant association between TFF3 levels and intestinal metaplasia (OR=1.20; 95%CI: 0.87-1.65; p-trend=0.273). The gastric cancer group had a median TFF3 level of 20.5ng/mL, and a significant association was found (OR=3.26; 95%CI: 1.29-8.27; p-trend=0.013). CONCLUSION: Serum levels of TFF3 do not discriminate intestinal metaplasia in this high-risk Latin American population. Nevertheless, we confirmed an association between TFF3 levels and invasive gastric cancer.

Helicobacter pylori infection: A balance between bacteria and host.

In Argentina, despite the important studies conducted on the prevalence of infection and the antibiotic resistance of Helicobacter pylori, there are no reports simultaneously analyzing a profile of virulence factors of the bacterium and polymorphisms in cytokine genes in patients with different alterations in the gastric mucosa (including intestinal metaplasia, IM). Our aim was to evaluate H. pylori genotypes in 132 adult patients with chronic gastritis presenting three different histological findings (inactive chronic gastritis, active chronic gastritis IM- and active chronic gastritis IM+) along with SNP-174 G>C in the IL-6 gene. cagA, vacA and babA2 genes were analyzed by multiplex PCR. The -174 G>C SNP IL-6 gene was analyzed by PCR-RFLP. Patients with active chronic gastritis IM+ showed the highest proportion of the cagA(+)/IL-6GG, cagA(+)/vacAm1s1/IL-6GG and cagA(+)/vacAm1s1/babA2(+)/IL-6GG combinations (p<0.05). There was 4-5 times greater probability of finding patients presenting the GG genotype for SNP-174 G>C IL-6, which in turn were infected with the most virulent H. pylori genotypes -cagA(+), cagA(+)/vacAm1s1 and cagA(+)/vacAm1s1/babA2- in the ACGIM+ group in comparison to the ICG group. Our results provide regional data to the idea that the transition towards severe alterations in the gastric mucosa would be the result of a balance between specific factors of H. pylori and inherent host factors. This fact can be useful to identify patients at greater risk and to select those individuals requiring appropriate eradication treatment to prevent progression to gastric cancer.

Image-enhanced endoscopy in the diagnosis of gastric premalignant conditions and gastric cancer. / Técnicas de imagen avanzada en la detección y caracterización de las lesiones precursoras del cáncer gástrico y del cáncer gástrico precoz.

Diagnosis of early gastric cancer and its precancerous lesions remains a challenge for great part of western endoscopists. Changes seen in the mucosal pattern are generally subtle and hence difficult to identify. In this article, we will review the usefulness of conventional and virtual chromoendoscopy and magnification endoscopy in the recognition and classification of these lesions.

Prevalencia y localización gástrica del Helicobacter pylori en pacientes con atrofia y metaplasia intestinal en una institución de alta complejidad en Colombia / Prevalence and Gastric Location of Helicobacter pylori in Patients with Intestinal Atrophy and Metaplasia in a Tertiary Care Institution in Colombia

Resumen Introducción: Helicobacter pylori juega un papel fundamental en la cascada de carcinogénesis del cáncer gástrico tipo intestinal; sin embargo, no existe claridad respecto a su prevalencia en condiciones preneoplásicas que generan cambio en el microambiente de la mucosa. Actualmente se recomienda la vigilancia endoscópica por protocolo de Sydney cada 2 a 3 años, pero no es clara la presencia de H. pylori en la región subcardial y el fondo gástrico. Objetivo: determinar la prevalencia y localización gástrica del H. pylori en pacientes con condiciones preneoplásicas. Materiales y métodos: estudio de corte transversal en adultos con diagnóstico previo de atrofia o metaplasia intestinal que ingresaron a endoscopia de control, a quienes se les tomaron biopsias del antro, cuerpo, incisura angularis, región subcardial y fondo gástrico. Se realizó un análisis descriptivo de los resultados por regiones gástricas. Resultados: se recolectó la información de 160 pacientes con una prevalencia de H. pylori del 37,5 %, la cual fue en aumento de proximal a distal iniciando con una prevalencia de 12,5 % en la región subcardial hasta una prevalencia de 30,6 % en el antro; hubo un patrón similar en la prevalencia de lesiones preneoplásicas. Se observó una mayor presencia de lesiones avanzadas (displasia, carcinoma) en la incisura. Conclusiones: la prevalencia de H. pylori en condiciones premalignas evidenció una mayor presencia en las regiones distales en comparación con las proximales, y es más frecuente en la región antral y menor en la región subcardial. En cuanto a la distribución gástrica de atrofia y metaplasia, se encontró mayor compromiso en el antro y la incisura, y es baja en la región subcardial y el fondo.

Abstract Introduction: Helicobacter pylori infection plays a critical role in the carcinogenesis cascade of intestinal gastric cancer. However, its prevalence in preneoplastic conditions generating changes in the gastric mucosa is unclear. Currently, endoscopic surveillance using the Sydney protocol is suggested every 2 to 3 years, but the presence of H. pylori infection in the subcardial region and gastric fundus is ill-defined. Objective: to determine the prevalence and gastric location of H. pylori infection in patients with preneoplastic conditions. Materials and methods: a cross-sectional study in adults with a previous diagnosis of atrophy or intestinal metaplasia who entered control endoscopy and were antrum, body, incisura angularis, subcardial region, and gastric fundus biopsied. A descriptive analysis of the results by gastric regions was performed. Results: data from 160 patients with a prevalence of H. pylori of 37.5% were collected. It increased from proximal to distal, starting with a 12.5% prevalence in the subcardial region to a 30.6% prevalence in the antrum. In addition, there was a similar pattern in the prevalence of preneoplastic lesions. Furthermore, advanced lesions (dysplasia, carcinoma) were observed in the incisura. Conclusions: the prevalence of H. pylori in precancerous conditions showed a high presence in the distal regions compared to the proximal ones, and it is more frequent in the antrum and lower in the subcardial region. As for the gastric distribution of atrophy and metaplasia, more involvement was found in the antrum and angular notch and lower in the subcardial region and fundus.

Identificación y evaluación de lesiones gástricas premalignas asociadas a la infección por Helicobacter pylori / Identification and evaluation of premalignant gastric lesions associated with Helicobacter pylori infection

Introducción: La infección por Helicobacter pylori es la causa principal de enfermedades gastroduodenales (gastritis crónica, úlceras pépticas y cáncer gástrico). En Guatemala existen pocos estudios sobre la prevalencia de H. pylori y su relación con enfermedades gastrointestinales, particularmente con cáncer. Objetivos: Identificar la presencia de lesiones premalignas (atrofia gástrica, metaplasia intestinal y displasia) y su relación con la infección por H. pylori en pacientes de consulta externa en unidades de gastroenterología de dos hospitales nacionales de la ciudad de Guatemala. Métodos: El diagnóstico histopatológico y bacteriológico se realizó por medio de las tinciones de H & E y Giemsa, cultivo e identificación bioquímica, detección de anticuerpos específicos mediante la prueba ELISA, diagnóstico molecular por la amplificación del gen glmM y genotipificación por PCR para identificar los genes VacA y CagA. Se analizaron datos clínico-epidemiológicos de los pacientes, la prevalencia de la infección por H. pylori y la genotipificación de la bacteria. Resultados: En 293 de los pacientes estudiados (83 por ciento) se encontró algún tipo de lesión premaligna; las más frecuentes fueron la atrofia gástrica (70 por ciento), metaplasia intestinal (11 por ciento) y displasia gástrica (2 por ciento). El 17 por ciento de los pacientes no presentó lesiones premalignas. Se halló una prevalencia de infección por H. pylori del 58 por ciento, y el gen cagA se detectó en 118 (57 por ciento) de los pacientes infectados. Conclusiones: La mayoría de los pacientes presentó atrofia gástrica (70 por ciento) y el 43,5 por ciento estaba infectado por H. pylori, principalmente con cepas CagA positivo. Este hecho confirma la importancia del estudio de H. pylori y su relación con cáncer gástrico(AU)

Introduction: Helicobacter pylori infection is the main cause of gastroduodenal diseases (chronic gastritis, peptic ulcer and gastric cancer). In Guatemala few studies have been carried out on the prevalence of H. pylori and its relationship with gastrointestinal diseases, particularly with cancer. Objective: To identify the presence of premalignant lesions (gastric atrophy, intestinal metaplasia and dysplasia) and their relationship with H. pylori infection in outpatients in gastroenterology units in two national hospitals in Guatemala City. Methods: Histopathological and bacteriological diagnostic testings were performed by H & E and Giemsa stain, culture and biochemical identification, detection of specific antibodies by ELISA, molecular diagnosis by glmM gene amplification, and genotypification by PCR to identify vacA and cagA genes. Clinical and epidemiological data from patients, prevalence of H. pylori infection, and bacterium genotypification were analyzed. Results: Among the studied patients, 293 (83 percent) presented some type of premalignant lesion. The most prevalent were gastric atrophy (70 percent), intestinal metaplasia (11 percent), and gastric dysplasia (2 percent). Seventeen percent of the patients did not have any premalignant lesions. The prevalence of H. pylori infection was 58 percent, and cagA gene was identified in 118 (57 percent) of the infected patients. Conclusions: The majority of the patients presented gastric atrophy (70 percent), and 43.5 percent were infected by H. pylori, mainly with positive cagA strains. This finding confirms the importance of studying H. pylori and its relationship with gastric cancer(AU)

Estimación de la frecuencia de infección por Helicobacter pylori en pacientes con lesiones potencialmente malignas gástricas del municipio de Pasto-Nariño, 2016-2019 / Estimation of the frequency of Helicobacter pylori infection in patients with potentially malignant stomach lesions of the city of Pasto- Nariño, 2016-2019

Resumen Objetivo: Estimar la frecuencia de infección por Helicobacter pylori en lesiones potencialmente malignas gástricas de pacientes de la ciudad de Pasto, Nariño. Materiales y métodos: Estudio retrospectivo con análisis secundario de información sociodemográfica e histopatológica obtenida de reportes de patología para biopsias gástricas de pacientes del departamento de Nariño, Colombia del año 2016-2019. Resultados: Los pacientes de la ciudad de Pasto (n=359) presentaron una frecuencia de infección por Helicobacter pylori de 35.6%, siendo significativamente mayor en hombres que en mujeres (p=0.037). La edad promedio de los hombres positivos para Helicobacter pylori fue de 44 años y de las mujeres de 47 años (p<0.001). La edad promedio de los casos de gastritis crónica atrófica en hombres y mujeres fue de 49 y 54 años respectivamente (p<0.001) y de metaplasia intestinal fue de 59 años en hombres y 61 años en mujeres (p<0.001). Conclusiones: En el presente estudio, la detección de Helicobacter pylori fue mayor en el grupo de hombres en comparación al de las mujeres (43.2% vs 31.6% respectivamente). La frecuencia de gastritis crónica atrófica y metaplasia intestinal en hombres fue de 37.9% y 23.1% respectivamente; mientras que en mujeres fue de 35.2% y 15.1% respectivamente.

Abstract Aim: To estimate the frequency of Helicobacter pylori infection in potentially malignant stomach lesions in patients of the city of Pasto- Nariño. Materials and methods: Retrospective study with secondary analysis of sociodemographic and histopathological information derived from pathology reports for gastric biopsies of patients from the department of Nariño, Colombia from year 2016-2019. Results: Patients from the city of Pasto (n=359) presented a percentage of detection for Helicobacter pylori of 35.6% and the infection was significantly higher in men than in women (p=0.037). The average age of men positive for Helicobacter pylori was 44 years and women 47 years (p<0.001). The average age of the cases of chronic atrophic gastritis in men and women was 49 and 54 years respectively (p<0.001) and for intestinal metaplasia cases, the average age was 59 years in men and 61 years in women (p<0.001). Conclusions: In the present study, the detection of Helicobacter pylori was higher in the male group compared to the female group (43.2% vs 31.6% respectively). The frequency of atrophic chronic gastritis and intestinal metaplasia in men was 37.9% and 23.1% respectively; in women was 35.2% and 15.1% respectively.

Papel da biópsia da incisura angular no estadiamento da gastrite e na avaliação de risco do câncer gástrico / Role of incisura angularis biopsy in gastritis staging and risk assessment of gastric cancer

Introdução: A atrofia gástrica (AG) e metaplasia intestinal (MI) são condições préneoplásicas no desenvolvimento de câncer gástrico, onde a avaliação endoscópica e histopatológica baseia-se no sistema atualizado de Sydney que inclui uma biópsia da incisura angular (IA) na sua avaliação, assim como os sistemas de estadiamento de risco de câncer gástrico Operative Link on Gastritis Assessment (OLGA) e o Operative Link on Gastritis Assessment using Intestinal Metaplasia (OLGIM). Objetivo: Comparar as classificações OLGA e OLGIM com e sem a biópsia da IA. Além disso, determinar a prevalência de Helicobacter pylori (HP) e das alterações pré-neoplásicas (AG, MI e displasia) por região biopsiada, e ainda identificar os achados exclusivos da IA, além de identificar potenciais fatores de risco para câncer gástrico associados às alterações pré-neoplásicas. Materiais e Métodos: Estudo observacional, retrospectivo e prospectivo, descritivo, unicêntrico com 350 pacientes sem diagnóstico de neoplasia gástrica, que realizaram endoscopia digestiva alta com biópsias na Gastroclínica Itajaí, no período de novembro de 2017 até outubro de 2018 (retrospectivo) e de março de 2020 a maio de 2022. A classificação histopatológica de gastrite obedeceu ao sistema Sydney atualizado, e a avaliação do risco de câncer gástrico aos sistemas OLGA e OLGIM. A metodologia aplicada avaliou os escores dos sistemas OLGA e OLGIM com e sem a avaliação da biópsia da IA. A análise estatística foi realizada utilizando medidas descritivas (frequências, porcentagens, média, desvio padrão, intervalo de confiança de 95%). A comparação entre os ranks foi feita pelo teste de Kruskal-Wallis ou Wilcoxon. Para analisar a relação entre as frequências foi utilizado o teste exato de Fisher bilateral. O score de Wilson com correção de continuidade foi aplicado ao intervalo de confiança. Resultados: A idade mediana foi de 54,7 anos, sendo 52,5% pacientes do gênero feminino e 47,5% do gênero masculino. A comparação entre o protocolo de biópsias empregado (corpo + antro [CA] vs corpo + antro + incisura [CAI]) e os estágios OLGA e OLGIM apresentou uma diminuição significativa em ambos os sistemas de estadiamento quando aplicado o protocolo de biópsia restrito ao corpo e antro (OLGA CAI vs CA; p 0,008 / OLGIM CAI vs CA; p 0,002). A prevalência das lesões pré-malignas (AG, MI e displasia) da mucosa gástrica foi de (33,4%, 34% e 1,1%, respectivamente) na amostra total. A região do antro foi o sítio que apresentou significativamente maior número de alterações (p≤0,0001), exceto para a positividade da infecção por HP, a qual esteve presente em 24,8% dos pacientes. Não foi possível fazer correlação entre os fatores de risco para desenvolvimento do câncer gástrico com os achados histológicos devido à baixa prevalência dos mesmos e a casuística ter resultado em uma amostra bastante limitada. Conclusão: A biópsia da incisura angular é importante porque aumentou o número de casos em estágios mais avançados de atrofia e metaplasia intestinal. O estudo apresentou limitações, onde a principal delas foi a amostra relativamente pequena e composta por indivíduos saudáveis apesar de idosos na sua maior parte

Introduction: Gastric atrophy (GA) and intestinal metaplasia (IM) are pre-neoplastic conditions in the development of gastric cancer, where endoscopic and histopathological evaluation is based on the updated Sydney system that includes a biopsy of the incisura angularis (IA), as well as the Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis Assessment using Intestinal Metaplasia (OLGIM) gastric cancer risk staging systems. Objective: To compare the OLGA and OLGIM classifications with and without IA biopsy. In addition, to determine the prevalence of Helicobacter pylori (HP) and preneoplastic changes (AG and IM) by biopsied region, and to identify the exclusive findings of IA. Also, to identify potential risk factors for gastric cancer associated with pre-neoplastic changes. Materials and Methods: Observational, retrospective and prospective, descriptive, unicentric study with 350 patients without a diagnosis of gastric cancer, who underwent upper digestive endoscopy with biopsies at Gastroclínica Itajaí, from November 2017 to October 2018 (retrospective) and from March 2020 to May 2022. The histopathological classification of gastritis followed the updated Sydney system, and the gastric cancer risk assessment followed the OLGA and OLGIM systems. The methodology applied evaluated the scores of the OLGA and OLGIM systems with and without the assessment of the IA biopsy. Statistical analysis was performed using descriptive measures (frequencies, percentages, mean, standard deviation, 95% confidence interval). Ranks were compared using the Kruskal-Wallis or Wilcoxon tests. To analyze the relationship between the frequencies, the bilateral Fisher's exact test was used. Wilson's score with continuity correction was applied to the confidence interval. Results: The median age was 54,7 years, with 52,5% female patients and 47,4% male patients. The comparison between the used biopsies protocol (corpus + antrum [CA] vs corpus + antrum + incisura angularis [CAI]) and the OLGA and OLGIM stages showed a significant decrease in both staging systems when the biopsy protocol restricted to the corpus and antrum was applied (OLGA CAI vs CA; p 0,008 / OLGIM CAI vs CA; p 0,002). The prevalence of pre-malignant lesions (GA, IM and dysplasia) of the gastric mucosa was (33,4%, 34% and 1,1%, respectively) in the total sample. The antrum region was the site that presented a significantly higher number of alterations (p≤0,0001), except for the positivity of HP infection, which was present in 24,8% of the patients. It was not possible to make a correlation between the risk factors for the development of gastric cancer and the histological findings because the casuistry resulted in a very limited sample with low prevalence of risk factors. Conclusion: Incisura angularis biopsy is important because it increased the number of cases in more advanced stages of intestinal metaplasia and atrophy. The study had limitations, the main one being the relatively small sample composed of healthy individuals, although mostly elderly

Frecuencia de cambios morfológicos en biopsias gástricas asociadas a infección por Helicobacter Pylori / Frequency of morphological changes in gastric biopsies associated with Helicobacter pylori infection

Resumen Introducción: se han descrito cambios morfológicos asociados a la infección gástrica por H. pylori como: gastritis crónica superficial, gastritis atrófica, gastritis folicular y metaplasia intestinal. Importancia: La atrofia y la metaplasia gástrica pertenecen a la cascada de cambios histológicos que conducen al cáncer gástrico. Metodología: estudio retrospectivo de corte transversal en el que se analizaron pacientes con dispepsia; durante su examen se practicó endoscopia y biopsias gástricas. Se documentó infección o no por H. pylori y los cambios morfológicos presentes. Resultado: total de casos positivos para infección H. pylori en biopsias gástricas 127/166 (76.5%), casos negativos para infección H. pylori en biopsias gástricas 39/166 (23.4%). Edad promedio 45.38 años, sexo femenino 80/127 (63%), gastritis crónica superficial 61/127 (48%), gastritis nodular 43/127 (33.87%), atrofia gástrica 7/127 (5.5%), metaplasia intestinal 7/127 (5.5%). Biopsias negativas para H.pylori con diagnóstico de atrofia 5/39 (12.8%), con hallazgo de metaplasia fueron: 4/39 (10.2%). Conclusiones: los cambios morfológicos encontrados en biopsias gástricas son similares a la literatura universal. La atrofia y especialmente la metaplasia intestinal son cambios morfológicos asociados a la infección por H.pylori y son a su vez factores de riesgo para el desarrollo del cáncer gástrico que fueron documentados en la serie que presentamos. Hay casos negativos para la infección H.pylori, con cambios superficiales de atrofia y metaplasia por lo que es recomendable hacer estudios adicionales para descartar completamente la infección por H. pylori. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1987).

Abstract Introduction: morphological changes associated with gastric H. pylori infection have been reported, such as chronic superficial gastritis, atrophic gastritis, follicular gastritis and intestinal metaplasia. Importance: Gastric atrophy and metaplasia are part of the cascade of histological changes that lead to gastric cancer. Methods: a retrospective cross-sectional study analyzing patients with dyspepsia; gastric endoscopy and biopsies were conducted during their exams. The presence or absence of H. pylori infection was documented along with the morphological changes present. Results: a total of 127/166 cases were positive for H.pylori infection on gastric biopsy (76.5%), and 39/166 cases were negative for H. pylori on gastric biopsy (23.4%). The average age was 45.38 years, 80/127 (63%) were female, 61/127 had superficial chronic gastritis (48%), 43/127 (33.87%) had nodular gastritis, 7/127 (5.5%) had gastric atrophy, and 7/127 (5.5%) had intestinal metaplasia. Of the biopsies which were negative for H. pylori, 5/39 (12.8%) had a diagnosis of atrophy, and 4/39 (10.2%) had a finding of metaplasia. in those with a diagnosis of atrophy Conclusions: the morphological changes found in gastric biopsies are similar to those reported in the international literature. Atrophy, and especially intestinal metaplasia, are morphological changes associated with H.pylori infection, and, in turn, risk factors for developing gastric cancer, which were documented in our study. There are H. pylori-negative cases with superficial atrophic and metaplastic changes; thus, it is advisable to carry out further studies to completely rule out H. pylori infection. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1987).

Quality in diagnostic upper gastrointestinal endoscopy for the detection and surveillance of gastric cancer precursor lesions: Position paper of AEG, SEED and SEAP. / Documento de posicionamiento de la AEG, la SEED y la SEAP sobre calidad de la endoscopia digestiva alta para la detección y vigilancia de las lesiones precursoras de cáncer gástrico.

This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.

Gastric cancer screening in low incidence populations: Position statement of AEG, SEED and SEAP. / Documento de posicionamiento de la AEG, la SEED y la SEAP sobre cribado de cáncer gástrico en poblaciones con baja incidencia.

This positioning document, sponsored by the Asociación Española de Gastroenterología, the Sociedad Española de Endoscopia Digestiva and the Sociedad Española de Anatomía Patológica, aims to establish recommendations for the screening of gastric cancer (GC) in low incidence populations, such as the Spanish. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates screening in the general population, individuals with relatives with GC and subjects with GC precursor lesions (GCPL). The goal of the interventions should be to reduce GC related mortality. We recommend the use of the OLGIM classification and determine the intestinal metaplasia (IM) subtype in the evaluation of GCPL. We do not recommend to establish endoscopic mass screening for GC or Helicobacter pylori. However, the document strongly recommends to treat H.pylori if the infection is detected, and the investigation and treatment in individuals with a family history of GC or with GCPL. Instead, we recommend against the use of serological tests to detect GCPL. Endoscopic screening is suggested only in individuals that meet familial GC criteria. As for individuals with GCPL, endoscopic surveillance is only suggested in extensive IM associated with additional risk factors (incomplete IM and/or a family history of GC), after resection of dysplastic lesions or in patients with dysplasia without visible lesion after a high quality gastroscopy with chromoendoscopy.

Helicobacter pylori y cáncer gástrico / Helicobacter pylori and gastric cancer

Introducción: El Helicobacter pylori se ha relacionado con el desarrollo de gastritis crónica atrófica, metaplasia intestinal y displasia, lesiones que pueden evolucionar a carcinoma gástrico. Existen investigaciones que demuestran que la erradicación de esta bacteria disminuye el riesgo de progresión histopatológica de las lesiones preneoplásicas, excepto la metaplasia intestinal y la displasia. Se realizó una revisión de los artículos publicados en las bases de datos Pubmed, Scielo, Medline y Cochrane, relacionados con el tema. Objetivo: Profundizar en los conocimientos relacionados con la infección por Helicobacter pylori y cáncer gástrico. Desarrollo: El adenocarcinoma es el tumor gástrico más frecuente y el Helicobacter pylori es el agente etiológico principal. En poblaciones de riesgo elevado, el adenocarcinoma gástrico de tipo intestinal, se precede de lesiones preneoplásicas (atrofia, metaplasia intestinal y displasia) que evoluciona al cáncer invasor. Conclusiones: Helicobacter pylori favorece la carcinogénesis gástrica, aunque existen otros factores de riesgo para el surgimiento del cáncer gástrico como son: la historia familiar, la pobre ingestión de frutas y vegetales y el bajo nivel socioeconómico(AU)

Introduction: Helicobacter pylori has been linked to the development of chronic atrophic gastritis, intestinal metaplasia, and dysplasia, lesions that can progress to gastric carcinoma. There is research showing that the eradication of this bacterium reduces the risk of histopathological progression of preneoplastic lesions, except for intestinal metaplasia and dysplasia. A bibliographic review was made of the articles published in the Pubmed, Scielo, Medline and Cochrane data bases, related to the topic, belonging to authors dedicated to the study of this problem. Objective: To go deepen in the knowledge related to Helicobacter pylori infection and gastric cancer. Development: Adenocarcinoma is the most frequent gastric tumor and Helicobacter pylori is the main etiologic agent. In high-risk populations, gastric adenocarcinoma of the intestinal type, is preceded by preneoplasic lesions (atrophy, intestinal metaplasia, and dysplasia), that progresses to invasive cancer. Conclusions: Helicobacter pylori favors gastric carcinogenesis, although there are other risk factors for the development of gastric cancer such as: family history, poor intake of fruits and vegetables, and low socioeconomic leve(AU)

Evaluation of upper endoscopic findings in patients with restless legs syndrome and gastric complaints / Avaliação dos achados endoscópicos superiores em pacientes com síndrome das pernas inquietas e queixas gástricas

Abstract Background: The effect of gastrointestinal system disorders on Restless Legs Syndrome/Willis-Ekbom disease (RLS/WED) has been previously demonstrated by using serological tests. However, this association has not been supported by histopathological studies so far. Objective: To investigate the relationship between RLS/WED, upper endoscopic imaging and histopathological results in patients diagnosed with RLS who underwent endoscopy because of gastrointestinal system (GIS) complaints. Methods: Case-control study, including 100 patients diagnosed with RLS who presented dyspeptic complaints and underwent upper GIS endoscopy and 106 age- and sex-matched controls. RLS diagnosis was evaluated according to the four main diagnostic criteria determined by the International RLS Study Group. All patients underwent upper GIS endoscopic intervention and at least one gastric and/or antral biopsy. Results: There was no significant difference between patients and controls in relation to endoscopically seen gastric ulcer, duodenal ulcer, gastroesophageal reflux disease (GERD) findings and Helicobacter pylori (HP) positivity (p>0.05). Intestinal metaplasia and mucosal atrophy were more common in RLS/WED patients compared to controls (p=0.026 and p=0.017, respectively). Additionally, ferritin levels were found to be lower than the reference value. Conclusions: The detection of increased severity of intestinal metaplasia, mucosal atrophy, and gastric inflammation in RLS/WED patients with dyspeptic complaints may entail the close gastrointestinal system evaluation of these patients. However, larger randomized and controlled trials are required on this subject where patients are evaluated by upper GIS endoscopic biopsy.

Resumo Introdução: Os efeitos das doenças do sistema digestório sobre a Síndrome das Pernas Inquietas/doença de Willis-Ekbom (SPI/DWE) foram demonstrados previamente por testes sorológicos. No entanto, até o momento tal associação não foi corroborada por estudos histopatológicos. Objetivo: Investigar a relação entre a SPI/DWE, imagens de endoscopia digestiva alta e resultados histopatológicos em pacientes diagnosticados com SPI/DWE com queixas do sistema digestório. Métodos: Estudo caso-controle incluindo 100 pacientes com SPI/DWE e queixas dispépticas que foram submetidos à endoscopia digestiva alta, e 106 controles emparelhados para idade e sexo. O diagnóstico de SPI/DWE foi determinado com base nos quatro principais critérios do International RLS Study Group. Todos os pacientes foram submetidos à intervenção endoscópica do sistema digestório superior e a pelo menos uma biópsia gástrica e/ou antral. Resultados: Não houve diferença significativa entre os grupos em relação à úlcera gástrica endoscopicamente observada, úlcera duodenal, doença do refluxo gastroesofágico (DRGE) e positividade para Helicobacter pylori (HP) (p>0,05). Metaplasia intestinal e atrofia da mucosa foram mais comuns em pacientes com SPI/DWE em comparação aos controles (p=0,026 e p=0,017, respectivamente). Níveis de ferritina encontravam-se abaixo do valor de referência. Conclusão: A detecção de metaplasia intestinal grave, atrofia de mucosa e inflamação gástrica em pacientes com SPI/DWE com queixas dispépticas pode justificar a avaliação cuidadosa do sistema digestório nestes pacientes. Entretanto, são necessários estudos controlados e com amostras maiores com pacientes avaliados com biópsia por via endoscópica.

Cyclooxigenase-2 and osteopontin in gastric pre-neoplastic lesions in relation to H-pylori infection and grade of inflammation.

The association between Helicobacter-pylori-induced inflammation and gastric adenocarcinoma is well documented and it has been suggested that the pro-mitotic and apoptotic effect of Cyclooxygenase-2 and Osteopontin on the epithelial cells of the gastric mucosa may have a role in carcinogenesis of the gastric mucosa. The aim of this study was to determine the expression of Cyclooxygenase-2 and Osteopontin in normal gastric mucosa, mucosa with gastritis and gastric mucosa with intestinal metaplasia, in relation to Helicobacter-pylori infection and grade of inflammation. Immunohistochemistry was performed on 108 gastric biopsies in order to detect Cyclooxygenase-2 and Osteopontin expression. The intensity and percentage of staining were evaluated using the H-Score, and its association with grade of inflammation, Helicobacter pylori infection and intestinal metaplasia was determined. Expression of Cyclooxygenase-2 and Osteopontin was higher in gastric biopsies (values shown respectively) with Helicobacter-pylori infection (179.9/142.3), intestinal metaplasia (208.8/179.3) or higher grades of inflammation (190/135.7) in comparison to normal gastric mucosa (100.7/80) or mild grade of inflammation (128.4/128.4), (p<0.05).There is an overexpression of Cyclooxygenase-2 and Osteopontin in gastric mucosa with H. pylori infection, intestinal metaplasia and high grades of inflammation, suggesting a constant up-regulation of protein expression in response to the inflammatory process generated by a Helicobacter-pylori infection, leading to the development of intestinal metaplasia.

Morfología y repercusiones diagnóstico-terapéuticas de las lesiones preneoplásicas gástricas / Morphology and diagnostic determinants of gastric precancerous conditions

El carcinoma gástrico (CG) de tipo intestinal se origina en un epitelio displásico, que a su vez se desarrolla en medio de una atrofia gástrica (AG) y metaplasia intestinal (MI). La infección por Helicobacter pylori (HP) es la causa más frecuente de AG, causando una pangastritis atrófica multifocal. Entre otras condiciones que producen inflamación crónica de la mucosa gástrica se encuentran también la gastritis autoinmune y la anemia perniciosa. El marco conceptual sobre el cual descansa gran parte de la investigación actual y nuestra comprensión de los cambios que ocurren en la mucosa gástrica se debe a la denominada "cascada de Correa"; quien planteó que la mucosa gástrica crónicamente inflamada, da paso a la AG, que va adquiriendo focos de MI y en dicho epitelio se desarrollará finalmente una displasia (DIS). Se ha acuñado el término lesiones preneoplásicas gástricas (LPG), para referirse a: AG, MI y DIS.Después de la erradicación de HP, se ha demostrado una reducción general de la incidencia de CG; efecto que no es tan claro, cuando la pangastritis por HP ha evolucionado a AG extensa. De tal modo que el efecto de la erradicación de HP medido a través de EC, ha sido poco consistente. La AG grave diagnosticada por histología representa la condición de mayor riesgo. Por otra parte, la MI puede ser de tipo intestinal (delgado-entérica ó incompleta) y la colónica (colónica ó completa) considerándose a esta última, como la variedad de peor pronóstico. El diagnóstico histológico de este tipo de lesiones determina que quien las padece, debe someterse a vigilancia endoscópica. El objetivo de este manuscrito fue resumir la evidencia existente respecto de las LPG, en términos de su caracterización morfológica y sus repercusiones diagnóstico-terapéuticas (significado patológico, graduación del riesgo, vigilancia recomendada; y factores de riesgo).

Gastric carcinoma (GC) of intestinal type, originates from a dysplastic epithelium, which in turn develops in the midst of gastric atrophy (GA) and intestinal metaplasia (IM). Helicobacter pylori (HP) infection is the most frequent cause of GA, causing a multifocal atrophic pangastritis. Among other conditions that produce chronic inflammation of gastric mucosa are also autoimmune gastritis and pernicious anemia. The conceptual framework on which much of current research rests and our understanding of the changes that occur in the gastric mucosa is due to the so-called "Correa waterfall"; who stated that gastric mucosa chronically inflamed, gives way to the GA, which is acquiring foci of IM and in said epithelium a dysplasia (DIS) will eventually develop. The term precancerous conditions (PCC) of the gastric mucosa have been coined to refer to: GA, IM and DIS. After HP eradication, a general reduction in the incidence of GC has been demonstrated; effect that is not so clear, when pangastritis by HP has evolved to extensive GA. Thus, the effect of HP eradication measured through clinical trials has been inconsistent. Severe GA diagnosed represents the highest risk condition. On the other hand, IM can be enteric (grade I), enterocolic (grade II) or colonic (grade III); considering IM III as the variety with the worst prognosis. Histological diagnosis of gastric PCC, determines that the one who suffers them, must undergo endoscopic surveillance. The aim of this manuscript was to update morphological aspects and diagnostic-therapeutic scope of gastric PCC.

Can neopterin be a useful immune biomarker for differentiating gastric intestinal metaplasia and gastric atrophy from non-atrophic non-metaplastic chronic gastritis?

INTRODUCTION: Helicobacter pylori (H. pylori) is closely related to pre-neoplastic lesions such as gastric atrophy (GA), gastric intestinal metaplasia (GIM) and eventually gastric cancer (GC). The diagnosis of GIM and GA is usually based on endoscopic and histopathological features. Nowadays, there are no recognized good serological markers of GIM and GA. Neopterin is an important marker of cellular inflammation. In this study, we aimed to comparatively evaluate C-reactive protein (CRP) and neopterin levels in patients with GIM, GA and chronic gastritis, and to show the increased serum neopterin levels in GIM and GA according to non-atrophic and non-metaplastic chronic gastritis. PATIENTS AND METHODS: 98 patients with GIM and 68 patients with GA and 70 patients with non-atrophic non-metaplastic gastritis were included in the study. CRP and neopterin levels were assessed in patients and controls. RESULTS: CRP and neopterin levels were significantly higher in patients with GIM and GA than in controls (p<0.05 and p<0.001, respectively). A multiple logistic regression analysis showed that high levels of serum neopterin were positively correlated with GIM and GA. According to the ROC curve analysis, the best cut-off value to differentiate between patients with GIM and/or GA from controls was ≥10.15nmol/l (p<0.001) for serum neopterin levels and ≥1.95mg/l (p<0.001) for serum CRP levels. DISCUSSION: CRP and neopterin levels are significantly increased in GIM and GA. Neopterin may be a useful biomarker and diagnostic test for detecting GIM and GA in clinical practice. CRP levels may be helpful for this observation.