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Published on: February 16, 2024
Pseudopyloric Metaplasia Is Not Associated With the Development of Gastric Cancer
Emanuele Dilaghi1, Francesca Baldaro1, Emanuela Pilozzi2
1Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy.
Introduction:
Corpus atrophic gastritis (CAG) is associated with intestinal metaplasia (IM) and pseudopyloric metaplasia (PPM). Prospective data on corpus mucosa PPM and its link to the development of gastric cancer (GC) are lacking. This study aimed to investigate the relationship between the presence of corpus mucosa PPM at baseline and the development of GC at follow-up in patients with CAG.
Methods:
A longitudinal cohort study was conducted on patients with consecutive CAG adhering to endoscopic-histological surveillance. Patients were stratified for the presence/absence of corpus PPM without concomitant corpus IM at baseline, and the occurrence of gastric neoplastic lesions at the longest available follow-up was assessed.
Results:
A total of 292 patients with CAG with a follow-up of 4.2 (3-17) years were included. At baseline, corpus PPM without corpus IM was diagnosed in 62 patients (21.2%). At the follow-up, GC was detected in 5 patients (1.7%) and gastric dysplasia (GD) in 4 patients (1.4%). In all these 9 patients with GC/GD at the follow-up, corpus IM was present at baseline and follow-up. Age <50 years (odds ratio [OR] 2.5), absence of pernicious anemia (OR 4.3), and absence of severe corpus atrophy (OR 2.3) were associated with corpus PPM without corpus IM.
Discussion:
At the 4.2-year follow-up, in patients with CAG characterized at baseline with corpus PPM without corpus IM, GC or GD was not observed because these lesions were consistently associated with corpus IM. Corpus PPM without corpus IM was associated with younger age, absence of pernicious anemia, and severe corpus atrophy, suggesting a lower stage of disease progression. Corpus PPM alone seems not to be associated with GC, whose development seems to require the presence of corpus IM as a necessary step.
Insights
Corpus pseudopyloric metaplasia (PPM) in atrophic gastritis (CAG) alone does not lead to gastric cancer (GC). Gastric cancer development in CAG patients requires intestinal metaplasia (IM) as a necessary precursor.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Corpus atrophic gastritis (CAG) is a precancerous condition.
- Intestinal metaplasia (IM) and pseudopyloric metaplasia (PPM) are common findings in CAG.
- The independent role of corpus PPM in gastric cancer (GC) development is not well understood.
Purpose of the Study:
- To investigate the association between corpus mucosa PPM and the incidence of GC in patients with CAG.
- To determine if corpus PPM without concomitant IM is a risk factor for GC development.
Main Methods:
- A longitudinal cohort study of 292 patients with CAG undergoing endoscopic-histological surveillance.
- Patients were stratified based on the presence or absence of corpus PPM without concurrent corpus IM at baseline.
- Gastric neoplastic lesions (GC/gastric dysplasia) were assessed at follow-up (mean 4.2 years).
Main Results:
- Corpus PPM without IM was diagnosed in 21.2% of patients at baseline.
- GC or gastric dysplasia occurred in 9 patients (3.1%) during follow-up.
- All patients who developed GC/dysplasia had corpus IM at baseline and follow-up; none had isolated corpus PPM.
Conclusions:
- Corpus PPM alone is not associated with an increased risk of GC development.
- The presence of corpus IM is a necessary step for GC development in patients with CAG.
- Corpus PPM without IM may indicate an earlier stage of disease progression.
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