慢性缩性胃炎和肠道转化:拉丁美洲的观点
Arnoldo Riquelme1,2, Felipe Silva1, Diego Reyes1
1Department of Gastroenterology, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.
概括
拉丁美洲的胃癌预防需要更好的风险工具. 这项研究建议在内镜监测中使用先进的胃前恶性状况分期,以改善早期检测和管理有限的资源.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 公共卫生 公共卫生
背景情况:
- 胃癌 (GC) 是全球主要的死亡原因,特别是在拉丁美洲男性中,往往是晚期诊断的,预后不佳.
- 杆菌感染是GC的主要危险因素,强调了"测试和治疗"战略对初级预防的重要性.
- 目前的西方指导方针建议EGD用于处于风险的个人,但在拉丁美洲的有限可用性需要风险分层工具.
研究的目的:
- 为胃前性疾病 (GPMC) 提出有效的风险分层工具,以优化拉丁美洲的内镜监测.
- 通过识别高风险患者进行有针对性的内镜评估,促进早期发现胃癌.
- 将预防策略与该地区普遍存在的资源限制相适应.
主要方法:
- 利用了智利ECHOS研究的结果,重点关注GPMC的OLGA/OLGIM分期.
- 集成的GPMC分级工具,如金村-塔克莫托和胃肠代谢的内镜分级.
- 推用于标准化活检协议 (更新的悉尼系统) 和组织学分级 (OLGA/OLGIM) 慢性缩性胃炎和肠道转化.
主要成果:
- 建议对先进的GPMC (OLGA/OLGIM阶段III-IV) 进行内镜监测,可靠的风险分层.
- 强调需要高质量的EGD和GPMC的增强诊断产量.
- 支持最近的智利策略,包括对H. pylori的"测试和治疗" (35-44岁) 和结合血清学/EGD (年龄>45岁).
结论:
- 可靠的风险分层工具对于有效的GPMC监测和在资源有限的环境中早期发现GC至关重要.
- 将OLGA/OLGIM等组织学分级系统与标准化活检技术相结合,可以改善GC风险评估.
- 量身定制的预防策略,结合H. pylori检测和血清学标记,可以优化资源分配,用于拉丁美洲的胃癌预防.
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