Gastroenterologists are very familiar with the metaplastic intestinalized epithelium found in the esophagus even though it occurs in less than 1%2% of the populationand largely in those with chronic gastroesophageal reflux disease. The prevalence of ag and im vary depending on countries, even it represents diverse results in the same nation. Gastric intestinal metaplasia gim is a common finding from routine endoscopies. Atrophic gastritis ag and intestinal metaplasia im are the main precursor lesions of gastric cancer as the incidence of gastric cancer increases in the gastric mucosa involved with ag and im. The risk of gastric cancer increases in elderly patients with atrophy of gastric mucosa and intestinal metaplasia. Gastric cancer consists of two pathological variants, intestinal and diffuse. Of the 206 dyspeptic patients without helicobacter pylori, 18 7. The advance of antralcorpus border produces a lawn of pseudopyloric mucosa onto which islands or patches of intestinal metaplasia may appear and over time.
Two weeks ago, i had a endoscopy in california, the resulting biopsy report only showed the existence of intestinal metaplasia in antrum and angularis, but. Antral type and intestinal metaplasia may represent local responses to chronic injury secondary to the presence of gallstones and inflammation. Intestinal metaplasia of the stomach video journal and. Nonendoscopic factors like older age, male sex and smoking status are all independently associated with increased risk for gastric intestinal metaplasia, according to study results.
Aga clinical practice guidelines on management of gastric. Cassaro m, rugge m, gutierrez o, leandro g, graham dy, genta rm. Im tends to appear initially at the antrumcorpus junction, especially at the gastric angularis. The significance of small intestinal epithelium in gastric. Risk factors for gastric intestinal metaplasia identified.
The first step in the treatment of intestinal metaplasia is using endoscopy to diagnose and biopsy the gastric lining endoscopy is a procedure in which a long, thin tube is inserted into your body. Intestinal metaplasia and glandular atrophy are preneoplastic gastric lesions and common in patients with chronic gastritis as in those with helicobacter pylori infection. Intestinal metaplasia, abbreviated im, refers to a transformation that results in an intestinal type mucosa. Intestinal metaplasia is the occurrence of intestinal cells changing from one type of cell to another. This condition is usually due to an underlying issue such as chronic gastritis and acid reflux. Intestinal metaplasia of the stomach gastric intestinal metaplasia or gim is defined by the occurrence of goblet cells in gastric mucosa, both gastric oxyntic mucosa of the body and fundus and pyloric antral mucosa figs. Im is highly prevalent in the general population, being detected in nearly 1 of every 4 patients undergoing upper endoscopy. Intestinal metaplasia im of the stomach is associated with a very small increased risk of developing gastric cancer. Topographic patterns of intestinal metaplasia and gastric cancer. Overview of current concepts in gastric intestinal metaplasia and gastric cancer david s. Gastric intestinal metaplasia is defined as the replacement of the surface, foveolar, and glandular epithelium in the oxyntic or antral mucosa by intestinal epithelium. We present two cases of pediatric patients with gim along with. Top 21 on gastric intestinal metaplasia treatment healthtap.
Pdf intestinal metaplasia of the stomach researchgate. On the basis of histological similarities with small intestinal or colonic epithelium, gim can be further classified into complete or incomplete intestinal metaplasia. Intestinal metaplasia of the gastric antrum is common in adults with chronic gastritis and occurs in helicobacterassociated gastritis in children. Gastric intestinal metaplasia gim is histologically identical to esophageal intestinal metaplasia or barretts esophagus. Esge made a strong recommendation based on lowquality evidence in favor of surveillance endoscopy every 3 years among individuals with severe gastric atrophy or gim in both the antrum and body, andor olga operative link on gastritis assessmentolgim operative link on gastritis assessment based on intestinal metaplasia stage iiiiv. Background it has been suggested that the subtyping of intestinal metaplasia in the stomach is useful in stratifying patients with regard to risk of developing gastric cancer. Overview of current concepts in gastric intestinal. Metaplasia definition of metaplasia by medical dictionary. Intestinal metaplasia is a condition where the cells lining the stomach transform into cells that resemble those found in the intestines. It is well recognised as a premalignant lesion in much the same way as barretts oesophagus, although management is much less clearly defined for gim. Left alone one would find an eventual gastric ulcer and invasive cancer. Is intestinal metaplasia of the stomach reversible. Having chronic inflammation with extensive intestinal metaplasia is the precursor for developing gastric cancer. Although current classification of intestinal type metaplasia should not generate larger issues, in the pathologists daily practice it is a real problem because of.
Backgroundaims intestinal metaplasia im is a common finding at the oesophagogastric junction, but the aetiopathogenesis of the different im subtypesthat is, incomplete im specialised columnar epithelium, sce and complete im and their associations with gastrooesophageal reflux disease and helicobacter pylori gastritis are unclear. Pdf intestinal metaplasia im at the cardia is likely to be a precursor of cardia cancer. Diagnosis and management of gastric intestinal metaplasia. Incomplete intestinal metaplasia resembles the colonic epithelium and lacks a. It is considered to be a precancerous condition, but.
This study examined the frequency and clinical correlates of intestinal epithelium in 1690 consecutive antral biopsies obtained from children over a 2year period in a tertiary pediatric care facility. Intestinal metaplasia is the transformation of epithelium usually of the stomach or the esophagus into a type of epithelium resembling that found in the intestine. In the pediatric population, gastric intestinal metaplasia gim is a finding with unknown frequency and, more importantly, unknown clinical implications. Endoscopic surveillance has been proposed and advocated for populations at risk. Antral glandular atrophy and intestinal metaplasia in. Improvement of intestinal metaplasia six month after.
Risk factors for im include helicobacter pylori infection, high salt intake, smoking, alcohol consumption, and chronic bile reflux. Intestinal metaplasia of the stomach sciencedirect. Gastric intestinal metaplasia is a precancerous change of the mucosa of the. Conclusions we suggest that goblet cells that express both intestinal and gastric antigens may represent local precursors of gastric metaplasia undergoing a transition to foveolarlike cells of mixed phenotype at the site of early metaplastic patches. The replacement cells are similar to the cells that create the lining of.
Evaluation of biopsy yield biopsy specimens were strati. Adherence to the sydney system guidelines increases the. The relationship between helicobacter pylori hp infection and gim is well documented, as well as an association between duodenogastric reflux and gim. Pdf bile reflux gastritis and intestinal metaplasia at. To study the relationship between intestinal metaplasia and helicobacter pylori infection, 2274 gastroscopic antral biopsies taken from 533 patients were examined. Intestinal metaplasia in endoscopic biopsyspecimens ofgastric mucosa table 3 meanageandmaletofemaleratio in thestudygroupandin intestinalmetaplasia andits subtypes all allsubjects typesofintestinal metaplasia sulphomucin subjects with intestinal positive intestinal metaplasia typei typeiia typeilb metaplasia male to female ratio 15 16 14 14 17. They were treated with misoprostol 200 mg twice daily for six months and, after stopping the treatment. In maps i, the operative link on gastritis assessment olga, and operative link on gastritis assessment based on intestinal metaplasia olgim systems were proposed for staging of atrophyandim,respectively. Overall, intestinal metaplasia was found in 5 patients 25. Intestinal metaplasia is a condition in which the cells that create the lining of your stomach are changed or replaced. Bile reflux gastritis and intestinal metaplasia at the cardia. Subtypes as gastric intestinal metaplasia is heterogenous, several classification systems are in use 36. This type is more common among elderly men, unlike the diffuse type, which is. Subtypes of intestinal metaplasia and helicobacter gut.
Gastric intestinal metaplasia on routine endoscopic biopsy. Alargebodyofevidence,consolidated in a recent metaanalysis, is now. The antrum is that portion of the lower stomach above the pylorus. Review of atrophic gastritis and intestinal metaplasia as. Nonhelicobacter pylori gastric intestinal metaplasia in. However, a small series of 93 patients with an initial diagnosis of intestinal metaplasia were followed prospectively with endoscopy and biopsy. Few studies indicated that endoscopichistological followup in patients with im is able to detect gastric cancer in an early stage with a considerable mortality reduction7,8. In the esophagus, this is called barretts esophagus. Gastric intestinal metaplasia gim is an intermediate precancerous gastric lesion in the gastric cancer cascade of chronic gastritis, atrophic gastritis, intestinal metaplasia im, dysplasia, and adenocarcinoma. Updated guideline on management of atrophic gastritis and. Gastric intestinal goblet cell metaplasia gim, originally described in the 19th century, is defined as the presence of intestinal type cells in the gastric mucosa. Risk of gastric cancer among patients with intestinal metaplasia of.
Intestinal metaplasia im is recognized as a precancerous lesion for gastric cancer, increasing the risk by 6fold. Intestinal metaplasia of antral superficialfoveolar epithelium in children with atrophic gastritis article pdf available in journal of clinical research in pediatric endocrinology 41. Gastric intestinal metaplasia gim is the replacement of normal gastric epithelium with intestinal type epithelium and is a result of chronic injury. Complete and incomplete intestinal metaplasia at the.
Metaplasia intestinal gastrica y displasia, metaplasia. Pdf intestinal metaplasia of antral superficialfoveolar. The presence of intestinal metaplasia and atrophy in children with h. As atrophy and metaplastic changes advance, they extend to the. Gastric cancer risk is higher in patients with incompletetype im, in those with both antral and gastric body involvement, and the risk significantly. The prevalence of gastric intestinal metaplasia and distribution of helicobacter pylori infection, atrophy, dysplasia, and cancer in its subtypes. Subtypes as gastric intestinal metaplasia is heterogenous, several classification systems are in use. Gastric intestinal metaplasia is defined as the replacement of the surface, foveolar, and glandular epithelium in the oxyntic or antral mucosa by intestinal epithelium 2. In other areas of the world such as southeast asia, screening for gastric cancer is already a widely accepted practice. Take a look below to see if any of your intestinal metaplasia questions have been answered by experts. Gastric im is categorized histopathologically into incomplete and complete. Globally, gastric cancer is the third leading cause of cancer mortality and the leading cause of infectionassociated cancers. The intestinal type is the endresult of an inflammatory process that progresses from chronic gastritis to atrophic gastritis and finally to intestinal metaplasia and dysplasia. Chronic inflammation gland atrophy intestinal metaplasia pylori metaplasia with involvement of the corpus patchy andor focal involvement.
Degree of severity of intestinal metaplasia mayo clinic. As metaplasia becomes more widespread, a more pure gastric phenotype emerges. How are we addressing gastric intestinal metaplasia. Gastric cancer is the third leading cause of cancer death worldwide.
Overview of current concepts in gastric intestinal metaplasia and. Aim to determine whether subtyping intestinal metaplasia provided useful information regarding the natural history of intestinal metaplasia. It is well known that intestinal metaplasia im and gastric dysplasia are the main precancerous lesions of the stomach. Intestinal metaplasia in endoscopicbiopsyspecimens of. As atrophy and metaplastic changes advance, they extend to the antrum and corpus.
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