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Prevalence of subtypes of intestinal metaplasia in the general population and in patients with autoimmune chronic atrophic gastritis
Linköping University, Department of Biomedicine and Surgery, Surgery. Linköping University, Faculty of Health Sciences.
2002 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 37, no 3, 262-266 p.Article in journal (Refereed) Published
Abstract [en]

Background: Gastric intestinal metaplasia (IM) is seen mostly in association with chronic gastritis, induced either by Helicobacter pylori infection or autoimmune mechanisms. IM can be categorized into three subtypes, where type III is associated with gastric carcinoma of intestinal type.

Methods: Gastric biopsies from 475 subjects randomly selected from the general population and from 27 patients with autoimmune gastritis associated with pernicious anaemia were used. The criteria of Filipe & Jass were applied using different histochemical techniques in combination with haematoxylin and eosin stained material.

Results: Twenty-three percent (109/475) of the subjects from the general population and 88% (24/27) in the group with autoimmune gastritis had IM. Type III IM occurred in 4% in both populations. Type III IM was located in the antrum in 90% in the general population. In the group with autoimmune gastritis, only one patient had type III IM, which was located in the corpus.

Conclusions: This study reveals for the first time the prevalence and distribution of subtypes of IM in a general population from the Western world. The comparatively high prevalence of type III IM in the general population (4%) indicates that its role as a precursor of gastric carcinoma may have been overemphasized. A similar prevalence of type III IM in patients with autoimmune gastritis may be considered low and suggests that mechanisms for gastric carcinogenesis other than the atrophy - metaplasia-dysplasia sequence could also operate in this condition.

Place, publisher, year, edition, pages
2002. Vol. 37, no 3, 262-266 p.
Keyword [en]
Chronic Gastritis, Epidemiology, Helicobacter, Pylori, Intestinal Metaplasia
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-24963DOI: 10.1080/003655202317284156Local ID: 9374OAI: oai:DiVA.org:liu-24963DiVA: diva2:245287
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
In thesis
1. Chronic gastritis in a sample of the general population: Helicobacter pylori infection, metaplastic transformation, epithelial proliferation, p53- and p21 expression and antral mucosal gastrin content with reference to gastric carcinoma development
Open this publication in new window or tab >>Chronic gastritis in a sample of the general population: Helicobacter pylori infection, metaplastic transformation, epithelial proliferation, p53- and p21 expression and antral mucosal gastrin content with reference to gastric carcinoma development
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Infection with H. pylori is the main cause of chronic inflammation in the stomach. lt is strongly associated with benign ulcer disease and a risk factor for gastric carcinoma (GC). Different tophographical types of gastritis bear different risks for future development of GC. Mucosal changes, atrophy and intestinal metaplasia (IM) are known precancerous conditions.

The aims of this thesis were to map out the prevalence of chronic gastritis, including different tophographical types, carditis and H. pylori infection in an adult Swedish general population sample. To determine the prevalence of atrophy and different types of IM and measure the mucosal proliferative activity (Ki-67), expression of p53 and p21 with immunohistochemistry. Furthermore, to determine plasma levels of gastrin and the content of G-cells in the antrum with immunohistochemistry measured with three different morphometrical methods.

The prevalence of chronic gastritis was 50%. lt was associated with H. pylori infection in 87%. The prevalence of carditis was 55% and it was associated with local H. pylori infection in 70%. The most common type of gastritis was antrum predominant (44%) followed by pangastritis (37%) and corpus predominant (19%). The prevalence of atrophy (antrum and/or corpus) was 55% and it increased with age, as did the prevalence of IM, which was present in the antrum or corpus in 23% and in the cardia in 10%. Corresponding figures for the prevalence of type III IM was 4% and 1%, repspectively. In all locations there was a strong correlation between the occurrence of IM and both H. pylori infection and chronic inflammation. Chronic inflammation and H. pylori infection were associated with increased mucosal proliferation and expression of p53. Atrophy as well as IM were associated with increased expression of p53 in both the corpus and antrum. IM was associated with increased proliferation in the mucosa, as was atrophy in the corpus. The expression of p21 was low and not affected by infection or inflammation. Plasma levels of gastrin were increased in subjects with H. pylori infection and showed no correlation with the amount of antral G-cells. The three different methods for G-cell quantification correlated poorly.

In conclusion,chronic gastritis and carditis in this sample of an adult Swedish general population were frequent and strongly associated with H. pylori infection. The prevalences of different gastritis types and mucosal changes associated with increased cancer risk were determined and the relationships between chronic gastritis/carditis and both increased mucosal proliferation and expression of p53 in all parts of the stomach were established. Increased plasma levels of gastrin among subejects with H. pylori infection were established, as was the lack of a correlation between circulating gastrin levels and the amount of G-cells in the antrum. Poor correlations between three different methods for G-cell quantification highlight a methodological problem.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2004. 85 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 855
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-23315 (URN)2744 (Local ID)91-7373-831-X (ISBN)2744 (Archive number)2744 (OAI)
Public defence
2004-09-24, Aulan, Länssjukhuset, Ryhov, Jönköping, 10:00 (Swedish)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-31Bibliographically approved

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Petersson, FredrikBorch, Kurt

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