[Nodular Gastritis as a Precursor Lesion of Atrophic and Metaplastic Gastritis]

Korean J Gastroenterol. 2019 Jun 25;73(6):332-340. doi: 10.4166/kjg.2019.73.6.332.
[Article in Ko]

Abstract

Background/aims: Chronic atrophic gastritis (CAG) and metaplastic gastritis (MG) are precancerous conditions of Helicobacter pylori (H. pylori)-related gastric cancer. This study aimed to identify the characteristics of nodular gastritis (NG) showing CAG or MG after nodule regression.

Methods: H. pylori-infected patients with NG were included after upper gastrointestinal endoscopy. Patients were excluded if their latest endoscopy had been performed ≤36 months after the initial diagnosis of NG. Small-granular-type NG was defined as the condition with 1-2 mm regular subepithelial nodules. Large-nodular-type NG was defined as those with 3-4 mm, irregular subepithelial nodules. The endoscopic findings after nodule regression were recorded.

Results: Among the 97 H. pylori-infected patients with NG, 61 showed nodule regression after a mean follow-up of 73.0±22.0 months. After nodule regression, 16 patients showed a salt-and-pepper appearance and/or transparent submucosal vessels, indicating CAG. Twenty-nine patients showed diffuse irregular elevations and/or whitish plaques, indicating MG. Sixteen patients with other endoscopic findings (14 normal, one erosive gastritis, and one chronic superficial gastritis) showed a higher proportion of H. pylori eradication (12/16, 75.0%) than those in the CAG group (5/16, 31.3%) and MG group (6/29, 20.7%; p=0.001). Patients with small-granular-type NG tended to progress toward CAG (14/27, 51.9%), whereas those with large-nodular-type NG tended to progress toward MG (25/34, 73.5%; p<0.001).

Conclusions: In patients with a persistent H. pylori infection, NG tended to progress to CAG or MG when the nodules regressed. Small-granular-type NG tended to progress to CAG, whereas large-nodular-type NG tended to progress to MG.

Keywords: Atrophy; Gastritis; Lymphoid tissue; Metaplasia.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Endoscopy, Digestive System
  • Female
  • Gastric Mucosa / pathology*
  • Gastritis / complications
  • Gastritis / diagnosis*
  • Gastritis / pathology
  • Gastritis, Atrophic / complications
  • Gastritis, Atrophic / diagnosis*
  • Gastritis, Atrophic / pathology
  • Helicobacter Infections / complications
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / drug therapy
  • Humans
  • Male
  • Metaplasia
  • Middle Aged
  • Prognosis
  • Proton Pump Inhibitors / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Proton Pump Inhibitors