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. 2004 Feb;57(2):177-82.
doi: 10.1136/jcp.2003.11270.

A follow up model for patients with atrophic chronic gastritis and intestinal metaplasia

M Dinis-Ribeiro  1 , C Lopes, A da Costa-Pereira, M Guilherme, J Barbosa, H Lomba-Viana, R Silva, L Moreira-Dias
Affiliations

A follow up model for patients with atrophic chronic gastritis and intestinal metaplasia

M Dinis-Ribeiro et al. J Clin Pathol. 2004 Feb.

Abstract

Aim: To devise a follow up model for patients with gastric cancer associated lesions, such as atrophic chronic gastritis (ACG) and intestinal metaplasia (IM).

Methods: Cohort study of 144 patients, followed for a minimum of one year, in whom at least two upper gastrointestinal endoscopic biopsies in flat gastric mucosa provided a diagnosis of ACG, IM, or low grade dysplasia (LGD).

Results: Of those diagnosed with ACG at first endoscopic biopsy (entry biopsy), 12% progressed to LGD in outcome biopsy, as did 8% of those with type I IM, 38% with type II or III IM, and 32% with LGD. Type of IM at entry independently predicted progression to LGD and cancer. Type II and III IM had a higher rate of progression to LGD than type I IM, which showed an indolent behaviour similar to ACG. Patients with type II or III IM were at higher risk for development of dysplasia, and 7% of patients with type III IM at first biopsy progressed to high grade dysplasia (HGD), whereas no cases of ACG or type I/II IM progressed to HGD during the first three years.

Conclusion: Patients with ACG or IM could possibly be allocated to different management schedules, based on differences in rate and proportion of progression to LGD or HGD. Less intensive follow up (two/three yearly with "serological evaluation" (pepsinogen)) may suit those with ACG or type I IM. Patients with type III IM may benefit from six to 12 monthly improved endoscopic examination (magnification chromoendoscopy).

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Figures

Figure 1
Figure 1
Histopathological evaluation of an endoscopic biopsy showing a case of incomplete intestinal metaplasia (haematoxylin and eosin staining; original magnification, ×200).
Figure 2
Figure 2
Histopathological evaluation of an endoscopic biopsy showing low grade dysplasia (haematoxylin and eosin staining; original magnification, ×200).
Figure 3
Figure 3
Histopathological evaluation of an endoscopic biopsy showing high grade dysplasia (haematoxylin and eosin staining; original magnification, ×200; inset, ×400).
Figure 4
Figure 4
Progression into lesions as severe as low grade dysplasia (LGD) in the outcome biopsy according to the diagnosis on the entry biopsy (Breslow’s test; p  =  0.009). The time to event (in months) was the time between the entry and outcome biopsies. Type III and II intestinal metaplasia (IM) show higher rates of progression to LGD in the outcome biopsy. Median time to lesions as severe as LGD is 34.6, 32, 15, and 11.3 months for atrophic chronic gastritis (ACG), type I, type II, and type III, respectively.
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