Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;479(4):679-686.
doi: 10.1007/s00428-021-03116-3. Epub 2021 May 14.

High-risk individuals for gastric cancer would be missed for surveillance without subtyping of intestinal metaplasia

Sergejs Isajevs  1   2 , Selga Savcenko  3   4 , Inta Liepniece-Karele  3   4 , Maria Blanca Piazuelo  5 , Ilze Kikuste  3   4   6 , Ivars Tolmanis  3   6 , Aigars Vanags  6 , Indra Gulbe  6 , Linda Mezmale  3 , Darhan Samentaev  7 , Altynbek Tazedinov  8 , Ramis Samsutdinov  7 , Tatjana Belihina  7 , Nurbek Igissinov  9 , Marcis Leja  3   4
Affiliations

High-risk individuals for gastric cancer would be missed for surveillance without subtyping of intestinal metaplasia

Sergejs Isajevs et al. Virchows Arch. 2021 Oct.

Abstract

The use of Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis Assessment based on Intestinal Metaplasia (OLGIM) staging system is recommended for identifying subjects at risk for developing gastric cancer; usually high-risk lesions are considered only as stages III and IV. Accumulating evidence suggests that incomplete intestinal metaplasia (IM) is important in the development of gastric cancer. Our aim has been to identify the prevalence of incomplete IM in patients with low-risk OLGA/OLGIM stages among a high-risk general population. Healthy adult volunteers aged 40-64 years were invited to undergo upper endoscopy within a regional GISTAR pilot study in Kazakhstan (n = 166). Gastric lesions were staged according to OLGA/OLGIM staging system. High iron diamine-alcian blue (HID-AB) was used for subtyping IM. IM prevalence overall was 45.8%. Incomplete IM was present in 52.6% (type II in 30.3% and type III in 22.3%), whereas complete IM was found in 47.4% individuals. The prevalence of OLGIM I and II stage were 39.8 and 4.8%, respectively, whereas OLGIM III was observed in 1.2%. The prevalence of incomplete IM in patients stratified to OLGIM I was 54.5% (type II in 31.8% and type III in 22.7%). High prevalence of incomplete IM was detected not only in subjects with extensive IM, but in those stratified as at the OLGIM I stage. Without IM subtyping, patients with high risk of gastric cancer development would be missed for surveillance.

Keywords: Gastric cancer; OLGA; OLGIM intestinal metaplasia; Risk stratification; Subtypes.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Photomicrographs of gastric intestinal metaplasia. A Complete type with well-defined goblet cells alternating with eosinophilic enterocytes and Paneth cells. B Incomplete type showing multiple intracytoplasmic mucin droplets of varying sizes and shapes. Arrow indicated incomplete IM. Hematoxylin and eosin; original magnification, × 200, scale bar 50 μm
Fig. 2
Fig. 2
Photomicrographs of different types of gastric intestinal metaplasia. A Complete IM (type I) showing a mixture of acid and neutral mucins in goblet cells. A few nonmetaplastic gastric glands are observed (stained magenta) in the lower left and right corners of the image. AB-PAS staining, original magnification, × 200, scale bar 50 μm. B Incomplete IM showing acid mucins in blue (or purple when combined with neutral) in both goblet cells and columnar cells (arrow indicate incomplete IM). AB-PAS staining, original magnification, × 200, scale bar 50 μm. C Complete IM (type I) shows sialomucins in goblet cells, and absence of sulfomucins, HID-AB staining, magnification × 200, scale bar 50 μm. D Incomplete IM (type III) with a mixture of sialomucins and sulfomucins in goblet cells and sulfomucins as the predominant type of mucins in columnar cells. HID-AB technique differentiates acid mucins. Sialomucins are stained blue, and sulfomucins are brown, magnification × 200, scale bar 50 μm
See this image and copyright information in PMC

References

    1. Pimentel-Nunes P, Libanio D, Marcos-Pinto R et al. (2019) Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update. Endoscopy 51(4):365–388. 10.1055/a-0859-1883 - DOI - PubMed
    1. Gupta S, Li D, El Serag HB, Davitkov P, Altayar O, Sultan S, Falck-Ytter Y, Mustafa RA (2020) AGA clinical practice guidelines on management of gastric intestinal metaplasia. Gastroenterology 158(3):693–702. 10.1053/j.gastro.2019.12.003 - DOI - PMC - PubMed
    1. Rugge M, Capelle LG, Cappellesso R, Nitti D, Kuipers EJ (2013) Precancerous lesions in the stomach: from biology to clinical patient management. Best Pract Res Clin Gastroenterol 27(2):205–223. 10.1016/j.bpg.2012.12.007 - DOI - PubMed
    1. Rugge M, Correa P, Dixon MF, Fiocca R, Hattori T, Lechago J, Leandro G, Price AB, Sipponen P, Solcia E, Watanabe H, Genta RM (2002) Gastric mucosal atrophy: interobserver consistency using new criteria for classification and grading. Pharmacol Ther 16(7):1249–1259. 10.1046/j.1365-2036.2002.01301.x - DOI - PubMed
    1. Cho SJ, Choi IJ, Kook MC, Nam BH, Kim CG, Lee JY, Ryu KW, Kim YW (2013) Staging of intestinal- and diffuse-type gastric cancers with the OLGA and OLGIM staging systems. Aliment Pharmacol Ther 38:1292–1302. 10.1111/apt.12515 - DOI - PubMed