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Multicenter Study
. 2025 May 23;16(8):e00862.
doi: 10.14309/ctg.0000000000000862. eCollection 2025 Aug 1.

Clinical and Endoscopic-Histological Features of Multifocal and Corpus-Restricted Atrophic Gastritis Patients With Non-Cardia Gastric Cancer or Dysplasia: A Multicenter, Cross-Sectional Study

Edith Lahner  1 , Bruno Annibale  1 , Emanuele Dilaghi  1 , Cristina Luciano Millado  1 , Marco Vincenzo Lenti  2   3 , Antonio Di Sabatino  2   3 , Emanuela Miceli  3 , Sara Massironi  4   5 , Nicola Zucchini  6 , Renato Cannizzaro  7   8 , Stefano Realdon  7 , Giuseppe Losurdo  9 , Antonia Valeria Borraccino  9 , Elisa Marabotto  10 , Edoardo Giovanni Giannini  10 , Andrea Pasta  10 , Francesco Calabrese  10 , Luca Mastracci  11   12 , Roberta Elisa Rossi  13 , Valentina Sciola  14 , Antonella Contaldo  15 , Antonio Pisani  15 , Angela Dalia Ricci  15 , Maria Savino  15 , Gianluigi Giannelli  15 , Mario Milco D'Elios  16 , Chiara Della Bella  16 , Damiano Martino  17 , Fabiana Zingone  17 , Fabio Farinati  18
Affiliations
Multicenter Study

Clinical and Endoscopic-Histological Features of Multifocal and Corpus-Restricted Atrophic Gastritis Patients With Non-Cardia Gastric Cancer or Dysplasia: A Multicenter, Cross-Sectional Study

Edith Lahner et al. Clin Transl Gastroenterol. .

Abstract

Introduction: Helicobacter pylori (Hp)-related atrophic gastritis (AG) affects corpus and antral mucosa, resulting in multifocal AG (MF-AG); autoimmunity-driven AG is corpus-restricted (CR-AG). AG carries increased gastric dysplasia (GD) and gastric cancer (GC) risk, well established in MF-AG, but debated in CR-AG. This study aimed to assess clinical, endoscopic-histological characteristics of GD-GC in patients with MF-AG and CR-AG.

Methods: This was the multicenter cross-sectional study across 11 Italian gastroenterology centers on data of non-cardia GD-GC in adult patients with MF-AG or CR-AG based on clinical, endoscopic, and histological charts.

Results: Eighty-four patients were included with MF-AG and CR-AG in 45 (53.6%) and 39 (46.4%), respectively. Low-grade GD, high-grade GD, and GC were diagnosed in 31 (36.9%), 6 (7.1%), and 47 (56.0%), respectively. GD-GC similarly occurred in patients with MF-AG and CR-AG: high-grade GD in 4 (8.9%) vs 2 (5.1%), low-grade GD in 17 (37.8%) vs 14 (35.9%), and GC in 24 (53.5%) vs 23 (59.0%) ( P > 0.05). Compared with MF-AG, in patients with CR-AG, GD-GC were more commonly polypoid (51.6% vs 27.3%, P = 0.048) and more frequent in the corpus (55.3% vs 28.6%, P = 0.02), but occurred also in the antrum (34.2%) and incisura (10.5%). Surgery was more frequent in CR-AG than in MF-AG (48.6% vs 23.1%, P = 0.02). Corpus atrophy severity and intestinal metaplasia were not different ( P > 0.05), histological Hp positivity was low in both (2.3% vs 2.9%, P = 0.87), but in Hp negatives, active inflammation was present in the antrum in 26.7% and 7.7% ( P = 0.02), and in the corpus in 31.1% and 21.5% ( P = 0.27).

Discussion: Non-cardia GC and GD may occur in both MF-AG and CR-AG, displaying differences in topography and endoscopic presentation but similarities in nonlesional mucosa, differentiation, and staging. Surveillance should be considered in corpus AG, regardless of extension and supposed etiology.

Background: La gastrite atrofica (AG) Helicobacter pylori (Hp)-relata interessa la mucosa dell'antro e del corpo-fondo dando luogo alla gastrite atrofica multifocale (MF-AG); la gastrite atrofica autoimmune invece è limitata al corpo-fondo risparmiando l'antro (CR-AG). L'AG è ad aumentato rischio per displasia (GD) e cancro gastrico (GC). Questo rischio è ben stabilito nella MF-AG, ma ancor adibattuto nella CR-AG. Questo studio ha come scopo di valutare le caratteristiche cliniche e endoscopico-istologiche di pazienti affetti da GD o GC in MF-AG e CR-AG.

Metodi: E' stato condotto uno studio trasversale multicentrico in 11 centri gastroenterologici italiani su dati di pazienti adulti con GD o GC non cardiali in MF-AG o CR-AG basati su schede cliniche e referti endoscopici e istologici.

Risultati: Sono stati inclusi 84 pazienti, di cui 45 (53.6%) con MF-AG e 39 (46.4%) con CR-AG. GD di basso (LG-GD) e di alto grado (HG-GD) e GC sono stati diagnosticati in 31 (36.9%), 6 (7.1%), and 47 (56.0%) pazienti, rispettivamente. GD e GC sono stati riscontrati con frequenza simile in pazienti con MF-AG e CR-AG: HG-GD in 4 (8.9%) vs 2 (5.1%), LG-GD in 17 (37.8%) vs 14 (35.9%), e GC in 24 (53.5%) vs 23 (59.0%) (p>0.05). Rispetto ai pazienti con MF-AG, nei pazienti con CR-AG GD e GC erano più frequentemente di aspetto polipoide (51.6% vs 27.3%, p=0.048) e più frequentemente localizzati nel corpo-fondo (55.3% vs 28.6%, p=0.02), ma venivano riscontrati anche nell'antro (34.2%) e a livello dell'incisura (10.5%). Il trattamento chirurgico era più frequente nei pazienti con CR-AG rispetto a coloro con MF-AG (48.6% vs 23.1%, p=0.02). La severità dell'atrofia del corpo-fondo e la presenza di metaplasia intestinale non erano differenti (p>0.05), mentre la positività istologica per l'Hp era bassa in ambedue i gruppi ((2.3% vs 2.9%, p=0.87), ma nei Hp negativi l'attività infiammatoria era presente nell'antro nel 26.7% e 7.7% (p=0.02), e nel corpo-fondo nel 31.1% e 21.5% (p=0.027).

Conclusioni: GD e i GC non cardiali possono sviluppare sia in pazienti con MF-AG che con CR-AG, con differenze nella topografia e nella presentazione endoscopica ma con similitudini nella mucosa non lesionale circostante, nella differenziazione e nella stadiazione. Pertanto, la sorveglianza dovrebbe essere considerata in tutti i pazienti con AG del corpo, a prescindere dall'estensione e dalla presunta eziologia.

Keywords: atrophic gastritis; autoimmune gastritis; gastric cancer; gastric dysplasia; multicenter study.

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Conflict of interest statement

Guarantor of the article: Edith Lahner, MD, PhD.

Specific author contributions: E.L., B.A., F.F.: planning and conducting the study, drafting the manuscript, and approving the final version; M.V.L., A.D. S., S.M., F.Z., M.M.D'E.: conducting the study, interpreting data, and drafting the manuscript; R.C., E.D., C.M.L., E.M., N.Z., S.R., G.L., A.V.B., E.M., E.G.G., A.P., F.C., L.M., R.E.R., V.S., A.C., A.P., A.D.R., M.S., G.G., C.D.B., D.M.: conducting the study, collecting and interpreting data. Each author has approved the final draft submitted.

Financial support: None to report.

Potential competing interests: None to report.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Flags mark participating centers across Italy.
Figure 2.
Figure 2.
Main features of non-cardia GD and GC in 84 patients with a histopathological background of MF-AG or CR-AG. AG, atrophic gastritis, CR, corpus-restricted; GC, gastric cancer; GD, gastric dysplasia; HG, high-grade; LG, low-grade; MF, multifocal.
See this image and copyright information in PMC

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