1,721,021 research outputs found
Gastric precancerous lesions: heading for an international consensus
Full text linkAs pathological criteria lie at the foundation for the classification of many diseases, a crucial requisite for such classifications to be valid is that their morphological basis be standardised. Inadequately standardised diagnostic criteria result in unacceptable interobserver variation, a factor that may influence both individual patient care and the evaluation of clinical protocols. One of the most important goals in gastric diseases today is to establish whether cure of Helicobacter pylori is an effective preventive measure against gastric cancer. To tackle this issue it is necessary to measure reliably intermediate outcomes, specifically gastric atrophy and dysplasia. However, there is little agreement on what gastric atrophy and atrophic gastritis are, and treatment and follow up results obtained at one clinical centre are often radically different from those obtained at another. Similarly, studies that examine the fate of dysplastic lesions in the stomach show a great divergence of outcomes between Europe and North America and Japan, where the concept of dysplasia has different connotations. To reach a consensus on the definitions and diagnostic criteria for atrophy and atrophic gastritis, a group of gastrointestinal pathologists and gastroenterologists met in Houston, Texas, USA, in February 1998. Substantive progress was made, but several problems remained, and a study aimed at resolving the issues that seem to stand in the way of an international agreement is currently underway. To fulfil the need for a broad discussion on the diagnostic differences of gastric dysplasia and cancer between East and West, an international group of pathologists gathered in Padova, Italy, in the spring of 1998. Their main objectives were: (1) to agree on the definitions of the spectrum of gastric preneoplastic lesions; (2) to establish an international glossary for gastric precancerous lesions; and (3) to test the consensus and eventually generate guidelines useful to clinicians for the development of management strategies. A consensus was achieved on the definition of gastric dysplasia as preinvasive neoplasia. Other validation studies are underway. The experiences achieved in the search for an international consensus on the phenotypes of atrophic gastritis and gastric dysplasia may represent a model in dealing with the new scenario of a modern evidence-based pathology
Assessing risks for gastric cancer: New tools for pathologists
Full text linkAbstract
Although the Sydney Systems (original and updated) for the classification of gastritis have contributed substantially to the uniformity of the reporting of gastric conditions, they lack immediacy in conveying to the user information about gastric cancer risk. In this review, we summarize the current understanding of the gastric lesions associated with an increased risk for cancer, and present the rationale for a proposal for new ways of reporting gastritis. In addition to the traditional histopathological data gathered and evaluated according to the Sydney System rules, pathologists could add an assessment expressed as grading and staging of the gastric inflammatory and atrophic lesions and integrate these findings with pertinent laboratory information on pepsinogens and gastrin levels. Such an integrated report could facilitate clinicians' approach to the management of patients with gastric conditions
Staging and grading of chronic gastritis
No full textAbstract
Chronic gastritis is an inflammatory condition of the gastric mucosa that may include structural alterations of the glandular compartment. The semiquantitative scoring systems advocated in the Sydney Systems and the subsequent Atrophy Club Guidelines remain essential for the recognition of the spectrum of the lesions detectable in gastric inflammatory disease. Most practicing pathologists, however, find them too cumbersome to use in their routine diagnostic activities. In this article, we propose a reporting system for chronic gastritis in staging and grading. Staging would convey information on the topography and extension of the gastric atrophic changes, whereas grading should represent the semiquantitative assessment of the combined severity of both mononuclear and granulocytic inflammation. This system could offer gastroenterologists a more immediate perception of the overall condition of the gastric mucosa while also providing useful information about gastric cancer risk
Staging gastritis: an international proposal.
No full textThe goals of obtaining and examining biopsy material are to acquire diagnostic and prognostic information to be used in patient management. In particular, the histological examination of gastric biopsies should answer 3 basic questions: (1) Are there inflammatory lesions?; (2) What is their possible etiology?; and (3) Are there mucosal lesions associated with increased cancer risk?1 The report ought to have informative relevance for the specialist, the general practitioner (who is often its ultimate recipient) and, hopefully, the patient. Internationally accepted staging systems are required for the effective communication of this information among clinicians and researchers. For example, the establishment of an internationally accepted staging method for hepatitis: (a) simplifies the message of the histology report; (b) increases the interobserver agreement in liver biopsy assessment; and (c) allows consistent comparisons of results obtained both by studies of natural history and therapeutic trials.
The Sydney System and its Houston updated version [2] and [3] provided a uniform nomenclature for gastritis, as well as visual analogue scales for the grading of inflammation, atrophy, metaplasia, and Helicobacter pylori density. The system, however, lacks the element of prognosis and the same pathologists who use it in their research activities find it too cumbersome for routine diagnostic activities.
In April 2005, an international group of gastroenterologists and pathologists (Operative Link for Gastritis Assessment [OLGA]) met in Parma, Italy, with the aim of reassessing critically the Updated Sydney System guidelines for reporting chronic gastritis and to determine whether staging could be added.4 As the risk of gastric cancer directly relates to the extent of gastritis and gastric mucosal atrophy, an atrophy-based staging system would provide implications for the prognosis and, possibly, the management of patients. Atrophy is defined as loss of appropriate gastric glands.5 In the gastric corpus, atrophy occurs as a distal to proximal replacement of oxyntic mucosa by pseudopyloric (ie, antral) or intestinal metaplasia. Pseudopyloric metaplasia affects native corpus glands, which assume the phenotype of muco-secreting antral glands, but can still retain pepsinogen I expression (normally featured by native oxyntic glands). The proposed Staging System (Figure 1) combines the antral and oxyntic mucosal atrophy scores as assessed according to the Updated Sydney System visual analog scales
Review article: pre-neoplastic states of the gastric mucosa - a practical approach for the perplexed clinician
No full textThe sequence leading to gastric cancer can be schematically reduced to Helicobacter pylori infection-chronic gastritis-atrophy-intestinal metaplasia-dysplasia-neoplasia. Although clinicians have not yet developed a uniform approach to the treatment of gastritis (when should H. pylori infection be treated?), the entity itself is not the subject of controversy. All other lesions are still the focus of debate. There are no guidelines for the management of patients with intestinal metaplasia; pathologists are still searching for universal diagnostic criteria for atrophic gastritis; dysplasia and early neoplasia have elicited scientific diatribes between Japanese and Western pathologists. Amidst such controversies and in the absence of guidelines to regulate the management of gastric lesions, the responsibility to provide sensible clinical advice is often bestowed upon pathologists. This review discusses whether pathologists have access to sufficient evidence to provide the requested advice, and whether a consensus on the management of gastric "pre-neoplastic" states is within reach. We conclude that, although many sensible and useful definitions, criteria and classifications are being generated, the final decision on how to manage the individual patient with gastric lesions will continue to be based on the communication between pathologist and clinicia
Staging gastritis: An international proposal (vol 129, pg 1807, 2005)
No full textWhen (according to the Houston-updated guidelines) a satisfactory set of gastric biopsies is available, staging should represent the conclusion of the histological report, preceded by the traditional description of the histological findings and possibly by an indication of the etiology. This scheme should offer clinicians an immediate overall perception of the extent of gastric disease and also provides information regarding cancer risk.
A decade ago, a similar nomenclature was proposed for the histology reporting of chronic viral hepatitis and, tested in routine practice, it is now used by virtually all hepatopathologists. The OLGA Group suggests that an international staging method is needed to advance research in gastritis and is preparing to test its feasibility and reproducibility
Management of Gastric Polyps: An Endoscopy Based Approach.
No full textI.F. 6.648 The endoscopic finding of a gastric polyp and the histopathologic report that follows may leave clinicians with questions not been addressed in formal guidelines: do all polyps need to be excised, or can they just be sampled for biopsy? If so, which ones and how many should be sampled? What follow-up is needed, if any? This review relies on the existing literature and our collective experience to provide practical answers to these questions. Fundic gland polyps, now the most frequent gastric polyps in Western countries because of widespread use of proton pump inhibitors, and hyperplastic polyps, the second most common polyps notable for their association with gastritis and their low, but important potential for harboring dysplastic or neoplastic foci, are discussed in greater detail. Adenomas have had their name changed to "Raised Intraepithelial Neoplasia" and are declining in parallel with H. pylori infection; however, they do retain their importance as harbingers of gastric cancer, particularly in East Asia. Gastrointestinal stromal tumors have low incidence and no known associations, but their malignant potential is high; early diagnosis and proper management are crucial. Although rare and benign, inflammatory fibroid polyps need to recognized, particularly by pathologists, to avoid misdiagnosis. Gastric neuroendocrine tumors (carcinoids) are important because of their association with either atrophic gastritis of the multiple endocrine neoplasia syndromes; those that do not arise in these backgrounds have high malignant potential and require aggressive management. The review concludes with some practical suggestions on how to approach gastric polyps detected at endoscop
Autoimmune atrophic gastritis-pathogenesis, pathology and management.
No full textAutoimmune gastritis is a chronic progressive inflammatory condition that results in the replacement of the parietal cell mass by atrophic and metaplastic mucosa. A complex interaction of autoantibodies against the parietal cell proton pump and sensitized T cells progressively destroy the parietal cells, inducing hypochlorhydria and then achlorhydria, while autoantibodies against the intrinsic factor impair the absorption of vitamin B12. The resulting cobalamin deficiency manifests with megaloblastic anaemia and neurological and systemic signs and symptoms collectively known as pernicious anaemia. Previously believed to be predominantly a disease of elderly women of Northern European ancestry, autoimmune gastritis has now been recognized in all populations and ethnic groups, but because of the complexity of the diagnosis no reliable prevalence data are available. For similar reasons, as well as the frequent and often unknown overlap with Helicobacter pylori infection, the risk of gastric cancer has not been adequately assessed in these patients. This Review summarizes the epidemiology, pathogenesis and pathological aspects of autoimmune metaplastic atrophic gastritis. We also provide practical advice for the diagnosis and management of patients with this disease
Effects of 6-12 months of esomeprazole treatment on the gastric mucosa.
No full textOBJECTIVE: The aim of this study was to determine the effect of 6-12 months of treatment with esomeprazole on the histopathology of the gastric mucosa.
METHODS: Two identically designed, randomized, placebo-controlled trials of esomeprazole 40, 20, or 10 mg daily for up to 6 months, as well as a noncomparative, multicenter trial of esomeprazole 40 mg daily for up to 12 months, were conducted in 1326 patients with healed erosive esophagitis (1294 negative for Helicobacter pylori [H. pylori]). Gastric biopsy samples were obtained before treatment and on completion of (or discontinuation from) the trials. Samples were evaluated for the presence of H. pylori, characteristics of acute gastritis or atrophic gastritis, and enterochromaffin-like cell pathology.
RESULTS: During treatment with esomeprazole, the number of patients with an improvement in gastric histological scores was typically greater than or equal to the number who worsened. Gastric histological scores worsened for each corporal or antral characteristic of gastritis in <6.2% of patients. Histological scores with esomeprazole and placebo were similar throughout the 6-month trials. Only one among 1326 patients treated with esomeprazole (H. pylori negative) had evidence of treatment-emergent atrophic gastritis. On final biopsy, 5-12% of patients had abnormal enterochromaffin-like cell scores (simple, linear, or micronodular hyperplasia). There were no instances of enterochromaffin-like cell dysplasia, carcinoids, or neoplasia.
CONCLUSIONS: Patients with healed erosive esophagitis receiving esomeprazole for up to 12 months had minor fluctuations in gastric histological scores, similar to those experienced in untreated populations. Use of esomeprazole did not raise any safety concerns with respect to the development of atrophic gastritis, or cause clinically significant changes in enterochromaffin-like cells
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