Background: 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 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 MF-AG and CR-AG patients. Methods: Multicenter-cross-sectional study across 11 Italian gastroenterology centres on data of non-cardia GD-GC in MF-AG or CR-AG adult patients based on clinical, endoscopic, and histological charts. Results: 84 patients were included with MF-AG and CR-AG in 45(53.6%) and 39(46.4%), respectively. Low-grade(LG)-GD, high-grade(HG)-GD, and GC were diagnosed in 31(36.9%), 6(7.1%), and 47(56.0%). GD-GC similarly occurred in MF-AG and CR-AG patients: HG-GD in 4(8.9%) vs 2(5.1%), LG-GD in 17(37.8%) vs 14(35.9%), GC in 24(53.5%) vs 23(59.0%)(p>0.05). Compared to MF-AG, in CR-AG patients GD-GC were more commonly polypoid (51.6% vs 27.3%, p=0.048) and more frequently 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), in the corpus in 31.1% and 21.5%(p=0.27). Conclusions: Non-cardia GC and GD may occur in both MF-AG and CR-AG, displaying differences in topography and endoscopic presentation but similarities in non-lesional mucosa, differentiation and staging. Surveillance should be considered in corpus AG, regardless of extension and supposed etiology.
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
Zingone, Fabiana;Farinati, Fabio
2025
Abstract
Background: 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 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 MF-AG and CR-AG patients. Methods: Multicenter-cross-sectional study across 11 Italian gastroenterology centres on data of non-cardia GD-GC in MF-AG or CR-AG adult patients based on clinical, endoscopic, and histological charts. Results: 84 patients were included with MF-AG and CR-AG in 45(53.6%) and 39(46.4%), respectively. Low-grade(LG)-GD, high-grade(HG)-GD, and GC were diagnosed in 31(36.9%), 6(7.1%), and 47(56.0%). GD-GC similarly occurred in MF-AG and CR-AG patients: HG-GD in 4(8.9%) vs 2(5.1%), LG-GD in 17(37.8%) vs 14(35.9%), GC in 24(53.5%) vs 23(59.0%)(p>0.05). Compared to MF-AG, in CR-AG patients GD-GC were more commonly polypoid (51.6% vs 27.3%, p=0.048) and more frequently 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), in the corpus in 31.1% and 21.5%(p=0.27). Conclusions: Non-cardia GC and GD may occur in both MF-AG and CR-AG, displaying differences in topography and endoscopic presentation but similarities in non-lesional mucosa, differentiation and staging. Surveillance should be considered in corpus AG, regardless of extension and supposed etiology.
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