Accurate diagnosis of gastric intestinal metaplasia is important; however, conventional endoscopy is known to be an unreliable modality for diagnosing gastric intestinal metaplasia (IM). The aims of the study were to evaluate the interobserver variation in diagnosing IM by high-definition (HD) endoscopy and the diagnostic accuracy of this modality for IM among experienced and inexperienced endoscopists. Selected 50 cases, taken with HD endoscopy, were sent for a diagnostic inquiry of gastric IM through visual inspection to five experienced and five inexperienced endoscopists. The interobserver agreement between endoscopists was evaluated to verify the diagnostic reliability of HD endoscopy in diagnosing IM, and the diagnostic accuracy, sensitivity, and specificity were evaluated for validity of HD endoscopy in diagnosing IM. Interobserver agreement among the experienced endoscopists was "poor" (kappa = 0.38) and it was also "poor" (kappa = 0.33) among the inexperienced endoscopists. The diagnostic accuracy of the experienced endoscopists was superior to that of the inexperienced endoscopists (P = 0.003). Since diagnosis through visual inspection is unreliable in the diagnosis of IM, all suspicious areas for gastric IM should be considered to be biopsied. Furthermore, endoscopic experience and education are needed to raise the diagnostic accuracy of gastric IM.
Adult ; Aged ; Endoscopy, Gastrointestinal ; Female ; Humans ; Intestinal Mucosa/*pathology ; Male ; Metaplasia/*diagnosis/epidemiology ; Middle Aged ; Observer Variation ; Physicians ; Stomach/*pathology

The materials used in this study consist 744 gastric resections removed subtotally at the Yonsei University College of Medicine and Severance Hospital during the last 11 years from Jan. 1. 1959 to Dec. 31, 1969. Among these, 446 cases of gastric carcinoma were diagnosed at the Department of Pathology Yonsei University College of Medicine for this same duration. Histopathological studies as well as clinical study on all cases were performed. Summary: 1. Among 744 gastric resections examined during the last 11 years, gastric carcinoma was found in 446 cases, giving an incidence of 59.95% for subtotally removed stomachs. 2. Male to female ratio was 2.28 to 1. The peak age incidence is between 50 and 59 years and accounted for 172cases(35.77%). 3. There is no relation between blood group and incidence of gastric carcinoma. 4. Clinical symptoms in order of frequency were as follows: epigastric discomfort and pain(86%), indigestion(66.67%), weight loss(35.67%), nausea and vomiting(35.33%) and palpable epigastric mass(23.33%). The duration of the chief complaints was usually within six months(54.66%). 5. The gastric acidity disclosed that achlorhydria was found in 36.21%, hypochlorhydria in 32.26% and hyperchlorhydria in 2.15%. 6. The location of the tumor was as follows: 44.86% at the pyloric canal, and 26.53% at the antrum. The size of the tumor varied in diameter. The most frequent size was 3-5cm (43.43%) and 6-10cm(42.90%). 7. On the macroscopical examination, the classification based on Borrmann's gross types and their incidences were as follows: Type I(3.71%), type II(11.22%), type III(62.18%), and type IV(23.64%). 8. On the histological classification, 70% of the cases were adenocarcinomas. Serosal involvement was found in most cases(86.89%). 9. Metastasis to the regional lymphnodes was found in 68.84%, and direct extension of the omentum was 21.39%. 10. According to the relationship between regional lymphnode metastases and lymphatic permeation, and relationship between lymphatic permeation and histologic type, the degree of lymphatic permeation is more, the more metastases to regional lymphnode is found. And metastasis to regional lymphnode and lymphatic permeation is more common in adenocarcinoma than other types. 11. There is no relationship between intestinal metaplasia and histologic type. But each histologic type was accompanied by intestinal metaplasia frequently. In conclusion based on the above findings, it can be stated that gastric carcinoma among Koreans exhibited a far advanced stage, both clinically and morphologically.
Adenocarcinoma/pathology* ; Adenocarcinoma, Mucinous/pathology* ; Adult ; Aged ; Carcinoma/pathology* ; Female ; Human ; Korea ; Male ; Metaplasia/epidemiology ; Middle Age ; Neoplasm Metastasis ; Sex Factors ; Statistics ; Stomach Neoplasms/epidemiology ; Stomach Neoplasms/pathology*

A total of 556 cases of stomachs resected for gastric carcinoma were classified according to Laur n's method (1965), and were studied for epidemiological evaluation, relation to chronic gastritis, especially that with intestinal metaplasia, and prognostic difference, with the following results: 1) When classified by Laur n's method, 52.2% (290/556) of gastric carcinomas among Koreans belonged to intestinal type, 40.6% (226/556) to diffuse and 7.2% (40/556) to the other type of carcinoma. 2) In males the incidence of diffuse carcinoma was less frequent than that of intestinal type carcinoma, but in the female it was as frequent as the latter. 3) The higher incidence of stomach carcinoma in the male among Koreans may be attributed to the frequent occurrence of not only intestinal type but also diffuse carcinoma. 4) The mean age of patients with intestinal type carcinoma was older than that of diffuse by approximately 7 years. 5) The lower mean age of gastric carcinoma among Koreans is attributable to the lower age distribution of intestinal type as well as of diffuse carcinoma. 6) The occurrence of large tumor size, short symptom duration, ulcero-infiltrative gowth, regional node metastasis and regional nodes showing lymphocyte depletion and unstimulated were more frequent in diffuse carcinoma, indirectly supporting the view that patients with intestinal type carcinoma are more likely to survive for longer periods than patients with diffuse carcinoma. 7) Intestinal metaplasia of the nearby stomach mucosa showed a significantly higher percentage in intestinal type than diffuse carcinoma, further supporting the suggestion that intestinal type carcinoma is pathogenetically related to intestinal metaplasia of stomach mucosa.
Adolescent ; Adult ; Aged ; Carcinoma/epidemiology* ; Carcinoma/pathology ; Child ; Female ; Gastric Mucosa/pathology* ; Human ; Korea ; Male ; Metaplasia ; Middle Age ; Stomach Neoplasms/epidemiology* ; Stomach Neoplasms/pathology

BACKGROUND/AIMS: The purpose of this study was to estimate the prevalence of Barrett's esophagus (BE) and its association with reflux esophagitis (RE) and peptic ulcer disease detected by free charge endoscopy which was covered by the National Health Insurance at a secondary care hospital, and to compare the results of the biopsy of BE with that of cardiac intestinal metaplasia (CIM). METHODS: A total of 4,002 patients underwent endoscopy from March 2010 to December 2012. BE was diagnosed if there was histologically proven specialized intestinal metaplasia, and CIM was diagnosed if intestinal metaplasia was accompanied with chronic gastritis. RESULTS: Four hundred twenty four patients underwent endoscopic biopsy, and the prevalence of BE was 1.0% (42/4,002). The mean age and the proportion of males in BE were significantly higher than those of the rest of study population, and BE had slight tendency related to RE than the rest of study population. CIM was observed in 34 patients and BE and CIM showed similar results, regarding age, sex and association with RE. The mean length of endoscopic Barrett's mucosa of BE group was 9.2+/-5.1 mm, and it was similar to that of CIM. CONCLUSIONS: The prevalence of BE in the secondary care hospital was not low, and old age and male sex were significantly associated with BE. Because BE was observed in about 10% of biopsied patients and CIM was observed in a similar percentage with BE, the precise targeted biopsy is warranted and the biopsy method should be reestablished through the large prospective study of multiple secondary care hospitals.
Adult ; Aged ; Aged, 80 and over ; Barrett Esophagus/complications/epidemiology/*pathology ; Duodenal Ulcer/complications/epidemiology/pathology ; Esophagoscopy ; Female ; Gastroesophageal Reflux/complications/epidemiology/pathology ; Hospitals ; Humans ; Male ; Metaplasia/complications/epidemiology/*pathology ; Middle Aged ; Prevalence ; Secondary Care ; Stomach Ulcer/complications/epidemiology/pathology

Gastric intestinal metaplasia (GIM) is a known premalignant condition of the human stomach along the pathway to gastric cancer (GC). Histologically, GIM represents the replacement of normal gastric mucosa by mucin-secreting intestinal mucosa. Helicobacter pylori infection is the most common etiologic agent of GIM development worldwide. The prevalence of GIM is heterogeneous among different regions of the world and correlates with the population endemicity of H. pylori carriage, among other environmental factors. GC remains the third leading cause of cancer-related mortality globally. GIM is usually diagnosed by upper endoscopy with biopsy, and histologic scoring systems have been developed to risk-stratify patients at highest risk for progression to GC. Several recent endoscopic imaging modalities may improve the optical detection of GIM and early GC. Appropriate surveillance of GIM may be cost effective and represents an opportunity for the early diagnosis and therapy of GC. Certain East Asian nations have established population-level programs for the screening and surveillance of GIM; guidelines regarding GIM surveillance have also recently been published in Europe. By contrast, few data exist regarding the appropriateness of surveillance of GIM in the United States. In this review, we discuss the pathogenesis, epidemiology, diagnosis, and management of GIM with an emphasis on the role of appropriate endoscopic surveillance.
Asian Continental Ancestry Group ; Biopsy ; Diagnosis ; Early Diagnosis ; Endoscopy ; Epidemiology ; Europe ; Gastric Mucosa ; Helicobacter pylori ; Humans ; Intestinal Mucosa ; Mass Screening ; Metaplasia ; Mortality ; Prevalence ; Stomach ; Stomach Neoplasms ; United States

OBJECTIVES: The objective of this study was to evaluate the prevalence of atrophic gastritis and intestinal metaplasia according to gender, age and Helicobacter pylori infection in a rural population in Korea. METHODS: Between April 2003 and January 2007, 713 subjects (298 men and 415 women, age range: 18-85) among the 2,161 adults who participated in a populationbased survey received gastrointestinal endoscopy. All the subjects provided informed consent. Multiple biopsy specimens were evaluated for the presence of atrophic gastritis and intestinal metaplasia. The presence of Helicobacter pylori was determined using CLO and histology testing. RESULTS: The age-adjusted prevalence of atrophic gastritis was 42.7% for men and 38.1% for women and the prevalence of intestinal metaplasia was 42.5% for men and 32.7% for women. The prevalence of atrophic gastritis and intestinal metaplasia increased significantly with age for both men and women (p for trend<0.001). The ageadjusted prevalence of Helicobacter pylori was similar for men (59.0%) and women (56.7%). The subjects with Helicobacter pylori infection showed a significantly higher prevalence of intestinal metaplasia (44.3%) compared with that (26.8%) of the noninfected subjects (p<0.001). However, the prevalence of atrophic gastritis was not statistically different between the Helicobacter pyloriinfected subjects and the noninfected individuals. CONCLUSIONS: Our findings suggest that the prevalence of atrophic gastritis and intestinal metaplasia is higher for a Korean rural population than that for a Western population; this may be related to the high incidence of gastric cancer in Koreans. Especially, the prevalence of intestinal metaplasia was high for the subjects with Helicobacter pylori infection. The multistep process of gastric carcinogenesis and the various factors contributing to each step of this process need to be determined by conducting future follow-up studies.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Demography ; Female ; Gastritis, Atrophic/*epidemiology/pathology ; Helicobacter Infections/*epidemiology/pathology ; *Helicobacter pylori ; Humans ; Intestine, Small/*pathology ; Male ; Metaplasia/epidemiology/pathology ; Middle Aged ; Rural Population ; Sex Factors ; Socioeconomic Factors

BACKGROUND/AIMS: Duodenal ulcers occur relatively frequently in adolescents, like in adults, and may relate to Helicobacter pylori infection and duodenal gastric metaplasia (DGM). This study investigated the association between H. pylori infection and DGM in healthy adults aged 20-29. METHODS: Between 1995 and 2005, endoscopic biopsies of the duodenum, antrum and body were taken from healthy, young volunteers, who were first-year medical students, faculty staff, residents, and research assistants of Gyeongsang National University in Jinju, Korea. Urease tests were performed and the extent of DGM and histopathological grades according to the Updated Sydney System were determined. RESULTS: In total, 662 subjects were enrolled (429 males and 233 females). The median age was 22.3 years. The overall incidence of DGM was 11.5% but DGM was more frequent in males (15.4%) than in females (4.3%) (p<0.0001). While H. pylori positivity rates changed significantly during the 1995-2005 period (p<0.01), the incidences of DGM did not. DGM was observed in 7.2% and 14.9% of subjects who were and were not colonized with H. pylori, respectively. DGM was also associated with less severe chronic gastritis and the absence of active gastritis in both the antrum and body, and the absence of follicles in the antrum (p<0.05). CONCLUSIONS: These findings suggested that DGM is not rare in healthy young adults and is unrelated to gastric H. pylori infection.
Adult ; Age Factors ; Duodenum/*pathology ; Female ; Gastric Mucosa/*pathology ; Helicobacter Infections/complications/*diagnosis/epidemiology ; *Helicobacter pylori ; Humans ; Male ; Metaplasia/complications/*diagnosis/epidemiology ; Pyloric Antrum/*pathology ; Severity of Illness Index ; Sex Factors ; Young Adult

BACKGROUND/AIMS: Atrophic gastritis is considered a premalignant lesion. We aimed to evaluate the risk factors for gastric tumorigenesis in underlying mucosal atrophy. METHODS: A total of 10,185 subjects who underwent upper gastrointestinal endoscopy between 2003 and 2004 were enrolled in this retrospective cohort study. Follow-up endoscopy was performed between 2005 and 2014. Atrophic gastritis and intestinal metaplasia were assessed by endoscopy using the Kimura-Takemoto classification. Helicobacter pylori infection was evaluated based on serum immunoglobulin G antibody levels, the rapid urease test, or the urea breath test. RESULTS: Atrophic gastritis was confirmed in 3,714 patients at baseline; 2,144 patients were followed up for 6.9 years, and 1,138 exhibited increased atrophy. A total of 69 subjects were diagnosed with gastric neoplasm during follow-up (35 adenoma and 34 carcinoma). Age ≥55 years (hazard ratio [HR], 1.234), alcohol consumption (HR, 1.001), and H. pylori infection (HR, 1.580) were associated with increased mucosal atrophy. The risk factors for gastric neoplasm in underlying mucosal atrophy were age ≥55 years (HR, 2.582), alcohol consumption (HR, 1.003), extent of mucosal atrophy (HR, 2.285 in C3-O1; HR, 4.187 in O2–O3), and intestinal metaplasia (HR, 2.655). CONCLUSIONS: Extent of atrophy, intestinal metaplasia, and alcohol consumption are significant risk factors for gastric neoplasm in underlying mucosal atrophy.
Adenoma ; Alcohol Drinking ; Atrophy* ; Breath Tests ; Carcinogenesis* ; Classification ; Cohort Studies ; Endoscopy ; Endoscopy, Gastrointestinal ; Epidemiology ; Follow-Up Studies ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Immunoglobulin G ; Metaplasia ; Retrospective Studies ; Risk Factors* ; Stomach ; Stomach Neoplasms ; Urea ; Urease

BACKGROUND/AIMS: Atrophic gastritis is considered a premalignant lesion. We aimed to evaluate the risk factors for gastric tumorigenesis in underlying mucosal atrophy. METHODS: A total of 10,185 subjects who underwent upper gastrointestinal endoscopy between 2003 and 2004 were enrolled in this retrospective cohort study. Follow-up endoscopy was performed between 2005 and 2014. Atrophic gastritis and intestinal metaplasia were assessed by endoscopy using the Kimura-Takemoto classification. Helicobacter pylori infection was evaluated based on serum immunoglobulin G antibody levels, the rapid urease test, or the urea breath test. RESULTS: Atrophic gastritis was confirmed in 3,714 patients at baseline; 2,144 patients were followed up for 6.9 years, and 1,138 exhibited increased atrophy. A total of 69 subjects were diagnosed with gastric neoplasm during follow-up (35 adenoma and 34 carcinoma). Age ≥55 years (hazard ratio [HR], 1.234), alcohol consumption (HR, 1.001), and H. pylori infection (HR, 1.580) were associated with increased mucosal atrophy. The risk factors for gastric neoplasm in underlying mucosal atrophy were age ≥55 years (HR, 2.582), alcohol consumption (HR, 1.003), extent of mucosal atrophy (HR, 2.285 in C3-O1; HR, 4.187 in O2–O3), and intestinal metaplasia (HR, 2.655). CONCLUSIONS: Extent of atrophy, intestinal metaplasia, and alcohol consumption are significant risk factors for gastric neoplasm in underlying mucosal atrophy.
Adenoma ; Alcohol Drinking ; Atrophy* ; Breath Tests ; Carcinogenesis* ; Classification ; Cohort Studies ; Endoscopy ; Endoscopy, Gastrointestinal ; Epidemiology ; Follow-Up Studies ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Immunoglobulin G ; Metaplasia ; Retrospective Studies ; Risk Factors* ; Stomach ; Stomach Neoplasms ; Urea ; Urease