Evaluation Of Chronic Gastritis Based On Early Diagnosis Of Gastric Cancer

Objective The aims of the present study were to evaluate chronic gastritis including atrophy and H pylori in order to diagnosis high-risk bacground mucosa of early gastric cancer?The research including two part:the role of endoscopic gastric atrophy(EGA)on predicting Operative Link on Gastritis Assessment(OLGA)gastritis stage and the usefulness of screening endoscopy findings for predicting Helicobacter pylori(H.pylori)infection status.To study the clinicopathological features of astric xanthelasma and its relationship with gastric mucosal lesion,and to evaluate the correlation between astric xanthelasma and gastric cancerMethods A cross-sectional study was carried out on 256 dyspeptic outpatients.H.pylori infection status was evaluated by the [13C]-labeled urea breath test and Serum concentrationsof pepsinogen(PG)? and ? were measured.EGA was assessed according to the Kimura–Takemoto classification.Gastritis stage was established according to the OLGA staging system based on histological findings of atrophy at five biopsy sites according to the updated Sydney system.we determined the presence or absence of the following endoscopic findings: mucus on the gastric mucosa,diffuse redness,spotty redness of fundic mucosa,patchy redness,enlarged fold,mucosal edema/swelling,Regular arrangement of collecting venules(RAC),red streaking,xanthoma,fundic gland polyp,hyperplastic polyp,gastric ulcer,duodenal ulcer,erosion,nodular change.A total of 8410 cases were selected after excluded patients with severe heart and kidney disease,long-term use of non-steroidal anti-inflammatory drugs,gastric resection and postoperative gastrostomy,and all patients were diagnosed by endoscopy pathology.The diagnostic criteria of astric xanthelasmar were based on gastroscopy and histopathological examination.Gastric xanthelasma was detected in187 of the 8410 patients.All the patients were divided into two groups: gastricxanthelasma group and non-gastric xanthelasma group.We retrospectively analyzed the sex,age and the severity of gastric atrophy,the number/size/ location of gastric xanthelasma,the presence of gastric cancer and various clinical and pathological features(HP,intestinal metaplasia,atypical hyperplasia,precancerous lesions),and to explore the relationship between gastric xanthelasma and the above factors.Gastric cancer was detected in 426 of the 8410 patients.All patients were divided into gastric cancer group and non-gastric cancer group.Then we retrospectively analyzed the sex,age,HP infection and gastric xanthelasma of two groups.The relationship between gastric cancer and the above factors was also discussed,especially with the relationship between gastric cancer and gastric xanthelasma.Results Of 256 patients,123 were male and 133 female;The mean age of patients was 58.0 years and 113(40.9%)were H.pylori-positive.The strength of agreement between endoscopic gastric atrophy and OLGA showed good reproducibility,with a weighted kappa value of 0.82.The serum PG I/II ratio showed a significant decreasing nature when the extent of atrophy by the Kimura-Takemoto classification was progressed.The mucus on the gastric mucosa,diffuse redness,spotty redness of fundic mucosa,enlarged fold,mucosal edema,RAC(type I and type D)were useful for diagnosing H.pylori infection.RAC(type R)and fundic gland polyp may be used as diagnostic features suggesting negative H.pylori infection.Gastric xanthelasma was detected in 187(2.2%)of the 8410 patients.It can be occur in the cardia,gastric fundus,gastric body,gastric angle and gastric antrum,which gastric antrum(51.3%)is the most common.It can be single or multiple,single(63.1%)is more.Gastric xanthelasma was significantly associated with atrophic gastritis,intestinal metaplasia,atypical hyperplasia,HP infection,gastric cancer(P<0.005,P<0.005,P<0.025,P<0.005,P<0.005 respectively),but not age ? 50 years,male gender(P>0.05,P>0.05 respectively).Gastric cancer was detected in 426 of the 8410 patients.It was significantly associated with HP infection,gastric xanthelasma(P<0.005,P<0.005respectively),but not age?50 years,male gender(P>0.05,P>0.05 respectively).Conclusion Endoscopic atrophy by the Kimura–Takemoto classification can predict histological atrophy with good reproducibility,endoscopic diagnosis of H.pylori infection in gastric mucosa by conventional endoscopy is mostly possible.It is indicating that precancerous conditions can be identified during screening endoscopy,particularly in patients in China.The incidence of gastric xanthelasma related to atrophic gastritis,intestinal metaplasia,atypical hyperplasia,HP infection and gastric cancer,these factors may be the risk factors for this disease.There is a correlationbetween gastric xanthelasma and gastric cancer,and gastric xanthelasma can be used as an early warning signal for presence ofgastric cancer.