The endoscopy demonstrated no abnormality but biopsy of normalappearing gastric mucosa demonstrated intestinal metaplasia and infection with h. Intestinal metaplasia is a condition in which the cells that create the lining of your stomach are changed or replaced. In contrast, incomplete metaplasia type ii shows a. The first step in the treatment of intestinal metaplasia is using endoscopy to diagnose and biopsy the gastric lining endoscopy is a procedure in which a long, thin tube is inserted into your body. Partial gastrectomy would probably be indicated at this time.
The characteristics of intestinal metaplasia in laboratory rodents are similar to those seen in humans with early increases in intestinal enzyme activity alkaline phosphatase, lactase, trehalase, sucrose and maltase, development of goblet cells containing neutral, sialo or sulphomucins, and intestinal crypts. In fact, h pylori was recognized as a class i carcinogen by the who in 1994,24 and a metaanalysis has shown that h pylori infection results in a 2 to 3fold. Intestinal metaplasia and gastric carcinogenesis wiley online library. The prevalence of gastric intestinal metaplasia and distribution of helicobacter pylori infection, atrophy, dysplasia, and cancer in its subtypes. The affected organ generally contains goblet cells and rudimentary villi, often associated with the colon. Improvement of intestinal metaplasia six month after misoprostol. Gastric intestinal metaplasia gim is an intermediate precancerous gastric lesion in the gastric cancer cascade of chronic gastritis, atrophic gastritis, intestinal metaplasia im, dysplasia, and adenocarcinoma. Intestinal metaplasia of the stomach is a relative common finding that is associated with a modest increased risk of gastric carcinoma it is also known as gastric intestinal metaplasia and may be abbreviated im. It is considered to be a precancerous condition, but.
Gastric intestinal metaplasia gim may represent the histologic step just before development of dysplasia. Difference between metaplasia and dysplasia compare the. Intestinal metaplasia of the stomach sciencedirect. Overview of current concepts in gastric intestinal. Left alone one would find an eventual gastric ulcer and invasive cancer. The metaplastic mucosal lining may have crypts, variably developed villi, goblet cells, paneth cells, and absorptive cells and may be enzymatically similar to the intestine. Intestinal metaplasia of the esophagus is defined by the presence of goblet cells in cardiac mucosa. Focal intestinal metaplasia tips and tricks from doctors. Metaplasia intestinal cancer, sintomas, causas, tratamento. Complete and incomplete intestinal metaplasia at the. Metaplastic epithelium that closely resembles normal small intestinal epithelium containing acid mucinproducing goblet cells and absorptive enterocytes with a brush border is considered complete type i.
Overview of current concepts in gastric intestinal metaplasia. They were treated with misoprostol 200 mg twice daily for six months and, after stopping the treatment. The patient comes to you for advice regarding management of gastric intestinal metaplasia. Pdf followup of intestinal metaplasia in the stomach.
Intestinal metaplasia in the stomach often develops as a consequence of chronic h. In the pediatric population, gastric intestinal metaplasia gim is a finding with unknown frequency and, more importantly, unknown clinical implications. Backgroundaims intestinal metaplasia im is a common finding at the oesophagogastric junction, but the aetiopathogenesis of the different im subtypesthat is, incomplete im specialised columnar epithelium, sce and complete im and their associations with gastrooesophageal reflux disease and helicobacter pylori gastritis are unclear. Gastric intestinal metaplasia has been recognized worldwide as a premalignant precursor to gastric cancer, but currently, there are limited u. Gastric intestinal metaplasia is a precancerous change of the mucosa of the stomach. Im was considered focal when found in of the biopsic sample, medium. It is well recognised as a premalignant lesion in much the same way as barretts oesophagus, although management is much less clearly defined for gim. The replacement cells are similar to the cells that create the lining of your intestines.
Therefore, followup of precancerous lesions is advisable for secondary gastric cancer prevention. Globally, gastric cancer is the third leading cause of cancer mortality and the leading cause of infectionassociated cancers. There is emerging epidemiological evidence that with long term follow up, im may be reversible although. Intestinal metaplasia im of the stomach is a risk factor in developing intestinal type gastric cancer and hence the question of reversibility is vital. Pdf intestinal metaplasia of the stomach researchgate. Risk of gastric cancer among patients with intestinal metaplasia of. Metaplasia intestinal e carcinoma gastrico rodrigues et al. Gastric intestinal metaplasia with prominent goblet cells replacing the normal gastric epithelium. Topographic patterns of intestinal metaplasia and gastric cancer. Gastric intestinal metaplasia gim is a common finding from routine endoscopies.
Although the risk of gastric cancer is increased in patients with gim, the absolute risk is modest. Cassaro m, rugge m, gutierrez o, leandro g, graham dy, genta rm. Overview of current concepts in gastric intestinal metaplasia and. Gastric intestinal metaplasia gim is the replacement of normal gastric epithelium with intestinal type epithelium and is a result of chronic injury. Nov 17, 2014 intestinal metaplasia consists of areas of gastric mucosa morphologically similar to the intestine figure 1 and figure 2. Mar 15, 2012 it is well known that intestinal metaplasia im and gastric dysplasia are the main precancerous lesions of the stomach. Having chronic inflammation with extensive intestinal metaplasia is the precursor for developing gastric cancer. Nonhelicobacter pylori gastric intestinal metaplasia in. The antrum is that portion of the lower stomach above the pylorus. Results cells in focal patches of gastric metaplasia contained secretory granules of both gastric and goblet cell phenotypes. Intestinal metaplasia usually poses no diagnostic problem, but occasional cases are difficult to distinguish from adenocarcinoma, in particular florid extensive forms and cases showing a variable degree of dysplasia fig. Intestinal metaplasia in endoscopic biopsy specimens of gastric. Answer intestinal metaplasia is also known commonly as barretts esophagus.
The aim of our study was to investigate the clinical significance of hgm with and without intestinal metaplasia in a large group of patients. Diagnosis and management of gastric intestinal metaplasia. Nov 23, 2017 the pathological change happening in metaplasia is the replacement of one type cells with another type whereas in dysplasia the pathological change taking place is the morphological alterations in the damaged cells. Basically, what happens is that the chronic irritation of the esophagus from heartburn or acid reflux disease causes changes in the tissue of the esophagus that predisposes it to future esophageal cancer. Intestinal metaplasia is a condition where the cells lining the stomach transform into cells that resemble those found in the intestines. Screening programs in some asian countries are impractical in the majority of other countries worldwide. Intestinal metaplasia pylori metaplasia with involvement of the corpus patchy andor focal involvement identified as the precancerous lesion in 95% of early gastric adenocarcinomas in japan. Of the 206 dyspeptic patients without helicobacter pylori, 18 7. Gastric cancer is the third leading cause of cancer death worldwide. Intestinal metaplasia consists of areas of gastric mucosa morphologically similar to the intestine figure 1 and figure 2. Muc5ac and tff1 were present as expected in gastric foveolar cells but in addition, muc2 core antigen, normally present only in the golgi of intestinal goblet cells, was expressed in secretory granules. Mar 06, 2020 the other variation of focal metaplasia is commonly referred to as incomplete intestinal metaplasia. Intestinal metaplasia im is recognized as a precancerous lesion for gastric cancer, increasing the risk by 6fold.
The relationship between helicobacter pylori hp infection and gim is well documented, as well as an association between duodenogastric reflux and gim. Intestinal metaplasia an overview sciencedirect topics. A 50yearold male recently had an endoscopy by another physician for the indication of dyspepsia. Is intestinal metaplasia of the stomach reversible. Gim has been considered as one specific marker to identify patients who might benefit from surveillance because it has been associated with increased risk for gastric cancer and is routinely encountered in clinical practice. Intestinal metaplasia of the esophagus never contains parietal cells. In this form, the transformed cells are similar to the microscopic structures found in the large intestine. This is the major difference between metaplasia and dysplasia.
Few studies indicated that endoscopichistological followup in patients with im is able to detect gastric cancer in an early stage with a considerable mortality reduction7,8. Aga clinical practice guidelines on management of gastric. However, due to the extremely frequent association of intestinal. Partial gastrectomy would probably be indicated at this. Pdf intestinal metaplasia im of the stomach is associated with a very small increased risk of. Therefore, studies of its demographic and clinical associations have relied on small numbers of patients and the prevalence and significance of intestinal metaplasia im in hgm has remained unclear. Intestinal metaplasia at the gastroesophageal junction. Pdf is intestinal metaplasia of the stomach reversible. Risk factors of gastric intestinal metaplasia and gastric cancer helicobacter pylori infection precancerous gastric lesions are highly associated with h pylori infection. The disorder is largely restricted to the duodenal bulb and involves the replacement of. Gastric metaplasia in the duodenal bulb gastric metaplasia is a term used to describe the presence of gastrictype mucussecreting cells in the surface epithelium of the duodenum.
Metaplasia intestinal gastrica y displasia, metaplasia. O diagnostico da metaplasia intestinal deve ser estabelecido por um profissional da saude, mais especificamente o medico gastroenterologista. Intestinal metaplasia of the stomach libre pathology. Metaplasia intestinal gastrica pagina 3 articulos intramed. Gastric intestinal metaplasia on routine endoscopic biopsy.
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