2022년 Postrad Med J 에 실린 내용입니다. Atrophic gastritis는 크게 Environmetal atrophic gastritis (EAG)와 Autoimmune atrphic gastritis (AAG) 두 가지의 subtypes으로 나누어 질 수 있습니다. 이 둘의 pathogenetically, clnically 차이는 있지만, histological features는 유사합니다. Atrophic gastritis를 histologic features에 따라서는 Non-metaplastic과 Metaplastic 으로 나눌 수 있으며, metaplastic atrophy는 pseudopylotic metaplasia (ie (id est), spasmolytic polypeptide-expression metaplasia, SPEM)와 intestinal metaplasia (IM) 로 나눌 수 있겠습니다. EAG의 원인은 Helicobacter pylori (H. pylori) 감염으로 국소적으로 atrophy, metaplasia, inflammation 등이 흩어져 나타날 수 있으며, antrum과 corpus/fundus 모두에 영향을 미치게 됩니다. AAG의 경우는 metaplastic transformation (SPEM과 IM이 공존)으로 인해 corpus/fundus의 glands가 사라지게 되고, 결국 iron deficiency anemia, pernicious anemia, type 1 carcinoid and gastric cancer의 risk를 갖게 됩니다. Pepsinogen (PG) test는 이미 gastric cancer screening에 poupular하게 사용하고 있으며, 이번 논문에서는 atrophic gastritis type에 따라 PG test level을 확인하고, OLGA와 OLGIM staging systems와 PG tests 간의 관계에 대해 조사를 시행하였습니다.
내용을 살펴 보겠습니다. Histopathologic examination을 통해 atrophy/IM가 확인 된 115명의 환자군과 32명의 대조군을 비교하였습니다 (Table 1). 환자군에서는 non-atrophic gastritis가 20명, atrophic gastritis는 총 95명이였고, EAG 79명, AAG 16명이였습니다. Non-atrophic gastritis 환자는 조직검사에서 IM가 확인 되었습니다.
<Pepsinogen tests>
<ABSTRACT>
Background
We assessed the validity of using serum pepsinogen tests (sPGTS) to differentiate autoimmune atrophic gastritis (MG) from environmental atrophic gastritis (EAG). We also investigated the correlation and prognostic value between disease stage, according to Operative Link for Gastritis Assessment (OLGA)/Operative Link on Gastric Intestinal Metaolasia Assessment (OLGlM), and sPGT results in patients with gastric atrophy.
Methods
We enroled 115 patients in this prospective study: 95 with atrophic gastritis (16 with AAG and 79 with EAG) and 20 non-atrophic gastritis. These patients, along with 32 control patients, underwent esophagogastroduodenoscopy. Atrophy and intestinal metaplasia of the gastric biopsy specimens were staged according to the OLGA/OLGlM staging systems.
Results
The median (lQR) age of the patients (83 females (56.5%))was 58 (46-67) years. Patients in the AAG group represented histologically advanced stages. The AAG group had lower pepsinogen (PG) | and ll levels, as well as a lower PGI/PGll ratio, compared with the EAG group (p<0.01, p<0.05 and p<0.01, respectively). The optimal PGI/PGll ratio for predicting AAG was <1.9 (100% sensitivity and 100% specificity), and that for predicting EAG was <9.2 (47 5% sensitivity and 90.6% specificity). The OLGA/OLGlM stage was negatively conelated with the PGI level and PGI/PGll ratio. ln the AAG group, four of five patients with low-grade dysplasia had OLGA/OLGlM stage lll-lV disease.
Conclusions
sPGT may provide valuable information for differentiating advanced-stage AAG from EAG, and in patients with atrophic gastritis, use of sPGTs and OLGA/OLGIM staging together may predict gastric cancer risk.
2022년 Postrad Med J 에 실린 내용입니다. Atrophic gastritis는 크게 Environmetal atrophic gastritis (EAG)와 Autoimmune atrphic gastritis (AAG) 두 가지의 subtypes으로 나누어 질 수 있습니다. 이 둘의 pathogenetically, clnically 차이는 있지만, histological features는 유사합니다. Atrophic gastritis를 histologic features에 따라서는 Non-metaplastic과 Metaplastic 으로 나눌 수 있으며, metaplastic atrophy는 pseudopylotic metaplasia (ie (id est), spasmolytic polypeptide-expression metaplasia, SPEM)와 intestinal metaplasia (IM) 로 나눌 수 있겠습니다. EAG의 원인은 Helicobacter pylori (H. pylori) 감염으로 국소적으로 atrophy, metaplasia, inflammation 등이 흩어져 나타날 수 있으며, antrum과 corpus/fundus 모두에 영향을 미치게 됩니다. AAG의 경우는 metaplastic transformation (SPEM과 IM이 공존)으로 인해 corpus/fundus의 glands가 사라지게 되고, 결국 iron deficiency anemia, pernicious anemia, type 1 carcinoid and gastric cancer의 risk를 갖게 됩니다. Pepsinogen (PG) test는 이미 gastric cancer screening에 poupular하게 사용하고 있으며, 이번 논문에서는 atrophic gastritis type에 따라 PG test level을 확인하고, OLGA와 OLGIM staging systems와 PG tests 간의 관계에 대해 조사를 시행하였습니다.
내용을 살펴 보겠습니다. Histopathologic examination을 통해 atrophy/IM가 확인 된 115명의 환자군과 32명의 대조군을 비교하였습니다 (Table 1). 환자군에서는 non-atrophic gastritis가 20명, atrophic gastritis는 총 95명이였고, EAG 79명, AAG 16명이였습니다. Non-atrophic gastritis 환자는 조직검사에서 IM가 확인 되었습니다.
<Pepsinogen tests>
<ABSTRACT>
Background
We assessed the validity of using serum pepsinogen tests (sPGTS) to differentiate autoimmune atrophic gastritis (MG) from environmental atrophic gastritis (EAG). We also investigated the correlation and prognostic value between disease stage, according to Operative Link for Gastritis Assessment (OLGA)/Operative Link on Gastric Intestinal Metaolasia Assessment (OLGlM), and sPGT results in patients with gastric atrophy.
Methods
We enroled 115 patients in this prospective study: 95 with atrophic gastritis (16 with AAG and 79 with EAG) and 20 non-atrophic gastritis. These patients, along with 32 control patients, underwent esophagogastroduodenoscopy. Atrophy and intestinal metaplasia of the gastric biopsy specimens were staged according to the OLGA/OLGlM staging systems.
Results
The median (lQR) age of the patients (83 females (56.5%))was 58 (46-67) years. Patients in the AAG group represented histologically advanced stages. The AAG group had lower pepsinogen (PG) | and ll levels, as well as a lower PGI/PGll ratio, compared with the EAG group (p<0.01, p<0.05 and p<0.01, respectively). The optimal PGI/PGll ratio for predicting AAG was <1.9 (100% sensitivity and 100% specificity), and that for predicting EAG was <9.2 (47 5% sensitivity and 90.6% specificity). The OLGA/OLGlM stage was negatively conelated with the PGI level and PGI/PGll ratio. ln the AAG group, four of five patients with low-grade dysplasia had OLGA/OLGlM stage lll-lV disease.
Conclusions
sPGT may provide valuable information for differentiating advanced-stage AAG from EAG, and in patients with atrophic gastritis, use of sPGTs and OLGA/OLGIM staging together may predict gastric cancer risk.