2022년 The 28th National Congress of Digestive Diseases (Digestive and Liver Disease 54S2 (2022) S85. OC.07.4)
Background and aim: Autoimmune atrophic gastritis (AAG), a corpus chronic inflammatory condition sparing the antrum featured by intrinsic-factor (IFA) and parietal-cells (PCA)-autoantibodies, is at risk for gastric type I neuroendocrine tumors (T1gNET). It is characterized by lower OLGA/OLGIM (Operative-link-on-gastritis-and intestinal-metaplasia-assessments) prognostic stages (1/2) supposed to have a very low risk for adenocarcinoma (ADK) compared to higher stages (3/4), typically found in Helicobacter pylori multifocal atrophic gastritis. Prospective studies quantifying the neoplastic risk in AAG are lacking. This study aimed to assess the gastric ADK, dysplasia and T1gNET incidence in AAG patients at long-term follow up.
Materials and methods: 254 AAG patients [75.6% female, age 57.5 (range 23-84) years] with a follow up of 4.5 (range 3-17) years were included. Inclusion criteria were histological AAG diagnosis and at least one follow up gastroscopy with biopsies at ≥3 years after diagnosis. Endoscopic-histological surveillance at 4 years and since 2012 (MAPS-guidelines) at 3-years-intervals was performed.
Results: Twenty gastric neoplastic lesions were found (crude-incidence 8%). ADK was detected in five patients with a 4.5 years median follow up (crude incidence 2%). Twelve T1gNETs and three low-grade dysplasia were diagnosed at a 4.5 years median follow up (crude incidence 4.7% and 1.2%, respectively). The annual incidence rates person-year were 0.4%,0.3%,1% for ADK, dysplasia, and T1gNETs, respectively. All patients with gastric neoplastic lesions had OLGA2, except one case with T1gNET who had OLGA1. OLGIM2 was present in all ADKs and dysplasias; of the 12 patients with T1gNETs, seven showed OLGIM1 and three OLGIM2.
Conclusions: In AAG at long term follow up, a 1.7% annual incidence rate person year for gastric neoplastic lesions was found confirming the neoplastic risk despite low OLGA/OLGIM-stages. Regular endoscopic-histological surveillance should be offered to AAG patients after diagnosis, whose optimal interval needs to be determined.
2022년 The 28th National Congress of Digestive Diseases (Digestive and Liver Disease 54S2 (2022) S85. OC.07.4)
Background and aim: Autoimmune atrophic gastritis (AAG), a corpus chronic inflammatory condition sparing the antrum featured by intrinsic-factor (IFA) and parietal-cells (PCA)-autoantibodies, is at risk for gastric type I neuroendocrine tumors (T1gNET). It is characterized by lower OLGA/OLGIM (Operative-link-on-gastritis-and intestinal-metaplasia-assessments) prognostic stages (1/2) supposed to have a very low risk for adenocarcinoma (ADK) compared to higher stages (3/4), typically found in Helicobacter pylori multifocal atrophic gastritis. Prospective studies quantifying the neoplastic risk in AAG are lacking. This study aimed to assess the gastric ADK, dysplasia and T1gNET incidence in AAG patients at long-term follow up.
Materials and methods: 254 AAG patients [75.6% female, age 57.5 (range 23-84) years] with a follow up of 4.5 (range 3-17) years were included. Inclusion criteria were histological AAG diagnosis and at least one follow up gastroscopy with biopsies at ≥3 years after diagnosis. Endoscopic-histological surveillance at 4 years and since 2012 (MAPS-guidelines) at 3-years-intervals was performed.
Results: Twenty gastric neoplastic lesions were found (crude-incidence 8%). ADK was detected in five patients with a 4.5 years median follow up (crude incidence 2%). Twelve T1gNETs and three low-grade dysplasia were diagnosed at a 4.5 years median follow up (crude incidence 4.7% and 1.2%, respectively). The annual incidence rates person-year were 0.4%,0.3%,1% for ADK, dysplasia, and T1gNETs, respectively. All patients with gastric neoplastic lesions had OLGA2, except one case with T1gNET who had OLGA1. OLGIM2 was present in all ADKs and dysplasias; of the 12 patients with T1gNETs, seven showed OLGIM1 and three OLGIM2.
Conclusions: In AAG at long term follow up, a 1.7% annual incidence rate person year for gastric neoplastic lesions was found confirming the neoplastic risk despite low OLGA/OLGIM-stages. Regular endoscopic-histological surveillance should be offered to AAG patients after diagnosis, whose optimal interval needs to be determined.