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The use of clinical, histologic, and serologic parameters to predict the intragastric extent of intestinal metaplasia: a recommendation for routine practice.

Abstract：

BACKGROUND:Surveillance of intestinal metaplasia (IM) of the gastric mucosa should be limited to patients at high risk of gastric cancer. Patients with extensive IM are at increased cancer risk; however, the intragastric extent of IM is usually unknown at the time of the initial diagnosis. OBJECTIVE:To assess the predictive value of clinical, histologic, and serologic parameters for the intragastric extent of IM. DESIGN AND SETTING:Prospective, multicenter study. PATIENTS:Eighty-eight patients with a previous diagnosis of IM of the gastric mucosa. INTERVENTION:Surveillance gastroscopy with extensive random biopsy sampling. MAIN OUTCOME MEASUREMENTS:Biopsy specimens were evaluated according to the Sydney classification system. In addition, serologic testing of Helicobacter pylori and cagA status, pepsinogens I and II, gastrin, and intrinsic factor antibodies was performed. The association between the available parameters and extensive IM was evaluated with logistic regression analysis. RESULTS:In 51 patients (58%), IM was present in the biopsy specimens from at least 2 intragastric locations. The most important predictors of extensive IM were a family history of gastric cancer, alcohol use > or = 1 unit/d (1 glass, approximately 10 mL or 8 g ethanol), moderate or marked IM of the index biopsy specimen, and a pepsinogen I to II ratio < 3.0. A simple risk score based on these factors could identify extensive IM in 24 of 25 patients (sensitivity 96%). LIMITATION:A prospective cohort study should confirm the proposed risk stratification. CONCLUSIONS:A risk score of clinical, histologic, and serologic parameters can predict extensive intragastric IM and may serve as a practical tool to select patients for surveillance endoscopy in routine clinical practice.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

de Vries AC,Haringsma J,de Vries RA,ter Borg F,Nagtzaam NM,Steyerberg EW,van Dekken H,Kuipers EJ

doi

10.1016/j.gie.2008.08.041

subject

Has Abstract

pub_date

2009-07-01 00:00:00

pages

18-25

issue

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(08)02503-0

journal_volume

pub_type

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The use of clinical, histologic, and serologic parameters to predict the intragastric extent of intestinal metaplasia: a recommendation for routine practice.