Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy (original) (raw)

2011, Gastroenterology Research

Background: Intestinal metaplasia (IM) is regarded as a premalignant lesion. However, endoscopic diagnosis of IM has been considered diffi cult. Using endoscopy, we found a unique pattern of erythema, "Mottled Patchy Erythema (MPE)," which includes severe IM. Helicobacter pylori (Hp) infection itself can cause erythema, which refl ects histologic changes in the gastric mucosa. Therefore we enrolled Hp eradication patients to validate the relation between MPE and pathologic fi ndings. Methods: We enrolled patients with chronic gastritis who underwent successful Hp eradication at least 6 months before the study. We defi ned MPE as multiple fl at or depressed erythematous lesions. When encountering MPE on endoscopy, we performed biopsy on both the MPE site and non-MPE site. The non-MPE site was defi ned as an adjacent mucosa located within 3 cm of the MPE site. All biopsy specimens were evaluated immunohistochemically for IM subtype using MUC2, MUC5AC, MUC6, CD10, and CDX2 stains. The degree of IM was defi ned according to the Updated Sydney System. The diagnostic accuracy of the MPE fi ndings for pathologic IM was calculated. The relation between MPE and IM subtype was also assessed. Results: A total of 102 patients were selected for the study. Of these, 55 (54%) patients had MPE. Biopsy specimens were taken from the MPE sites and non-MPE sites from these 55 patients. The IM percentages and median scores of IM were both signifi cantly higher at the MPE sites (P < 0.001) than at the non-MPE sites. The sensitivity and specifi city for MPE in the detection of histologic IM were 72.7% and 84.1%, respectively. No signifi cant associations were observed in the expression of MUC2, MUC5AC, MUC6, CD10, and CDX2 between the MPE sites and non-MPE sites. There were no signifi cant differences in the ratios (complete/incomplete) of IM subtypes between the two groups. Conclusions: MPE is a useful endoscopic fi nding to detect histologic IM without the use of chromoendoscopy and magnifying endoscopy. However, the IM subtype is diffi cult to identify. In the era of Hp eradication, MPE has the potential to become a predictive fi nding for the risk of gastric cancer.