RISK OF GASTRIC-CARCINOMA IN PATIENTS WITH MUCOSAL DYSPLASIA ASSOCIATED WITH ATROPHIC GASTRITIS - A FOLLOW-UP-STUDY

Aims-To assess the risk of gastric carcinoma in patients with histolog ically verified dysplasia and atrophic gastritis of the stomach. Metho ds-One hundred and one patients with mild (n = 84), moderate (n = 14), or severe (n = 3) dysplasia among 359 elderly men who smoked underwen t gastroscopy because of low serum pepsinogen. Patients with dysplasia were prospectively followed up for an average of four years with repe ated gastroscopies and multiple biopsies. Results-Four of the 84 (4.8% ) cases of mild dysplasia had progressed to moderate dysplasia during the follow up. Most of the cases of mild dysplasia had resolved sponta neously. No surgical intervention was required. Three of the 14 (21%) cases of moderate dysplasia had progressed to severe dysplasia, but no carcinomas were observed during follow up. Five moderately dysplastic lesions were removed surgically or endoscopically. In two of these fi ve cases, moderate or severe dysplasia recurred. Two of the three seve re dysplasias progressed to carcinoma. Conclusions-In atrophic gastrit is progression of mild and moderate dysplastic lesions seems to be a s low process and is rare in mild dysplasia. However, severe dysplasia i s highly predictive of subsequent cancer. It is suggested that a five year follow up interval is sufficient in cases with mild dysplasia and two years in those with moderate dysplasia. Local removal of moderate dysplasia is indicated but does not guarantee that the lesion will no t progress. Severe dysplasia requires immediate surgical intervention.