Topographic patterns of intestinal metaplasia and gastric cancer

OBJECTIVE: The role of intestinal metaplasia in gastric oncogenesis has bee n demonstrated by both cross-sectional and longitudinal studies. This study was designed to determine whether, in a population at high risk for gastri c cancer, different topographical patterns and phenotypes of intestinal met aplasia were associated with different degrees of cancer risk. METHODS: A total of 68 Colombian patients with gastric cancer and 67 contro ls with nonulcer dyspepsia were studied by an extensive biopsy protocol. In testinal metaplasia was assessed semiquantitatively by histology and was ch aracterized histochemically. In both patients and controls, the Spearman's correlation test was applied to the test if the gastric distribution of met aplastic lesions resulted in specific topographical patterns associated wit h different risks for cancer. RESULTS: Four topographical patterns of intestinalization emerged: 1) "Foca l," in 14 cancer patients and 16 controls; 2) "Antrum-predominant," in seve n cancer patients and six controls; 3) "Magenstra beta e" (involving the le sser curvature from cardia to pylorus) in 25 cancer patients and four contr ols. This pattern was associated with higher cancer risk (OR = 5.7; 95% CI: 1.3-26) than were the two less extensive patterns; and 4) "Diffuse," invol ving essentially the entire gastric mucosa with the exception of the fundus , was unique to 13 cancer patients. The OR for cancer was 12.2; 95% CI: 2.0 -72.9. Incomplete-type metaplasia significantly correlated with the extent of total metaplasia and was also associated with greater cancer risk. CONCLUSIONS: In a population with high risk for gastric cancer, the extensi on of intestinal metaplasia correlates with the extent of its "incomplete" phenotype and is significantly associated with increased cancer risk. Both the extent and location of intestinal metaplasia along the lesser curvature (from the cardia to the prepyloric zones) identify patients with the highe st cancer risk. (Am J Gastroenterol 2000;95:1431-1438. (C) 2000 by Am. Coll . of Gastroenterology).