What does the pathology report of atrophic gastritis and intestinal epithelial metaplasia mean?

by Specialist

Many patients are confused by the terms “atrophic gastritis” and “intestinal epithelial metaplasia” when confronted with a gastroscopic biopsy report. This article explains what these two terms mean and how they relate to gastric cancer.

What is atrophy?

What is atrophic gastritis?

Gastritis occurs when the balance between the protective barrier of the normal gastric mucosa and the barrier-disrupting factors is disrupted. Chronic atrophic gastritis usually develops from chronic superficial gastritis and is most often seen in patients over middle age. Chronic atrophic gastritis may be described in pathology reports as: inflammation involving the entire mucosa; atrophy of the intrinsic mucosal glands; and glandular epithelial hyperplasia, with intestinal epithelial hyperplasia being common.

It is evident that intestinal epithelial hyperplasia is one of the structural changes in atrophic gastritis, and the two are usually found in conjunction with each other.

What is intestinal epithelial hyperplasia?

Carcinogenesis is the replacement of one type of differentiated mature cells by another type of differentiated mature cells. Intestinal epithelial metaplasia refers to the replacement of the original epithelial cells of the gastric mucosa by intestinal-type epithelial cells and is a manifestation of damage caused by repeated irritation of the gastric mucosa and is an important structural change in atrophic gastritis. More importantly, intestinal epithelial hyperplasia is an abnormal proliferation that is a precancerous lesion of gastric cancer and may become malignant.

How are the two related to gastric cancer?

The relationship between atrophic gastritis and intestinal epithelial hyperplasia and gastric cancer can be described as the following progression: H. pylori infection and other irritants → superficial gastritis → atrophic gastritis → intestinal epithelial hyperplasia → heterogeneous hyperplasia → early gastric cancer → progressive gastric cancer.

While this relationship diagram suggests that chronic atrophic gastritis and intestinal epithelial hyperplasia appear to be closely related to gastric cancer, there is no need for patients to be overly alarmed. The development of gastric lesions in H. pylori-negative patients is a slow process. Infection with H. pylori plays an accelerating role in the progression of gastric disease, and the role of different types of H. pylori varies, especially type I H. pylori infection has a dominant pathogenic role in the gastric disease process. In 229 patients with atrophic gastritis, 3.5% developed cancer after 2 to 14 years of follow-up.

What next?

Chronic atrophic gastritis and intestinal epithelial metaplasia are two changes that are usually reversible with appropriate treatment and guidance for healthy lifestyle habits, meaning that the gastric mucosal tissue can usually return to normal. By diagnosing and treating atrophic gastritis as well as intestinal epithelial hyperplasia early, it is key to preventing the development of gastric cancer and improving its survival rate.

The main methods include: medication to remove H. pylori; regular rest and diet, avoiding hot, pickled and smoked or irritating foods such as squash, bacon, and spicy foods; quitting smoking and limiting alcohol; avoiding or adjusting the use of drugs that damage the gastric mucosa; and eating more fresh fruits and vegetables.

H. pylori infection, how to deal with it?

Eat this way to stay away from nitrite. div>

Along with follow-up monitoring:

  • Patients with mild heterogeneous hyperplasia, not younger than 60 years of age and/or with severe atrophic gastritis, are to be followed up with regular gastroscopy every 6 months, which may be extended to 1 year for mild heterogeneous hyperplasia in other cases.

  • Moderate heterogeneous hyperplasia has a high rate of cancer and should be followed up every 3 months in the first year after diagnosis, and then extended to 6 months.
  • Severe heterogeneous hyperplasia has the highest rate of carcinoma and should be reviewed immediately with gastroscopy and pathology, and as much material as possible should be taken at the original biopsy site to improve consistency before and after review, and if necessary, microscopic mucosal resection or surgery should be performed.

When faced with atrophic gastritis and intestinal epithelial metaplasia in a pathology report, it is important to defy strategically, so that patients do not have to panic in the face of such a report, but also to pay attention tactically, to reverse the changes in gastric mucosa through standardized treatment, and to conduct regular follow-up for early detection of adverse changes in order to achieve ultimate victory in the battle against gastric cancer. (Contributed by Jianhua Wu, Department of Gastrointestinal Oncology, The First Hospital of China Medical University)