Insights into the Development of Preneoplastic Metaplasia: Spasmolytic Polypeptide-Expressing Metaplasia and Oxyntic Atrophy

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Deaths from gastric adenocarcinoma are the third largest cause of cancer-related mortality in the world (Pisani et al. 1999). Early recognition and resection of gastric cancers remains the mainstay of gastric cancer therapy, and adjuvant treatment regimens provide only minimal benefits beyond surgery (Wainess et al. 2003). Although aggressive endoscopic screening procedures in Asian countries, such as Japan and South Korea, have led to earlier discovery and surgical removal of gastric cancers (Rembacken et al. 2001), little is known of the cellular etiology of gastric neoplasms. Although the concept of preneoplasia does spur screening endoscopy, there is a general lack of knowledge of the sequence of events leading first to metaplasia and later to preneoplastic lesions and gastric cancer. This uncertainty in the analysis of precancerous events hobbles efforts to develop effective screening methods for patient populations at risk for gastric cancer. Thus, detaile