Skip to main content

Advertisement

SpringerLink
Log in

Endoscopic Diagnosis of Open-Type Atrophic Gastritis Is Related to the Histological Diagnosis of Intestinal Metaplasia and Cdx2 Expression

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Objectives

Long-term Helicobacter pylori infection results in atrophic gastritis and intestinal metaplasia (IM) with Cdx2 expression. We have tried to determine if there was a link between endoscopic and histological diagnosis of IM based on the status of aberrant Cdx2 expression.

Methods

One hundred and one subjects agreed to upper gastrointestinal endoscopic examination, with biopsy sampling for histology, Giemsa, and Cdx2 immunohistochemical staining before and after the treatment. On endoscopic examination, atrophic gastritis was defined as discoloration with blood vessel transparency, and was classified as either closed or open. Metaplastic gastritis was defined by the presence of whitish patches, whitish plaques, and/or homogeneous whitish discoloration. Histologic analysis was performed to determine H. pylori density, intensity of acute polymorphonuclear cell infiltrates and chronic mononuclear infiltrates, gastric atrophy, and IM as demonstrated using immunohistochemistry for cdx2.

Results

Cdx2 protein expression (P = 0.018) and the prevalence of histologically detected IM (P = 0.011) were higher in cases of endoscopically diagnosed open-type atrophic gastritis and metaplastic gastritis than in closed-type atrophic gastritis and nonatrophic/nonmetaplastic cases. The degree of activity (P = 0.006) and inflammation (P = 0.007) improved significantly after four weeks of successful H. pylori eradication treatment, whereas the degree of atrophy, metaplasia, and Cdx2 expression did not.

Conclusions

Unlike endoscopic diagnosis of closed-type atrophic gastritis, that of open-type atrophic gastritis is highly correlated with the histological diagnosis of IM and Cdx2 expression. Endoscopically diagnosed open-type atrophic gastritis and endoscopically diagnosed metaplastic gastritis have similar histological features, which suggests that a high percentage of IM cases are diagnosed as open-type atrophic gastritis by endoscopic examination.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Correa P. A human model of gastric carcinogenesis. Cancer Res. 1988;48:3554–3560.

    PubMed  CAS  Google Scholar 

  2. Shiotani A, Nishi R, Uedo N, et al. Helicobacter pylori eradication prevents extension of intestinalization even in the high-risk group for gastric cancer. Digestion. 2010;81:223–230.

    Article  PubMed  Google Scholar 

  3. Silberg DG, Swain GP, Suh ER, Traber PG. Cdx1 and cdx2 expression during intestinal development. Gastroenterology. 2000;119:961–971.

    Article  PubMed  CAS  Google Scholar 

  4. Kaimaktchiev V, Terracciano L, Tornillo L, et al. The homeobox intestinal differentiation factor CDX2 is selectively expressed in gastrointestinal adenocarcinomas. Mod Pathol.. 2004;17:1392–1399.

    Article  PubMed  CAS  Google Scholar 

  5. Seno H, Oshima M, Taniguchi MA, et al. CDX2 expression in the stomach with intestinal metaplasia and intestinal-type cancer: prognostic implications. Int J Oncol. 2002;21:769–774.

    PubMed  CAS  Google Scholar 

  6. Bonhomme C, Duluc I, Martin E, et al. The Cdx2 homeobox gene has a tumour suppressor function in the distal colon in addition to a homeotic role during gut development. Gut. 2003;52:1465–1471.

    Article  PubMed  CAS  Google Scholar 

  7. Bai YQ, Yamamoto H, Akiyama Y, et al. Ectopic expression of homeodomain protein CDX2 in intestinal metaplasia and carcinomas of the stomach. Cancer Lett. 2002;176:47–55.

    Article  PubMed  CAS  Google Scholar 

  8. Moskaluk CA, Zhang H, Powell SM, Cerilli LA, Hampton GM, Frierson HF Jr. Cdx2 protein expression in normal and malignant human tissues: an immunohistochemical survey using tissue microarrays. Mod Pathol. 2003;16:913–919.

    Article  PubMed  Google Scholar 

  9. Mizoshita T, Tsukamoto T, Inada K, et al. Immunohistochemically detectable Cdx2 is present in intestinal phenotype elements in early gastric cancers of both differentiated and undifferentiated types, with no correlation to non-neoplastic surrounding mucosa. Pathol Int. 2004;54:392–400.

    Article  PubMed  CAS  Google Scholar 

  10. Kimura K. Chronological transition of the fundic–pyloric border determined by stepwise biopsy of the lesser and greater curvatures of the stomach. Gastroenterology. 1972;63:584–592.

    PubMed  CAS  Google Scholar 

  11. Lin BR, Shun CT, Wang TH, Lin JT. Endoscopic diagnosis of intestinal metaplasia of stomach–Accuracy judged by histology. Hepatogastroenterology. 1999;46:162–166.

    PubMed  CAS  Google Scholar 

  12. Jass JR, Filipe MI. The mucin profiles of normal gastric mucosa, intestinal metaplasia and its variants and gastric carcinoma. Histochem J. 1981;13:931–939.

    Article  PubMed  CAS  Google Scholar 

  13. Mallo GV, Rechreche H, Frigerio JM, et al. Molecular cloning, sequencing and expression of the mRNA encoding human Cdx1 and Cdx2 homeobox. Down-regulation of cdx1 and cdx2 mRNA expression during colorectal carcinogenesis. Int J Cancer. 1997;74:35–44.

    Article  PubMed  CAS  Google Scholar 

  14. Mutoh H, Hakamata Y, Sato K, et al. Conversion of gastric mucosa to intestinal metaplasia in cdx2-expressing transgenic mice. Biochem Biophys Res Commun. 2002;294:470–479.

    Article  PubMed  CAS  Google Scholar 

  15. Shiotani A, Iishi H, Uedo N, et al. Helicobacter pylori-induced atrophic gastritis progressing to gastric cancer exhibits sonic hedgehog loss and aberrant CDX2 expression. Aliment Pharmacol Ther. 2006;24(Suppl 4):71–80.

    PubMed  Google Scholar 

  16. Rokkas T, Filipe MI, Sladen GE. Detection of an increased incidence of early gastric cancer in patients with intestinal metaplasia type III who are closely followed up. Gut. 1991;32:1110–1113.

    Article  PubMed  CAS  Google Scholar 

  17. Liu Q, Teh M, Ito K, Shah N, Ito Y, Yeoh KG. CDX2 expression is progressively decreased in human gastric intestinal metaplasia, dysplasia and cancer. Mod Pathol. 2007;20:1286–1297.

    Article  PubMed  CAS  Google Scholar 

  18. Shiotani A, Uedo N, Iishi H, et al. Re-expression of sonic hedgehog and reduction of CDX2 after Helicobacter pylori eradication prior to incomplete intestinal metaplasia. Int J Cancer. 2007;121:1182–1189.

    Article  PubMed  CAS  Google Scholar 

  19. Uedo N, Ishihara R, Iishi H, et al. A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy. Endoscopy. 2006;38:819–824.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by Konkuk University in 2010.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, South Korea

    Su Young Ahn, Sun-Young Lee, Sung Noh Hong, Jeong Hwan Kim, In-Kyung Sung, Hyung Seok Park, Chan Sup Shim & Choon Jo Jin

  2. Department of Pathology, Konkuk University School of Medicine, Seoul, Korea

    Hye Seung Han

Authors
  1. Su Young Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sun-Young Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sung Noh Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeong Hwan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. In-Kyung Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyung Seok Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chan Sup Shim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Choon Jo Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hye Seung Han
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sun-Young Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ahn, S.Y., Lee, SY., Hong, S.N. et al. Endoscopic Diagnosis of Open-Type Atrophic Gastritis Is Related to the Histological Diagnosis of Intestinal Metaplasia and Cdx2 Expression. Dig Dis Sci 56, 1119–1126 (2011). https://doi.org/10.1007/s10620-010-1531-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-010-1531-8

Keywords

Search

Navigation