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Journal of Clinical Immunology

, Volume 38, Issue 7, pp 768–777 | Cite as

Gastric Cancer Screening in Common Variable Immunodeficiency

  • David K. van der Poorten
  • Duncan McLeod
  • Golo Ahlenstiel
  • Scott Read
  • Avelyn Kwok
  • Cositha Santhakumar
  • Milan Bassan
  • Suzanne Culican
  • David Campbell
  • Sue W. J. Wong
  • Louise Evans
  • Bilel Jideh
  • Alisa Kane
  • Constance H. Katelaris
  • Karuna Keat
  • Yanna Ko
  • Jessie A. Lee
  • Sandhya Limaye
  • Ming Wei Lin
  • Ari Murad
  • Martina Rafferty
  • Dan Suan
  • Sanjay Swaminathan
  • Sean D. Riminton
  • Catherine Toong
  • Lucinda J. Berglund
Original Article

Abstract

Individuals with common variable immunodeficiency (CVID) have an increased risk of gastric cancer, and gastrointestinal lymphoma, yet screening for premalignant gastric lesions is rarely offered routinely to these patients. Proposed screening protocols are not widely accepted and are based on gastric cancer risk factors that are not applicable to all CVID patients. Fifty-two CVID patients were recruited for screening gastroscopy irrespective of symptoms or blood results and were compared to 40 controls presenting for gastroscopy for other clinical indications. Overall, 34% of CVID patients had intestinal metaplasia (IM), atrophic gastritis or moderate to severe non-atrophic gastritis, which can increase the risk of gastric cancer, compared to 7.5% of controls (p < 0.01). Focal nodular lymphoid hyperplasia, a precursor lesion for gastrointestinal lymphoma, was seen in eight CVID patients (16%), one of whom was diagnosed with gastrointestinal lymphoma on the same endoscopy. High-risk gastric pathology was associated with increased time since diagnosis of CVID, smoking, Helicobacter pylori, a low-serum pepsinogen I concentration, and diarrhea, but not pepsinogen I/II ratio, iron studies, vitamin B12 levels or upper gastrointestinal symptoms. There was a lower rate of detection of IM when fewer biopsies were taken, and IM and gastric atrophy were rarely predicted by the endoscopist macroscopically, highlighting the need for standardized biopsy protocols. The prevalence of premalignant gastric lesions in patients with CVID highlights the need for routine gastric screening. We propose a novel gastric screening protocol to detect early premalignant lesions and reduce the risk of gastric cancer and gastric lymphoma in these patients.

Keywords

Common variable immunodeficiency CVID gastric cancer gastroscopy intestinal metaplasia 

Abbreviations

CVID

common variable immunodeficiency

FNLH

focal nodular lymphoid hyperplasia

GI

gastrointestinal

H. pylori

Helicobacter pylori

Ig

immunoglobulin

IM

intestinal metaplasia

N/A

not applicable

Notes

Acknowledgments

The authors thank the patients and their families for their participation.

Compliance with Ethical Standards

The study was approved by the Western Sydney Local Health District Human Research Ethics Committee, with local governance approval at each site.

Competing Interests

The authors declare that have no competing interests.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • David K. van der Poorten
    • 1
    • 2
  • Duncan McLeod
    • 3
    • 4
  • Golo Ahlenstiel
    • 2
    • 5
    • 6
    • 7
  • Scott Read
    • 7
  • Avelyn Kwok
    • 8
  • Cositha Santhakumar
    • 8
  • Milan Bassan
    • 9
    • 10
  • Suzanne Culican
    • 4
  • David Campbell
    • 4
  • Sue W. J. Wong
    • 4
  • Louise Evans
    • 10
    • 11
  • Bilel Jideh
    • 1
  • Alisa Kane
    • 11
  • Constance H. Katelaris
    • 12
    • 13
  • Karuna Keat
    • 12
    • 13
  • Yanna Ko
    • 14
  • Jessie A. Lee
    • 11
  • Sandhya Limaye
    • 2
    • 14
  • Ming Wei Lin
    • 2
    • 15
  • Ari Murad
    • 11
  • Martina Rafferty
    • 14
  • Dan Suan
    • 2
    • 15
    • 16
  • Sanjay Swaminathan
    • 2
    • 15
  • Sean D. Riminton
    • 2
    • 14
  • Catherine Toong
    • 4
    • 10
    • 11
    • 14
  • Lucinda J. Berglund
    • 2
    • 4
    • 15
  1. 1.Department of Gastroenterology and HepatologyWestmead HospitalSydneyAustralia
  2. 2.Faculty of MedicineThe University of SydneySydneyAustralia
  3. 3.Department of Anatomical PathologyWestmead HospitalSydneyAustralia
  4. 4.NSW Health PathologySydneyAustralia
  5. 5.Blacktown Clinical School, School of MedicineWestern Sydney UniversityPenrithAustralia
  6. 6.Department of Gastroenterology and HepatologyBlacktown HospitalBlacktownAustralia
  7. 7.Storr Liver Centre, Westmead Institute of Medical ResearchWestmeadAustralia
  8. 8.Department of Gastroenterology and HepatologyConcord Repatriation General HospitalSydneyAustralia
  9. 9.Department of Gastroenterology and HepatologyLiverpool hospitalSydneyAustralia
  10. 10.Faculty of MedicineThe University of New South WalesSydneyAustralia
  11. 11.Department of ImmunologyLiverpool HospitalSydneyAustralia
  12. 12.Department of ImmunologyCampbelltown HospitalCampbelltownAustralia
  13. 13.Faculty of MedicineWestern Sydney UniversitySydneyAustralia
  14. 14.Department of ImmunologyConcord Repatriation General HospitalSydneyAustralia
  15. 15.Departments of Immunology and ImmunopathologyWestmead HospitalSydneyAustralia
  16. 16.Garvan Institute of Medical ResearchSydneyAustralia

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