Gastric epithelial dysplasia

• Published in: Gut Vol. 45; no. 5; pp. 784 - 790
• Main Authors: LAUWERS, G Y, RIDDELL, R H
• Format: Journal Article Book Review
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01-11-1999; BMJ; BMJ Publishing Group LTD
• Subjects: Biological and medical sciences; Classification; Endoscopy; Gastric cancer; Gastric Mucosa - pathology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Infections; Medical sciences; Observer Variation; Population; Precancerous Conditions - classification; Precancerous Conditions - pathology; Review; Stomach Neoplasms - classification; Stomach Neoplasms - pathology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; Asia; Japan; Human; Stomach; Dysplasia; West; Stage classification; Etiopathogenesis; Review; Epithelium; Handbook; Recommendation; Pathology; Histopathology; Digestive diseases; Benign neoplasm; Diagnosis; Gastric disease
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.45.5.784

In the field of gastrointestinal pathology the term dysplasia is used by histopathologists to describe premalignant lesions. 1-3 In the stomach, like any other segment of the gut, it is defined as an unequivocal neoplastic non-invasive epithelial alteration. 1 4 The observation of gastric dysplasia as a precursor lesion of gastric cancer was made over a century ago, but it is only with the accrued use of upper endoscopy that its clinical significance has been stressed. 5 Thus, the relevance of standardising the diagnostic criteria for gastric dysplasia and early invasive carcinoma, and of refining our understanding of its natural history have become increasingly important. Epidemiological and histopathological studies pioneered by Correa have shown that intestinal type gastric cancer frequently develops through a sequence of histological events: namely diffuse chronic gastritis, often mucosal atrophy, intestinal metaplasia (complete and/or incomplete), dysplasia, and finally invasive carcinoma. 15 Following this scheme gastric dysplasia usually develops in the setting of intestinal metaplasia (frequently of incomplete type) although it may also occur in apparently normal gastric mucosa. 16 Several prospective and retrospective serological studies have now linked Helicobacter pylori infection to gastric cancer. 17-20 Helicobacter pylori infection is clearly associated with the induction of chronic inflammation of the gastric mucosa and the progressive development of metaplastic changes. 21 However, the exact biological role of Helicobacter pylori in the genesis of neoplastic changes is not clearly established.