Murat CİĞERİM, Ahmet TÜZÜN, Mustafa GÜLŞEN, Yüksel ATEŞ, Ömer GÜNHAN, Zülfikar POLAT, Murat ASLAN, Necmettin KARAEREN, Kemal DAĞALP

Skuamokolumnar bileşkede inflamasyon ve intestinal metaplazi: Helicobecter pylori infeksiyonunun rolü

Giriş ve amaç: Batı ülkelerinde Helicobacter pylori (Hp) prevalansmın azalması ile birlikte, özofagus ve kardiya adenokarsinomalarının insidansında artış olduğu bildirilmektedir. Türkiye'de yetişkin popülasyonda Hp pozitifliği halen %75'in üzerindedir. Klasik Barrett özofagusu bulunmayan hastalarda, gastroözofageal bileşkedeki adenokarsinomalann, gastroskopiye giren hastaların % 9-36'sında saptanan, skuamokolumnar bileşkedeki intestinal metaplazi (İM) odaklarından köken aldıkları görülmektedir. ÎM'nin, kronik inflamasyonun bir sonucu olduğu var sayılmaktadır. Skuamokolumnar bileşke (SKB)'deki ÎM'de, bu bölgedeki inflamasyon gibi, Hp veya gastroözofageal reflü hastalığı ile ilişkilidir. Bu çalışmanın amacı, SKB'deki inflamasyon ve İM'nin, Hp pozitifliği yüksek olan bir popülasyonda araştırılması; sözkonusu bakteri ile mul-tipl endoskopik biyopsi örnekleri alınarak olası korelasyonlarını belirlemektir. Gereç ve yöntem: Bu çalışmada, özofagogastroduodenoskopi için başvuran 38 hastada (30 erkek, 8 kadın) gastrik fundus, korpus, antrum, postbulber bölge, SKB ve özofagustan endoskopik biyopsiler alındı. Biyopsi örnekleri tek bir patolog tarafından inflamasyon, aktivite, atrofi varlığı, gastrik ve kardiyak İM açısından değerlendirildi. Bulgular: Sonuçta çalışma grubunda 36 gastrit hastasının 29'unda kronik Hp gastriti; 38 hastanın 28'inde (% 73.5) histolojik özofajit; 38 hastanın 37'sinde (%97) SKB'de inflamasyon, 5'inde (%13) İM (4'ü komplet, 1'i in-komplet) saptandı. Fundus, korpus ve antrumdaki inflamasyon ve aktivite arasında anlamlı korelasyon saptandı (p

Anahtar Kelimeler:

Biyopsi, Helicobacter pylori, Endoskopi, sindirim sistemi, Yaygınlık, Metaplazi, Adenokarsinom

Inflamation and intestinal metaplasia in the squamocolumnar junction: The role of Helicobacter pylori infection

Background/aim: It is reported that the incidence of adenocarcinoma of the cardia and esophagus has increased in western countries simultaneously with a decrease in Helicobacter pylori (Hp) prevalence. In Turkey, Hp positivity is still above 75% in the adult population. In patients without classic Barrett's esophagus, adenocarcinomas of the gastroesopha-geal junction appear to arise from foci of intestinal metaplasia (IM) at the squamocolumnar junction (SCJ), which occur in 9-36% of patients un¬dergoing gastroscopy. IM is assumed to be a consequence of chronic inflammation. Like inflammation at the SCJ, IM at the cardia has also been associated either with Hp gastritis or with gastroesophageal reflux disease. The aim of this study was detection of IM and inflammation at SCJ in a population with high Hp positivity, by multiple biopsy speci¬mens, and definition of probable correlations. Materials and methods: In this study, endoscopic biopsy specimens were taken from 38 patients» (30 male, 8 female) who presented for esophagogastroduodenoscopy (from gastric fundus, corpus, antrum, second portion of duodenum, SCJ, esophagus). Biopsy specimens were examined by one pathologist for inflammation, activity, and presence of atrophy and gastric-cardiac IM. Results: Chronic Hp gastritis was detected in 29 of 36 patients with gastritis; histologic esophagitis in 28 of 38 patients (73.5%); inflammation at SCJ in 37 of 38 patients (97%); and IM at SCJ in 5 of 38 patients (13%)(4 complete, 1 incomplete). A significant correlation was detected between inflammation and activity in fundus, corpus and antrum (p<0.05). Biopsy specimens taken from the columnar side of the SCJ were oxyntic in 24, cardiac in 12, and squamous in 1. Comparison of the patients detected to have oxyntic and cardiac mucosa revealed that the mean age of the patients in the first group was significantly lower than that of the second group (p<0.01). Conclusion: We have shown, in a population with high Hp prevalence, a correlation between inflammation at the gastric cardia and IM with chronic gastritis caused by the aforementioned bacterium; but put forward complete type IM, which is infrequently associated with adenocarcinoma, has been seen.

Keywords:

Biopsy, Helicobacter pylori, Endoscopy, Digestive System, Prevalence, Metaplasia, Adenocarcinoma,

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