Korean J Helicobacter Up Gastrointest Res.  2011 Jun;11(1):52-58. 10.7704/kjhugr.2011.11.1.52.

Clinical Parameters Including Serum Pepsinogen Level and Management Strategy in Patients with Gastric Low-Grade Dysplasia

• Cho JH
• Chang YW
• Hwangbo Y
• Shim J
• Jang JY
• Kim HJ
• Kim BH

• KMID: 2305189
• DOI: http://doi.org/10.7704/kjhugr.2011.11.1.52

Abstract

BACKGROUND/AIMS
There are no proper guidelines for the management of gastric low-grade dysplasia (LGD). We evaluated clinical parameters, histological results and follow-up endoscopies to find a management strategy of LGD.
MATERIALS AND METHODS
A total of 590 patients with LGD, high-grade dysplasia (HGD), functional dyspepsia (FD), early or advanced gastric cancer (early gastric cancer [EGC] or advanced gastric cancer [AGC]) were consecutively enrolled. We examined the association of clinical parameters including low serum pepsinogen (PG) I/II ratio < or =3.0 with the disease phenotypes. Histological results between initial forceps-biopsy and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) specimens were compared.
RESULTS
The PG I/II ratio in FD was 4.2+/-1.7, but was significantly low in LGD (2.8+/-1.6, P<0.0001). The ratio was not further decreased in the HGD, EGC, and AGC groups. In FD patients with the ratio of < or =3.0, smoking habits and high salt intake were independent risk factors for gastric dysplasia or gastric cancer. In about 11% (n=8/70) of LGD lesions, the pathologic diagnoses were upgraded to HGD or EGC after endoscopic resection. Neither serious complications nor recurrence at the primary site were found.
CONCLUSIONS
It is proposed that endoscopic resection followed by endoscopic surveillance might be a beneficial strategy for patients with LGD having a PG I/II ratio of < or =3.0.

Keyword

Stomach neoplasms; Pepsinogen

MeSH Terms

Dyspepsia
Follow-Up Studies
Humans
Pepsinogen A
Phenotype
Recurrence
Risk Factors
Smoke
Smoking
Stomach Neoplasms
Pepsinogen A
Smoke