This is my thesis subject The role of non invasive diagnosis in the evolution of chronic atrophic gastritis

1. DIPLOMA THESIS
Ministry of Health, Labor and Social Protection of the Republic of Moldova
„Nicolae Testemiţanu” State University of Medicine and Pharmacy of the
Republic of Moldova
The role of non-invasive diagnosis in the
evolution of chronic atrophic gastritis
Author: Kewan Ibrahim Anwar
VI year, group 1751
Scientific advisor: Botezatu Adriana,
MD, PhD, assistant professor

2. DEFINITION
Chronic atrophic gastritis is a chronic inflammatory
condition of the mucosa, characterized by loss of gastric
glandular structures and their replacement by
connective tissue (apoptosis atrophy) or intestinal
epithelium (atrophy by substitution).

3. THE ACTUALITY OF THE PROBLEM
Gastric cancer is still a major global issue.
 In the latest global cancer statistics, the disease ranks
fifth for incidence (about 7% of all cancers) and,
according to various sources, is the 2-3rd leading
cause of cancer death in both sexes.
 The high incidence rate, as well as the problems of
early diagnosis of gastric cancer, determines the
importance of studying precancerous pathology.
Adamu M., Weck M., Gao L., Brenner H. Incidence of chronic atrophic gastritis: systematic
review and meta-analysis of follow-up studies. Eur J Epidemiol. 2010; 25(7): 439-448.

5. consists in elucidating the link and
interdependence between chronic atrophic gastritis
and gastric cancer.
THE AIM OF THE THESIS

6. 1. To evaluate the clinical manifestations in
patients with chronic atrophic gastritis
2. To identify the relationship between the
precancerous gastric lesions and gastric cancer.
3. To explain the relationship between infection
with H. pylori and the severity of gastric
structural changes.
4. To determine the role and value of non-invasive
serological diagnosis in the prognosis of chronic
atrophic gastritis.
THE GOALS OF THE THESIS

7. THE PATH OF GASTRO-ONCOGENESIS
Gomez J.M., Wang A.Y. Gastroenterol Hepatol (NY) 2014:10

8. HELICOBACTER PYLORI
 H.pylori infection induces chronic atrophic gastritis, which
initially develops distally (in the antrum) at the gradually
expanding antrum-body boundary line, mainly proximal (in the
body), with the development of pseudo-pyloric metaplasia and /
or intestinal metaplasia, and finally with the development of
gastric cancer.
 The speed of chronic atrophic gastritis expansion is faster on low
curvature than on high curvature.
The infection is currently considered to be the
main human pathogen - class I carcinogen
WHO, causing chronic and progressive
changes in the gastric mucosa, etiologically
related to peptic ulcers, gastric atrophy and
gastric cancer.
Chiriac D., Ţurcanu A., Berliba E., Tofan-Scutaru L., Tcaciuc E., Peltec A. Metodele invazive în diagnosticul infecției cu helicobacter pylori
– mijloace eficiente ce sporesc rata de eradicare. Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale. 2017; (3): 48-53.

9. THE CLINICAL PICTURE
Chronic atrophic gastritis is traditionally considered
asymptomatic or with nonspecific symptoms and accidentally
diagnosed, especially autoimmune chronic atrophic gastritis.
 dyspeptic syndrome (anorexia, belching, nausea, fullness
and satiety of the stomach),
 excessive bacterial growth syndrome (noise and flatulence
in the abdomen
 unstable stool, with frequent diarrhea may occur
 weight loss
 anemic syndrome
 pain syndrome
 dystrophic syndrome.
Nard Akbari M., Tabrizi R., Kardeh S., Lankarani K. Gastric cancer in patients with gastric atrophy and intestinal
metaplasia: A systematic review and meta-analysis. PLoS One. 2019; 14(7): e0219865.

10.  In 2008, a group of experts, represented by
renowned morphologists and well-known clinical
gastroenterologists, proposed a new system for
classifying gastritis - the OLGA Classification.
 The biopsy specimens were collected strictly
according to the sampling protocol defined by the
updated Sydney System and the OLGA
classification, which recommends at least 5
biopsy samples.
Bodrug N., Botezatu A., Antonova N., Luca E., Botnari C., Branişte C. et al. Rolul clasificării OLGA în gastrita cronică atrofică. Info-
Med. 2016; (2): 49-52.
OLGA HISTOLOGICAL CLASSIFICATION
(OPERATIVE LINK FOR GASTRITIS ASSESSMENT)

11.  2 biopsies of the antrum: a
fragment on the small curvature
(1) and a fragment on the large
curvature (2);
 1 biopsy from the body
transition area of the gastric
angle (3);
 2 biopsies from the gastric body:
a fragment on the small
curvature (4) and a fragment on
the middle portion of the large
curvature (5)
1
2
3
4
5
 and adjuvant target biopsies were performed in areas
with endoscopic stigmas characteristic of intestinal
metaplasia, in areas suspected of dysplasia and early
neoplasia.
Capelle L., de Vries A., Haringsma J., Ter Borg F., de Vries R., Bruno M. et al. The staging of gastritis with the OLGA system by using
intestinal metaplasia as an accurate alternative for atrophic gastritis. Gastrointest Endosc. 2010; 71(7): 1150-1158.

12. OLGA HISTOLOGICAL CLASSIFICATION
(OPERATIVE LINK FOR GASTRITIS ASSESSMENT)
Crafa P., Russo M., Miraglia C., Barchi A., Moccia F., Nouvenne A. et al. From Sidney to OLGA: an overview of atrophic
gastritis. Acta Biomed. 2018; 89(8-S): 93-99.
GASTRIC CANCER RISK STRATIFICATION

13. Stanford Department of Medicine, From Sidney to OLGA: an overview of atrophic gastritis. Acta Biomed. 2018; 89(8-S): 93-
99.
SCORING ATROPHY FOR OLGA STAGING

14. Non-invasive methods are also used to stratify
the risk of gastric cancer - serological tests to
determine the level of pepsinogen I, II, gastrin-
17 the ratio of pepsinogen I/pepsinogen II and
Ab H.pylori (GastroPanel®)
 The screening of 9293 patients in Japan showed
that in patients with a normal level of
pepsinogen I, the risk of developing gastritis into
gastric cancer is low, even if H. pylori is present.
GASTRIC CANCER RISK STRATIFICATION
Crafa P., Russo M., Miraglia C., Barchi A., Moccia F., Nouvenne A. et al. From Sidney to OLGA: an overview of atrophic
gastritis. Acta Biomed. 2018; 89(8-S): 93-99.

15. GASTRIC CANCER RISK STRATIFICATION
 In patients with low levels of pepsinogen I,
which demonstrates the presence of gastric
atrophy, the risk of developing cancer is
higher (3-6 cases per 1000 patients per year).
 Taking these data into account, it is
recommended to use the strategy “to search
and screen” widely in H. pylori-induced
gastritis, desirable before the formation of
chronic atrophic gastritis and intestinal
metaplasia.

16. MANAGEMENT FOR PRECANCEROUS CONDITIONS AND
LESIONS IN THE STOMACH (MAPS, 2012 / 2019)
1. Dinis-Ribeiro E.et al (MAPS I):
Endoscopy. 2012; 44(1): 74-94.
2. Pimentel-Nunes P.. et al. Management
of epithelial precancerous conditions and
lesions in the stomach (MAPS II):
Endoscopy. 2019; 51(4): 365-388.

17. CONCLUSIONS:
1. Chronic atrophic gastritis is considered a multifaceted
condition because it can manifest itself in a variable
spectrum of gastric and extra-gastric symptoms,
ranging from dyspeptic symptoms to gastroesophageal
reflux symptoms.
2. Chronic atrophic gastritis falls into the category of
pathologies with a high risk of developing gastric
cancer, so establishing an early diagnosis and initiating
the correct treatment is essential.

18. CONCLUSIONS:
3. As a first line in the treatment of patients with
chronic atrophic gastritis, it is mandatory to
eradicate H. pylori, such an approach significantly
reduces the risk of gastric cancer.
4. The use of serum biomarkers - GastroPanel® is a
reliable tool for the diagnosis of chronic atrophic
gastritis, which should be used as a first line for
the diagnosis and screening of people at high risk
for gastric cancer.