Reverzibilnost intestinalne metaplazije želodčne sluznice pri otrocih​

Drnovšek, Jan (author), Homan, Matjaž (mentor)

POVZETEK Uvod: Intestinalna metaplazija želodčne sluznice velja za ireverzibilno predrakavo spremembo pri nastanku adenokarcinoma želodca intestinalnega tipa pri odraslih. Glavni etiološki dejavnik za nastanek raka želodca, z izjemo kardije, ostaja okužba z bakterijo Helicobacter pylori. Poznavanje kliničnega pomena in naravnega poteka intestinalne metaplazije, ugotovljene pri otrocih, še vedno omejeno. Namen naše raziskave je bil oceniti dolgoročni izid intestinalne metaplazije želodčne sluznice, ugotovljene v otroštvu. Metode: Identificirali smo vse bolnike, mlajše od 18 let, ki so v obdobju od leta 2000 do 2020 opravili ezofagogastroduodenoskopijo na Pediatrični kliniki v Ljubljani in so imeli histopatološko potrjeno intestinalno metaplazijo želodčne sluznice. Ob prehodu v odraslo dobo (≥ 18 let) smo te bolnike povabili na kontrolno ezofagogastroduodenoskopijo s ponovnim vzorčenjem. Biopsije želodčne sluznice so bile odvzete skladno s posodobljenim Sydneyskim protokolom. Izhodiščne in kontrolne histopatološke vzorce sta pregledala dva izkušena gastrointestinalna patologa z uporabo barvanja po Kreybergu. Rezultati: Intestinalno metaplazijo želodčne sluznice smo ugotovili pri 178 bolnikih (1,2 %) izmed skupno opravljenih 14 409 ezofagogastroduodenoskopij v preiskovanem obdobju. Pri 50 odraslih pacientih z diagnosticirano intestinalno metaplazijo v otroštvu, ki so se odzvali povabilu za sodelovanje v raziskavi, smo opravili kontrolni endoskopski pregled zgornjih prebavil z biopsijami želodčne sluznice. Povprečna starost ob izhodiščni preiskavi v otroštvu je bila 14,3 leta (mediana 15 let), ob kontrolni preiskavi v odrasli dobi pa 25,2 leta (mediana 24 let). Povprečni časovni interval med obema preiskavama je znašal 10,5 leta (razpon 2-22 let). Histopatološko so vsi bolniki imeli kompletni tip IM, tako ob izhodiščni kot ob kontrolni endoskopski preiskavi. Ključna ugotovitev naše raziskave je, da je intestinalna metaplazija popolnoma regredirala pri 41/50 pacientov (82 %) do odrasle dobe. Pri nobenem izmed bolnikov nismo ugotovili displazije ali karcinoma. Tako prisotnost okužbe s Helicobacter pylori kot tudi drugi preučevani dejavniki niso bili statistično značilno povezani z obstojem intestinalne metaplazije do odrasle dobe (11,2 % proti 29,3 %, p = 0,414). Zaključek: Intestinalna metaplazija pri otrocih je redek pojav, ki ima ugoden klinični potek. Ugotovili smo visoko stopnjo njene reverzibilnosti, ne glede na status okužbe s Helicobacter pylori, brez primerov displazije ali raka želodca v povprečnem desetletnem intervalu spremljanja.

• Language: Slovenian
• Keywords: intestinalna metaplazija, otroci, prekanceroza, rak želodca, Helicobacter pylori, ezofagogastroduodenoskopija
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2025
• PID: 20.500.12556/RUL-181770
• Publication date in RUL: 15.04.2026

Secondary language

• Language: English
• Title: Reversibility of gastric intestinal metaplasia in children​

Abstract

ABSTRACT Background: Gastric intestinal metaplasia is considered an irreversible preneoplastic precursor for adult gastric intestinal-type adenocarcinoma. Helicobacter pylori infection remains the leading etiologic factor for non-cardia gastric cancer in adults. On the other hand, the natural history and significance of intestinal metaplasia in children remain poorly understood. This study aimed to assess the long-term outcome of gastric intestinal metaplasia diagnosed in childhood. Methods: All children (≤18 years) diagnosed with gastric intestinal metaplasia between 2000 and 2020 were identified at a tertiary paediatric referral centre. Upon reaching adulthood (≥18 years), the patients were invited to undergo follow-up esophagogastroduodenoscopy (using narrowed-spectrum endoscopy additionally to high-definition white light), with gastric biopsies obtained according to the updated Sydney system biopsy protocol. Childhood and adulthood gastric biopsies were re-evaluated by two experienced gastrointestinal pathologists using Kreyberg staining. Results: Paediatric gastric intestinal metaplasia was diagnosed in 178/14, 409 (1.2%) esophagogastroduodenoscopies performed during the study period. Fifty adult patients with childhood gastric intestinal metaplasia agreed to participate in the study and underwent follow-up endoscopy. The mean age at childhood and adulthood endoscopies were 14.3 years (median 15) and 25.2 years (median 24), respectively. The mean interval between both samplings was 10.5 years (range 2-22 years). All childhood gastric metaplasia cases were classified as complete type. Notably, gastric intestinal metaplasia completely resolved in 41/50 patients (82%) by the time of adulthood follow-up. No dysplasia or carcinoma was detected in any patient. Childhood Helicobacter pylori infection, similar to other evaluated host-related factors, was not significantly associated with the persistence of gastric intestinal metaplasia into adulthood (11.2% vs. 29.3%, p = 0.414). Conclusion: Childhood gastric intestinal metaplasia was a rare finding, but demonstrated a high rate of reversibility by adulthood regardless of Helicobacter pylori status, with no cases of dysplasia or carcinoma observed during long-term follow-up.

• Keywords: gastric intestinal metaplasia, children, preneoplastic lesion, gastric cancer, Helicobacter pylori, esophagogastroduodenoscopy