Different histological status of gastritis in superficial adenocarcinoma of the esophagogastric junction.
OBJECTIVE
Although many gastric cancers arise in chronic gastritis, the association between adenocarcinoma of the esophagogastric junction and the status of background gastritis remains unclear. We aim to investigate the histological status of gastritis in the background fundic gland mucosa of adenocarcinoma of the esophagogastric junction.


METHODS
The present study included 121 consecutive patients with superficial adenocarcinoma of the esophagogastric junction obtained by surgical and/or endoscopic resection. We re-evaluated the histogenesis of adenocarcinoma of the esophagogastric junction, including the background fundic gland mucosa using the Updated Sydney System. The prevalence of histologic atrophic gastric mucosa with gastritis (positive gastritis), non-atrophic gastric mucosa without gastritis (negative gastritis) and Barrett's adenocarcinoma was examined.


RESULTS
Histologic-positive gastritis was found in 67 (55%) of all patients, in 24 (38%) of 63 Barrett's adenocarcinoma patients and in 43 (74%) of 58 non-Barrett's adenocarcinoma patients (P < 0.01). A higher female ratio in non-Barrett's adenocarcinoma with gastritis patients `and younger age in non-Barrett's adenocarcinoma without gastritis patients were shown. There were no differences in clinicopathological features related to the gastritis status in Barrett's adenocarcinoma patients. Reflux esophagitis was observed in most (81%) of all patients, and 32 (74%) of the non-Barrett's adenocarcinoma with gastritis patients. In the 67 positive gastritis patients, the mean Updated Sydney System scores of glandular atrophy and intestinal metaplasia were 1.45 and 1.10, respectively, and these scores were higher in the non-Barrett's adenocarcinoma patients than in the Barrett's adenocarcinoma patients.


CONCLUSIONS
This study suggests that about half of the patients with adenocarcinoma of the esophagogastric junction harbor histological gastritis. Adenocarcinoma of the esophagogastric junction is considered to be a heterogeneous entity, including Barrett's esophagus-related, positive gastritis-related, and Barrett's esophagus and gastritis-unrelated adenocarcinoma of the esophagogastric junction.
*5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. rkushima@ncc.go.jp.
Masayoshi
M
Yamada
Ryoji
R
Kushima
Ichiro
I
Oda
Kaveh
K
Mojtahed
Satoru
S
Nonaka
Haruhisa
H
Suzuki
Shigetaka
S
Yoshinaga
Akiko
A
Matsubara
Hirokazu
H
Taniguchi
Shigeki
S
Sekine
Yutaka
Y
Saito
Tadakazu
T
Shimoda
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D001471:Barrett Esophagus / Q000453:epidemiology / Q000473:pathology; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005756:Gastritis / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D015995:Prevalence; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology*
Barrett's adenocarcinoma; Helicobacter pylori; Updated Sydney System; adenocarcinoma of the esophagogastric junction; gastritis