title: Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy.
abstract: BACKGROUND
  Intestinal metaplasia (IM) is regarded as a premalignant lesion. However, endoscopic diagnosis of IM has been considered difficult. Using endoscopy, we found a unique pattern of erythema, "Mottled Patchy Erythema (MPE)," which includes severe IM.Helicobacter pylori(Hp) infection itself can cause erythema, which reflects histologic changes in the gastric mucosa. Therefore we enrolledHperadication patients to validate the relation between MPE and pathologic findings.
  
  
  METHODS
  We enrolled patients with chronic gastritis who underwent successfulHperadication at least 6 months before the study. We defined MPE as multiple flat or depressed erythematous lesions. When encountering MPE on endoscopy, we performed biopsy on both the MPE site and non-MPE site. The non-MPE site was defined as an adjacent mucosa located within 3 cm of the MPE site. All biopsy specimens were evaluated immunohistochemically for IM subtype using MUC2, MUC5AC, MUC6, CD10, and CDX2 stains. The degree of IM was defined according to the Updated Sydney System. The diagnostic accuracy of the MPE findings for pathologic IM was calculated. The relation between MPE and IM subtype was also assessed.
  
  
  RESULTS
  A total of 102 patients were selected for the study. Of these, 55 (54%) patients had MPE. Biopsy specimens were taken from the MPE sites and non-MPE sites from these 55 patients. The IM percentages and median scores of IM were both significantly higher at the MPE sites (P < 0.001) than at the non-MPE sites. The sensitivity and specificity for MPE in the detection of histologic IM were 72.7% and 84.1%, respectively. No significant associations were observed in the expression of MUC2, MUC5AC, MUC6, CD10, and CDX2 between the MPE sites and non-MPE sites. There were no significant differences in the ratios (complete/incomplete) of IM subtypes between the two groups.
  
  
  CONCLUSIONS
  MPE is a useful endoscopic finding to detect histologic IM without the use of chromoendoscopy and magnifying endoscopy. However, the IM subtype is difficult to identify. In the era ofHperadication, MPE has the potential to become a predictive finding for the risk of gastric cancer.
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine (NCGM), Tokyo, Japan.
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.affiliation: Department of Clinical Research and Informatics International Clinical Research Center Research Institute, NCGM, Tokyo, Japan.
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine (NCGM), Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine (NCGM), Tokyo, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Nakashima
authors.affiliation: Division of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Hyung Hun
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology and Hepatology, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takeichi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Clinical Laboratory Pathological Division, NCGM, Tokyo, Japan.
authors.forename: Kazufusa
authors.initials: K
authors.lastname: Hoshimoto
authors.affiliation: Department of Gastroenterology and Hepatology, NCGM, Kohnodai Hospital, Chiba, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
keywords: Endoscopic finding; Erythema; Helicobacter pylori; Intestinal metaplasia; Premalignant lesion; Subtype, eradication; White-light endoscopy