Gastroenterologìa (Apr 2022)
Morphofunctional parallels of the stomach in patients with chronic atrophic gastritis
Abstract
Background. Despite some progress in addressing gastric cancer, a marked reduction in morbidity in all developed countries, the search for changes that precede carcinogenesis remains relevant and far from complete. The purpose of the study: to assess the content of aggressive and protective factors of gastric juice and oral fluid in comparison with morphological changes in patients with chronic atrophic gastritis. Materials and methods. The study included 56 patients: group I included 12 patients with atrophic changes of the gastric mucosa of varying severity, group II — 24 patients with atrophic changes diagnosed with intestinal metaplasia only in the antrum of the stomach, in group III group — 20 patients with intestinal metaplasia in the body and antrum of the stomach. The control group consisted of 16 healthy individuals. Assessment of the degree of atrophy and inflammation in the gastric mucosa was performed with the subsequent determination of integral indicators — stage and degree of atrophy according to the OLGA system and metaplasia — according to the OLGIM system. According to the morphometric study of sections using a light microscope XSP-139TP (“Ulab“, Ukraine) calculated indicators: nuclear-cytoplasmic ratio, the ellipticity of the nuclei. The content of glycoproteins, sialic acids, fucose, hexosamines was determined in gastric juice and oral fluid. Results. Morphometric study showed a significant decrease in the nuclear-cytoplasmic ratio to (0.12 ± 0.04) % in patients of group III. The coefficient of ellipticity of the nuclei of native cells decreased with the development of intestinal metaplasia: in group I it was equal to (0.76 ± 0.04) %, for group II it was (0.65 ± 0.11) %, and for group III — 0.41 ± 0.12) %. In patients with intestinal metaplasia in 82 % of cases with a 3-fold increase in the content of sialic acids in gastric juice was diagnosed with an increase in hexosamines by 35 %, while patients with only atrophic changes in the stomach showed a decrease in hexosamines 2 times compared to controls (p < 0.05). The spread of intestinal metaplasia in the stomach is associated with an increase in the amount of glycoproteins and hexosamines in the oral fluid of patients, while sialic acids in this biological fluid are increased in all study groups. There are direct relationships between the presence of intestinal metaplasia in the body of the stomach and the content of glycoproteins in both gastric juice (r = 0.446, p = 0.008) and in oral fluid (r = 0.378, p = 0.021). The relationship between the content of sialic acids in gastric juice with the degree and stage of gastritis by OLGA (r = 0.431, p < 0.01; r = 0.482, p < 0.01), the level of hexosamines in oral fluid with the coefficient of ellipticity of the nuclei (r = 0.447, p = 0,037). Conclusions. A comprehensive study of morpho-functional changes in the stomach and the ratio of aggressive and projective factors of oral fluid will determine the risk groups of patients with precancerous conditions.
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