Neuroendocrine Tumour as a Diagnostic and Prognostic Criterion for Autoimmune Gastritis

Autoimmune gastritis and stomach cancer: assessing the risks

The purpose of this publication is to systematize available data on the risks of developing stomach cancer in patients with a chronic autoimmune gastritis with a demonstration of the clinical case of a patient with a chronic autoimmune gastritis and a neuroendocrine gastric tumor of the type 1. Discussion: the article discusses the risks of stomach cancer in patients with chronic autoimmune gastritis. A mechanism for the formation of a neuroendocrine gastric tumor of the type 1, associated with autoimmune gastritis, is given. A clinical example of a patient with a long history of dyspepsia, the presence of concomitant changes in the results of laboratory tests, describes an algorithm for diagnosis of autoimmune gastritis and associated neuroendocrine tumors. The risks of the development in patients with autoimmune gastritis of formidable complications as an adenocarcinoma of the stomach are considered. Conclusion: Chronic autoimmune gastritis is a precancerous diseases of the stomach, with the progressive atrophy of the gastric body mucosa, and associated with an increased risk of developing neuroendocrine gastric tumor of the type 1 and adenocarcinoma of the stomach. Patients with autoimmune gastritis need dynamic outpatient observation, with endoscopic control and assessment of the degree and stage of gastritis in OLGA system, with immunogistochemistry to evaluate the risks of stomach cancer and timely implementation of the necessary measures of carcinoprection.

Are physicians ready to comply with the guidelines for diagnosis and management of Helicobacter pylori-associated diseases: the survey results 2020–2021

Objective: To assess compliance of physicians with diagnostic and management guidelines for H. pylori-associated diseases with a question-naire-based survey.

Materials and methods: We conducted an anonymous voluntary online survey of 775 physicians of the following specialties: internal medicine 459 (59.2%), gastroenterology 279 (36%), and endoscopy 34 (4.4%). The respondents expressed their level of agreement with the questionnaire items as follows: 0 – I do not know, 1 – disagree, 2 – partially agree, and 3 – fully agree.

Results: 613 (79.4%) of the physicians fully agreed to diagnose and treat H. pylori in patients with chronic atrophic gastritis, 602 (78.0%) in the 1 st degree relatives of gastric cancer patients, 525 (68.0%) in patients with chronic superficial gastritis, 423 (54.8%) in peptic ulcer at remission, and 336 (43.4%) in those with dyspepsia syndrome. The physicians were equally compliant with eradication therapy in the patients, for whom long term use of proton pump inhibitors (PPI) or non-steroid anti-inflammatory drugs (NSAID) is being planned (386 (50.0%) and 397 (51.4%), respectively). Internists were less compliant with diagnosis and management of H. pylori in patients taking both PPI (χ2 = 66.525, p = 0.004) and NSAID (χ2 = 103.354, p = 0.003). Among the primary diagnostic tools for H. pylori the physicians preferred 13/14С-urease breath test (545 physicians, or 70.6%) and gastric bioptate morphology (574, or 74.4%), and among the control diagnostic methods they chose fаeces analyses (enzyme-linked immunosorbent assay and polymerase chain reaction). The respondents considered bismuth-enhanced standard triple therapy with clarithromycin to be the most effective regimen for the 1 st line eradication therapy (606, 78.5%). To increase the efficacy of eradication therapy, the physicians were more prone to administer esomeprazole or rabeprazole (70.6%), bismuth-based agents (79.4%), than to use rebamipid (35%), probiotics (44.9%) and/or to double PPI doses (44.2%). The respondents expressed their concerns with low patient compliance to treatment (59.4%) and limited diagnostic capabilities (49.4%).

Conclusion: Physician's compliance with the guidelines on diagnosis and management of H. pylori-associated diseases is adequate and might depend on both their awareness and availability of the proposed diagnostic and therapeutic methods.