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Massironi S, Rossi RE, Milanetto AC, Andreasi V, Campana D, Nappo G, Partelli S, Gallo C, Scaravaglio M, Zerbi A, Panzuto F, Pasquali C, Falconi M, Invernizzi P. Duodenal Gastric Metaplasia and Duodenal Neuroendocrine Neoplasms: More Than a Simple Coincidence? J Clin Med 2022; 11:jcm11092658. [PMID: 35566783 PMCID: PMC9099754 DOI: 10.3390/jcm11092658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Duodenal gastric metaplasia (DGM) is considered a precancerous lesion. No data are available regarding its possible role as a risk factor for duodenal neuroendocrine neoplasms (dNENs). Aims: To assess the prevalence of DGM in a cohort of dNENs. Methods: Subgroup analysis of a retrospective study including dNEN patients who underwent surgical resection between 2000 and 2019 and were observed at eight Italian tertiary referral centers. Results: 109 dNEN patients were evaluated. Signs of DGM associated with the presence of dNEN were reported in 14 patients (12.8%). Among these patients, nine (64.4%) had a dNEN of the superior part of the duodenum, one (7.1%) a periampullary lesion, three (21.4%) a dNEN located in the second portion of the duodenum, with a different localization distribution compared to patients without DGM (p = 0.0332). Ten were G1, three G2, and in one patient the Ki67 was not available. In the group with DGM, six patients (35.7%) were classified at stage I, five (28.6%) at stage II, three (21.4%) at stage III, and no one at stage IV. In the group without DGM, 20 patients (31%) were at stage I, 15 (15%) at stage II, 42 (44%) at stage III, and 19 (20%) at stage IV (p = 0.0236). At the end of the study, three patients died because of disease progression. Conclusions: our findings might suggest that DGM could represent a feature associated with the occurrence of dNEN, especially for forms of the superior part of the duodenum, which should be kept in mind in the endoscopic follow up of patients with DGM. Interestingly, dNEN inside DGM showed a more favorable staging, with no patients in stage IV. The actual relationship and the clinical relevance of this possible association require further clarification.
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Affiliation(s)
- Sara Massironi
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (C.G.); (M.S.); (P.I.)
- Correspondence: (S.M.); (R.E.R.)
| | - Roberta Elisa Rossi
- HBP Surgery, Hepatology and Liver Transplantation Unit, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), 20133 Milan, Italy
- Correspondence: (S.M.); (R.E.R.)
| | - Anna Caterina Milanetto
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, 35122 Padua, Italy; (A.C.M.); (C.P.)
| | - Valentina Andreasi
- Pancreatic Surgery Unit, ENETS Center of Excellence, San Raffaele IRCCS, “Vita-Salute” University, 20132 Milan, Italy; (V.A.); (S.P.); (M.F.)
| | - Davide Campana
- ENETS Center of Excellence, Department of Experimental, Diagnostic and Specialty Medicine, Bologna University, St. Orsola-Malpighi University Hospital, 40138 Bologna, Italy;
| | - Gennaro Nappo
- ENETS Center of Excellence, Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy; (G.N.); (A.Z.)
| | - Stefano Partelli
- Pancreatic Surgery Unit, ENETS Center of Excellence, San Raffaele IRCCS, “Vita-Salute” University, 20132 Milan, Italy; (V.A.); (S.P.); (M.F.)
| | - Camilla Gallo
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (C.G.); (M.S.); (P.I.)
| | - Miki Scaravaglio
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (C.G.); (M.S.); (P.I.)
| | - Alessandro Zerbi
- ENETS Center of Excellence, Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy; (G.N.); (A.Z.)
| | - Francesco Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant’Andrea University Hospital, 00189 Rome, Italy;
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Claudio Pasquali
- Pancreatic and Endocrine Digestive Surgical Unit, Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, 35122 Padua, Italy; (A.C.M.); (C.P.)
| | - Massimo Falconi
- Pancreatic Surgery Unit, ENETS Center of Excellence, San Raffaele IRCCS, “Vita-Salute” University, 20132 Milan, Italy; (V.A.); (S.P.); (M.F.)
| | - Pietro Invernizzi
- Division of Gastroenterology, San Gerardo Hospital, University of Milano-Bicocca School of Medicine, 20900 Monza, Italy; (C.G.); (M.S.); (P.I.)
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Watanabe H. Intestinal metaplasia -the effect of Acid on the gastric mucosa and gastric carcinogenesis-. J Toxicol Pathol 2010; 23:115-23. [PMID: 22272022 PMCID: PMC3234614 DOI: 10.1293/tox.23.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 06/02/2010] [Indexed: 12/25/2022] Open
Abstract
This review concerns stem cells and their relation to intestinal metaplasia. When
gastric regions of mice, Mongolian gerbils or several strains of rats were
irradiated with a total dose of 20 Gy of X-rays given in two fractions,
intestinal metaplasia was only induced in rats. In addition, it was greatly
influenced by rat strain and sex. Alkaline phosphatase (ALP) positive
metaplastic foci were increased by administration of ranitidine (H2
receptor antagonist), crude stomach antigens or subtotal resection of the fundus
and decreased by cysteamine (gastric acid secretion stimulator), histamine or
removal of the submandibular glands. Recent studies have shown that
Cdx2 transgenic mice with gastric achlorhydria develop
intestinal metaplasia and that in men and animals, Helicobacterpylori (H. pyrlori) infection can cause intestinal metaplasias
that are reversible on eradication. Our results combined with findings for
H. pylori infection or eradication and transgenic mice
suggest that an elevation in the pH of the gastric juice due to disappearance of
parietal cells is one of the principal factors for development of reversible
intestinal metaplasia. When different organs were transplanted into the stomach
or duodenum, they were found to transdifferentiate into gastric or duodenal
mucosae, respectively. Organ-specific stem cells in normal non-liver tissues
(heart, kidney, brain and skin) also differentiate into hepatocytes when
transplanted into an injured liver. Therefore, stem cells have a multipotential
ability, transdifferentiating into different organs when transplanted into
different environments. Finally, intestinal metaplasia has been found to
possibly increase sensitivity to the induction of tumors by colon carcinogens of
the 1,2-dimethylhydrazine (DMH), azoxymethane (AOM) or
2-amino-1-methyl-6-phenylimidazo[4.5-b]pyridine (PhIP) type. This carcinogenic
process, however, may be relatively minor compared with the main gastric
carcinogenesis process induced by N-methy1-N’-nitro-N-nitrosoguanidine (MMNG) or
N-methylnitrosourea (MNU), which is not affected by the presence of intestinal
metaplasia. The protocol used in these experiments may provide a new approach to
help distinguish between developmental events associated with intestinal
metaplasia and gastric tumors.
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Affiliation(s)
- Hiromitsu Watanabe
- Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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Li XB, Ge ZZ, Chen XY, Liu WZ. Duodenal gastric metaplasia and Helicobacter pylori infection in patients with diffuse nodular duodenitis. ACTA ACUST UNITED AC 2008; 40:897-902. [PMID: 17653441 DOI: 10.1590/s0100-879x2006005000117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 04/26/2007] [Indexed: 11/22/2022]
Abstract
Whether the regression of gastric metaplasia in the duodenum can be achieved after eradication of Helicobacter pylori is not clear. The aim of the present study was to investigate the relationship between H. pylori infection and gastric metaplasia in patients with endoscopic diffuse nodular duodenitis. Eighty-six patients with endoscopically confirmed nodular duodenitis and 40 control patients with normal duodenal appearance were investigated. The H. pylori-positive patients with duodenitis received anti-H. pylori triple therapy (20 mg omeprazole plus 250 mg clarithromycin and 400 mg metronidazole, all twice daily) for one week. A control endoscopy was performed 6 months after H. pylori treatment. The H. pylori-negative patients with duodenitis received 20 mg omeprazole once daily for 6 months and a control endoscopy was performed 2 weeks after treatment. The prevalence of H. pylori infection was 58.1%, and the prevalence of gastric metaplasia was 57.0%. Seventy-six patients underwent endoscopy again. No influence on the endoscopic appearance of nodular duodenitis was found after eradication of H. pylori or acid suppression therapy. However, gastric metaplasia significantly decreased and complete regression was achieved in 15/28 patients (53.6%) 6 months after eradication of H. pylori, accompanied by significant improvement of other histological alterations. Only mild chronic inflammation, but not gastric metaplasia, was found in the control group, none with H. pylori infection in the duodenal bulb. Therefore, H. pylori infection is related to the extent of gastric metaplasia in the duodenum, but not to the presence of diffuse nodular duodenitis.
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Affiliation(s)
- X B Li
- Department of Gastroenterology, Renji Hospital, Shanghai Institute of Digestive Diseases, Medical College of Shanghai Jiaotong University, Shanghai, China.
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Abstract
BACKGROUND In cases of known aetiology, gastric duodenal metaplasia (GMD) is a reversible lesion. In cases of unknown aetiology, the fate of GMD remains elusive. GMD was recently found in a duodenal adenoma. AIM To audit the frequency of GMD occurring in a cohort of duodenal adenomas. METHODS Filed H&E-stained sections from 306 consecutive duodenal adenomas were investigated for the presence of GMD. RESULTS 68% of the adenomas (n = 208) were from patients with familial adenomatous polyposis (FAP), and the remaining 32% (n = 98) were sporadic. GMD was found in 31.7% (66/208) of the duodenal FAP adenomas and in 59.2% (58/98) of the duodenal sporadic adenomas (p<0.05). The causes for this difference are elusive. CONCLUSIONS As for other metaplasias of the gastrointestinal tract (intestinal metaplasia of the oesophagus and of the stomach, and metaplastic-hyperplastic polyposis of the colon, known to antedate neoplastic transformation), a subset of GMDs of unknown cause might be present in the duodenal mucosa before adenomatous changes ensue. That subset of GMD might have neoplastic proclivity similar to the metaplastic epithelium in other organs of the gastrointestinal tract. The known carcinogenic effect of high concentrations of bile acids and pancreatic juices bathing the duodenal mucosa carrying an irreversible subset of GDM might set aflame the adenomatous neoplastic transformation in these patients.
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Affiliation(s)
- C A Rubio
- Gastrointestinal and Liver Pathology Research Laboratory, Department of Pathology Karolinska Institute and University Hospital, Stockholm, Sweden.
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Abstract
BACKGROUND In cases of known aetiology, gastric duodenal metaplasia (GMD) is a reversible lesion. In cases of unknown aetiology, the fate of GMD remains elusive. GMD was recently found in a duodenal adenoma. AIM To audit the frequency of GMD occurring in a cohort of duodenal adenomas. METHODS Filed H&E-stained sections from 306 consecutive duodenal adenomas were investigated for the presence of GMD. RESULTS 68% of the adenomas (n = 208) were from patients with familial adenomatous polyposis (FAP), and the remaining 32% (n = 98) were sporadic. GMD was found in 31.7% (66/208) of the duodenal FAP adenomas and in 59.2% (58/98) of the duodenal sporadic adenomas (p<0.05). The causes for this difference are elusive. CONCLUSIONS As for other metaplasias of the gastrointestinal tract (intestinal metaplasia of the oesophagus and of the stomach, and metaplastic-hyperplastic polyposis of the colon, known to antedate neoplastic transformation), a subset of GMDs of unknown cause might be present in the duodenal mucosa before adenomatous changes ensue. That subset of GMD might have neoplastic proclivity similar to the metaplastic epithelium in other organs of the gastrointestinal tract. The known carcinogenic effect of high concentrations of bile acids and pancreatic juices bathing the duodenal mucosa carrying an irreversible subset of GDM might set aflame the adenomatous neoplastic transformation in these patients.
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Affiliation(s)
- C A Rubio
- Gastrointestinal and Liver Pathology Research Laboratory, Department of Pathology Karolinska Institute and University Hospital, Stockholm, Sweden.
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Abstract
AIM: To investigate the ultrastructural and morphological changes of non-specific duodenitis (NSD) in an attempt to grade them according to the extent of the lesions.
METHODS: Biopsies were taken from the mucosa of duodenal bulb of 44 patients selected from the patients undergoing upper gastrointestinal endoscopy for epigastric discomforts. From each patient, two pinch biopsies on the same area were obtained from duodenal bulb. One was for scanning electron microscopy and the other was stained with hematoxylin-eosin, Warthin-Starry silver and both were then examined under light microscope. A total of 12 specimens (three from each degree of the normal and I-III of NSD diagnosed and graded by histology) selected from the 44 patients were dehydrated, critical point dried, coated with gold palladium and examined under a JEOL JSM-30 scanning electron microscope (SEM) at 20 kV.
RESULTS: According to the ultrastructural morphologic changes, non-specific duodenitis was divided into normal (as control group), mild, moderate and severe degrees according to results of SEM. The normal villi of duodenal bulb were less than 0.2 mm. There were inflammation cells, occasionally red blood cells and macrophages on the mucosal epithelial surface. Erosion and desquamation of epithelium could be seen. Three cases (25%, 3/12) had gastric metaplasia and Helicobacter pylori (H pylori) infection could be found in 5 cases (41.67%, 5/12) in duodenal bulb mucosa. The most distinctive feature was the ulcer-like defect on the surface of epithelial cells.
CONCLUSION: Non-specific duodenitis is a separate entity disease caused by different factors. SEM is of value as an aid in the diagnosis of mucosal diseases of duodenum.
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Affiliation(s)
- Cheng-Xin Wang
- Department of Pathology and Pathophysiology, School of Medicine and Life Sciences, Jianghan University, Wuhan 430056, Hubei Province, China.
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Abstract
Duodenal mucosa, especially its proximal portion, is exposed to intermittent pulses of gastric acid (H+). This review summarises the mechanisms of duodenal bicarbonate (HCO3-) secretion and their role in protecting duodenal epithelium against gastric H+. Duodenal epithelium is a leaky barrier against gastric H+, which diffuses into duodenocytes, but fails to damage them due to: (a) an enhanced expression of cyclooxygenase, producing protective prostaglandins and expression of nitric oxide synthase, releasing nitric oxide, both stimulating duodenal HCO3- secretion and (b) the release of several neurotransmitters also stimulating HCO3- secretion such as vasoactive intestinal peptide, pituitary adenylate cyclase-activating polypeptide, acetylcholine and melatonin. At the apical duodenocyte membrane, several HCO3-/Cl- anion exchangers operate in response to luminal H+ to extrude HCO3- into duodenal lumen. In baso-lateral duodenocyte membrane, both non-electrogenic and electrogenic Na+-HCO3- cotransporters are activated after exposure of duodenum to gastric H+, causing inward movement of HCO3- from extracellular fluid to duodenocytes. There are also at least three Na+/H+ exchangers, eliminating H+ which diffused into these cells. The Helicobacter pylori infection with gastric metaplasia in the duodenum and bacterium inoculation results in the inhibition of HCO3- secretion by its endogenous inhibitor dimethyl arginine, resulting in ulcerogenesis.
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Affiliation(s)
- P C Konturek
- First Department of Medicine, University Erlangen-Nuernberg. Erlangen, Germany
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Adamopoulos AB, Efstathiou SP, Tsioulos DI, Tzamouranis DG, Tsiakou AG, Tiniakos D, Mountokalakis TD. Bleeding duodenal ulcer: comparison between Helicobacter pylori positive and Helicobacter pylori negative bleeders. Dig Liver Dis 2004; 36:13-20. [PMID: 14971811 DOI: 10.1016/j.dld.2003.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS To provide a direct comparison of Helicobacter pylori-positive subjects bleeding from duodenal ulcer with H. pylori-negative ones, in terms of severity of bleeding and outcome. PATIENTS AND METHODS A case-control study was prospectively conducted in 105 H. pylori-negative duodenal ulcer bleeders and same number of sex- and age-matched H. pylori-positive ones. RESULTS NSAID consumption was more common among H. pylori-negative subjects (81%) compared to their H. pylori-positive counterparts (58.1%, P < 0.001). H. pylori-negative bleeders were found to need more often haemostasis (55.2% versus 31.4%, P < 0.001) or surgical intervention (15.2% versus 4.8%, P = 0.011) and to have a greater proportion of rebleeding (32.4% versus 13.3%, P = 0.001), a more prolonged hospitalisation (11.6 +/- 4.1 versus 6.2 +/- 1.5 days, P < 0.001) and a higher rate of in-hospital mortality (15.2% versus 3.8%, P = 0.005). In the overall population (N = 210), H. pylori negativity, among other known risk factors, emerged as independent predictor (odds ratio: 3.2; 95% CI: 1.5, 11.2; P = 0.004) of an unfavourable outcome (surgery or death). CONCLUSIONS Duodenal ulcer bleeding in H. pylori-negative subjects appears to be more severe, to have a higher rate of rebleeding, and to lead more often to surgery or fatality compared to the vast majority of H. pylori-positive duodenal ulcer bleeders.
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Affiliation(s)
- A B Adamopoulos
- Third Department of Internal Medicine, University of Athens, Medical School, Sotiria General Hospital, Building Z, Mesogion 152, 11527 Athens, Greece.
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