Search

The diagnostic value of double contrast barium meal and endoscopy was assessed in a material of 100 patients with upper abdominal symptoms. Although endoscopy turned out to be more sensitive in revealing pathologic conditions of the stomach, barium meal is by no means obsolete, provided that due attention is paid to the examination technique.

To evaluate the significance of gastritis as a cause of upper abdominal complaints consecutive cases with upper abdominal complaints have been subjected to gastroscopy with biopsies of the antral and body mucosa. The results were compared with those obtained from two representative population samples: one Finnish and one Estonian. The progression of gastritis on an individual level was expressed as an age-adjusted score. It appeared that the progression of gastritis in the series did not significantly differ from the controls, confirming our earlier experience that gastritis as such can hardly be used for the explanation of upper abdominal complaints.

The development of atrophic gastritis (AG) in antrum and body was studied in a series consisting of 301 first-degree relatives of 73 gastric carcinoma patients, and in 431 controls, that is, 73 control probands and their 358 first-degree relatives. An analysis was performed in terms of four population pools: subjects with normal mucosa and/or superficial gastritis in antrum and body; AG occurring in the antrum only; AG in the body only; AG present in antrum and body. Antral AG commenced in the patients' teens and progressed at a constant rate up to 55 years, being retarded thereafter with decreasing age-specific prevalence of AG limited to the antral mucosa. The process started later in the body, but its constant-rate progression continued up to old age. In the pool of those subjects who had both antral and body AG the development approximated that seen in the pool with body AG only. The process was qualitatively similar in the Series and in the Controls, but marked differences were observed after the age of 55 years in the transition to the different AG pools.

To elucidate the behaviour of gastritis on a family level 301 first degree relatives of 73 patients with different types of gastric carcinoma have been subjected to a closer analysis. A stochastic mathematical approach was employed in calculating mean score values for each family. In addition, the location of the tumours was taken into account. The findings are compared with those in a series of 358 first-degree relatives (the "controls") of 73 control probands, computer-matched by age and sex to the carcinoma probands. The mean progression of gastritis in the body in the carcinoma families was significantly more rapid than in the controls. In the relatives of probands with diffuse carcinoma the progression of gastritis was significantly more rapid than in the controls in both body and antrum; no such difference was seen in the families of intestinal carcinoma probands. On the other hand, a significant positive correlation was established between the location of all carcinomas and the progression of both antral and body gastritis. Furthermore, intestinal carcinoma of antral location was associated with progression of antral gastritis significantly faster than expected. On the whole, in contrast to the control families, the mean gastritis scores of all carcinoma families were above zero. It is concluded that our earlier finding of a relationship between gastritis and gastric carcinoma at an individual level is also found at a family level.

In 13 200 consecutive gastroscopies polyp-like lesions were found in 454 patients and of these 425 were examined histologically. Tumours other than polyps were excluded and there remained 357 cases which were divided in four groups: adenoma (8%), hyperplastic polyp (34%), foveolar hyperplasia (21%) and inflammatory polyp (36%). Transitional forms between different groups were seen and sometimes characteristics of different polyptypes could be seen within one and same polyp. In addition, the mean age of the patients increased in order: inflammatory polyp, foveolar hyperplasia, hyperplastic polyp and adenoma, suggesting that the different groups are not separate entities but represent related stages in the morphogenesis of gastric polyps. 219 cases out of 357 patients were re-examined endoscopically on average 2.5 years after the first examination. This examination revealed new polyps in 26% of all cases and spontaneous disappearance of the polyps in 14% of cases suggesting that gastric polyps, particularly those of the hyperplastic and inflammatory type are in a dynamically labile state. Gastric carcinoma was found in 27 (8%) of patients with polyps. In 4 of these cases the carcinoma was found at the re-examination (which in 3 cases was performed within 0.5 and in 1 case within 1.5 year). In 14 cases carcinoma was found inside the polyps and in 6 of these carcinoma was "early" in its growth. In 13 cases carcinoma was found outside the polyps and in all of these carcinoma was "advanced". Carcinoma was found in 38% of adenoma cases and in 5% of cases with polyps other than adenomas.

Three hundred and seventy-seven subjects with different conditions of the gastric body mucosa have been followed up for 30-34 years, first by the 'blind' suction biopsy method and since 1973-1976 by the direct-vision endoscopic method. Body gastritis revealed a distinct worsening trend during the whole follow-up period. However, during the last follow-up period some slowing down of the process was also discernible. In the antrum there was a distinct healing trend during that period. Thus all cases of distinct atrophic gastritis limited to the antrum and found at the re-examination in 1973-1976 had disappeared during the last follow-up period owing to regression of the antral or continuation of the body process. On the other hand, a considerable proportion of cases of diffuse antrofundal atrophic gastritis found in 1973-1976 appeared in 1983-1984 in the 'pure' body atrophic gastritis group, obviously due to regression of the antral process. This indicates the existence of an alternative pathway via diffuse antrofundal atrophic gastritis for the development of atrophic gastritis limited to the body area. The occurrence of parietal cell antibodies was on the whole a poor indicator of the progression of atrophic gastritis. However, the development of the end-stage (severe) atrophic gastritis was significantly associated with their presence. Atrophic changes of the body mucosa were not found in 1983-1984 in any cases of duodenal ulcer disease, whereas in patients with gastric polyps atrophic gastritis affecting only the body was, as a rule, present. No case of gastric carcinoma was detected during the last follow-up examination.

Campylobacter pylori is supposed to be involved in the pathogenesis of gastroduodenal peptic ulcer diseases and chronic gastritis. In order to study whether the Campylobacter pylori in the stomach of peptic ulcer patients is related to ulcer itself or to a co-existing chronic gastritis, we examined the frequency of the bacteria in Giemsa stained histological sections of biopsy specimens from a series of patients with active peptic ulcer and from series of non-ulcer control subjects. We found no difference in the frequency of Campylobacter- positive cases between ulcer patients and non-ulcer controls when the comparison was done within the same category of chronic gastritis; e.g., within the category of chronic superficial gastritis 74% and 78% of cases showed the bacteria in antral biopsies from ulcer patients and from non-ulcer controls, respectively. In both ulcer patients and control subjects, in similar way in both antral and body mucosa, the Campylobacter pylori was strongly associated with chronic superficial gastritis but was more weakly associated with chronic atrophic gastritis, and the bacteria were only occasionally seen in normal mucosa. We conclude that Campylobacter pylori is associated with chronic gastritis in peptic ulcer patients but is not related to active ulcer.

311 first-degree relatives of 78 consecutive patients with gastric carcinoma and 386 first-degree relative of control probands computer matched from a large Finnish population were studied by means of biopsies from antrum and the fundus and by functional and immunological methods. Both the A and B type of Strickland the McKay as well as the AB types of Pitchumoni and Glass were discernable in the present series and often accumulated in the same families. Particularly the A type associated with high serum gastrin values and parietal cell antibodies revealed a family accumulation. In general members of the same family tended to behave similarly with regard to morhology, function and immunology of the antro-fundal mucosa. The 386 computer matched controls from the general population were treated by means of mathematical methods derived from stochastic theory. It appeared that on a family level there was clearly discernable a line representin families with predominance of fundal gastritis (A type?) which significantly deviated from the main population. However, no such behavior was found as to the families with predominantly antral gastritis (B type?) which behaved like the population at large.

The course of antrum and body gastritis was studied using an essentially linear multicompartmental model in pernicious anemia probands, their first-degree relatives, and controls consisting of a representative family sample of a large Finnish population. Our earlier dynamic approach showed that progression of body gastritis was virtually identical in a series followed up with biopsies and in cross-comparison analyses, indicating that cross-sectional data can be used for dynamic analyses at a population level. The collected data fitted a model which consisted of stepwise progression of body gastritis to severe atrophy, of corresponding progressive steps for antral gastritis, and of regression of the antral changes after the end-stage of the body process had been reached. In addition, acceleration of the progression of gastritis in older subjects had to be taken into account in the model construction. The main findings which characterized pernicious anemia probands and their close relatives were: (1) a rapid overall progression of body gastritis particularly after 50 years of age; (2) a very rapid progression of body atrophy in its final stages, which was unrelated to age; (3) the occurrence of juvenile severe body atrophy; and (4) the healing of antral gastritis which was most marked at the stage of superficial gastritis. These results may offer a dynamic explantation for the occurrence of severe body atrophy in association with a normal or slightly altered antral mucosa in pernicious anemia and the prepernicious anemia state.

Relative risk (RR) and cumulative risk of gastric cancer (GCA) were calculated for different grades of atrophic gastritis (AG) of the antrum and body. Cross-sectional data on the occurrence of AG in a representative population sample (371 subjects), and Finnish Cancer Registry data on GCA were used in the calculations. The RR was increased significantly in severe AG of the antrum and the body (18.1 and 4.6 times, respectively), but not significantly in the less severe grades of AG. As a risk factor, severe antral and body gastritis were independent of each other. The cumulative risk, i.e., the probability of contracting GCA within the following 10 years in age groups 50-54 . . . 70-74 years was calculated to vary from 2.3% to 9.3% and from 8.7% to 31.9% in severe antral AG and from 0.9% to 4.5% and from 3.6% to 16.6% in severe body AG in males and females, respectively.