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Korean J Gastroenterol  <  Volume 73(6); 2019 <  Articles

Korean J Gastroenterol 2019; 73(6): 332-340  https://doi.org/10.4166/kjg.2019.73.6.332
Nodular Gastritis as a Precursor Lesion of Atrophic and Metaplastic Gastritis
Young Jung Kim, Sun-Young Lee , Hojun Yang, Jeong Hwan Kim, In-Kyung Sung and Hyung Seok Park
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
Correspondence to: Sun-Young Lee, Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea. Tel: +82-2-2030-7747, Fax: +82-2-2030-7748, E-mail: sunyoung@kuh.ac.kr, ORCID: https://orcid.org/0000-0003-4146-6686

Financial support: This study was supported by the Korean National Research Foundation (NRF 2016R1D1A1B02008937).
Received: March 22, 2019; Revised: April 20, 2019; Accepted: April 28, 2019; Published online: June 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: Chronic atrophic gastritis (CAG) and metaplastic gastritis (MG) are precancerous conditions of Helicobacter pylori (H. pylori)-related gastric cancer. This study aimed to identify the characteristics of nodular gastritis (NG) showing CAG or MG after nodule regression.
Methods: H. pylori-infected patients with NG were included after upper gastrointestinal endoscopy. Patients were excluded if their latest endoscopy had been performed ≤36 months after the initial diagnosis of NG. Small-granular-type NG was defined as the condition with 1-2 mm regular subepithelial nodules. Large-nodular-type NG was defined as those with 3-4 mm, irregular subepithelial nodules. The endoscopic findings after nodule regression were recorded.
Results: Among the 97 H. pylori-infected patients with NG, 61 showed nodule regression after a mean follow-up of 73.0±22.0 months. After nodule regression, 16 patients showed a salt-and-pepper appearance and/or transparent submucosal vessels, indicating CAG. Twenty-nine patients showed diffuse irregular elevations and/or whitish plaques, indicating MG. Sixteen patients with other endoscopic findings (14 normal, one erosive gastritis, and one chronic superficial gastritis) showed a higher proportion of H. pylori eradication (12/16, 75.0%) than those in the CAG group (5/16, 31.3%) and MG group (6/29, 20.7%; p=0.001). Patients with small-granular-type NG tended to progress toward CAG (14/27, 51.9%), whereas those with large-nodular-type NG tended to progress toward MG (25/34, 73.5%; p<0.001).
Conclusions: In patients with a persistent H. pylori infection, NG tended to progress to CAG or MG when the nodules regressed. Small-granular-type NG tended to progress to CAG, whereas large-nodular-type NG tended to progress to MG.
Keywords: Gastritis; Lymphoid tissue; Atrophy; Metaplasia


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