Gastric ulcer and gastritis. Results of short-term follow-up.
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Adult↗
Biomedical subjects
M Kekki
Publications and source records attributed to M Kekki.
Progression of fundal gastritis in gastric ulcer patients.
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Gastritis↗
Development and progression of chronic gastritis in the antrum and body mucosa: results of long-term follow-up examinations.
A bioptical follow-up over 6 years of the status of the antral and body mucosa has been carried out in 81 subjects who formed a part of a random sample of an Estonian rural population. Gastritis in the body mucosa showed an expected progression. In the antral mucosa, on the other hand, progression was seen only in younger subjects, while in those over 50 years of age antral gastritis displayed a distinct slowing and even retardation of the gastritic process.
Adolescent↗
Gastric cancer risk in chronic atrophic gastritis: statistical calculations of cross-sectional data.
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.
Adult↗
Seven-year follow-up study of chronic gastritis in gastric ulcer patients.
The course of chronic gastritis in the antrum and body was followed up for 7 years in 112 patients with gastric ulcer (GU). As controls served 155 subjects collected at random from the same geographical area. At the start of the study (first examination) there was a slight predominance of antrum gastritis in the series, but during the follow-up period (second examination at 4 years (61 out of 112 patients) and third examination at 7 years (39 out of 112 patients] a distinct body gastritis gradually predominated in GU patients. The healing tendency of active ulcer was accompanied by a more pronounced progression of body gastritis. The rate of body gastritis progression was very rapid and was calculated to be 11-fold as compared with that in the population at large. No immunological phenomena were associated with the body atrophy process.
Adult↗
Hypersecretion of gastric acid in a representative Finnish family sample.
To evaluate the family behaviour of acid secretion and particularly of 'hypersecretion', we have examined by pentagastrin test and direct vision gastric biopsy 342 subjects with a normal mucosa or superficial gastritis of the body mucosa, collected from a large family sample of the Finnish population. Acid output (AO) was expressed in terms of fat-free body weight (FFB), which eliminates the sex factor found by other expressions of AO. Subjects with values above 1.0 mmol/h/FFB were considered 'hypersecretors' (14 subjects, or 4% of the whole sample). They differed from the whole sample with regard to a high prevalence of signs of duodenal ulcer disease, of high serum pepsinogen, and of blood group O and lack of gastric antibodies and of high serum gastrin levels. The Fisher distribution test showed a significant family aggregation of AO values. In addition, at low AO levels there were subgroups with distinct gaps between them. This finding suggests the effect of genetic variation rather than of a common family environment. The occurrence of higher AO values in sibs but not in children of 'hypersecretors' seems to rule out the possibility of a dominant Mendelian inheritance. These present results are considered to be best compatible with a multigenetic mode of inheritance of gastric hypersecretion.
Adolescent↗
The sequelae and course of chronic gastritis during a 30- to 34-year bioptic follow-up study.
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.
Age Factors↗
Chronic gastritis: dynamic and clinical aspects.
A simple method for grading gastritis is to assess the severity of round cell infiltration and the loss of normal glands, and this may be applied to both antral and body changes. However, there is, as yet, no satisfactory classification of gastritis. In population samples, gastritis shows a linear increase in age-specific prevalence so that the annual increase in the body atrophic gastritis pool up to geriatric age is constant (1.5%). In the elderly, there appears to be a retardation of the process, particularly in the antral mucosa, where some healing trend is demonstrable. This dynamic behaviour is qualitatively similar in all population samples collected in Finland and Estonia. On the other hand, the dynamic behaviour of gastritis in different subpopulations differs markedly from that in the population at large. In pernicious anemia patients and their first-degree relatives, the progression of body atrophic gastritis in its final stages is about 20 times more rapid than in a general population, while, simultaneously, antral gastritis displays a distinct healing tendency. A behaviour opposite to that in pernicious anemia is seen in patients with active or healed duodenal ulcer disease and in duodenitis: antral gastritis behaves, on the whole, similarly to that in the general population, but in the body mucosa there occurs virtually no progression with age, and the mucosa generally remains normal or at the stage of superficial gastritis. However, after antrectomy body gastritis progresses rapidly in the remnant at first, but it slows down later and then closely resembles that in the general population.(ABSTRACT TRUNCATED AT 250 WORDS)
Age Factors↗
Chronic gastritis and gastric acid secretion in uraemic and renal transplant patients.
Upper gastrointestinal endoscopy with biopsies from the antrum, body and duodenum, as well as tests for acid secretion were performed on 43 uraemic patients, 17 women and 26 men, (mean age 49.7 years) and on 46 patients with well-functioning renal transplant received 10 months earlier (12 women and 34 men, mean age 40.6 years) in order to study the background of peptic lesions in uraemic patients. Eighty-nine age- and sex-matched subjects selected from a random population sample consisting of 434 persons served as a control group. All groups of renal patients were similar with respect to the prevalence and severity of antral or body chronic gastritis. Compared with control subjects their antrum had significantly less advanced chronic gastritis, which was due to the lack of atrophic changes. Furthermore, the gastric body tended to show fewer alterations than that of the controls. The acid secretion capacity in the renal patients decreased with the increasing severity of atrophic changes in the body mucosa. However, definite hypoacidity was found in some of the renal patients with normal body mucosa. Thus, a true "state of hypoacidity" seems to occur in chronic uraemia.
Adult↗
Age-related trends of gastritis and intestinal metaplasia in gastric carcinoma patients and in controls representing the population at large.
Age-related trends of gastritis and intestinal metaplasia (IM) were studied in 476 endoscopically examined and bioptically proved cases of gastric carcinoma (GC), 263 of which were of intestinal (IGC) and 213 of diffuse (DGC) types. Endoscopic biopsy specimens from the area around the tumour were available in all cases, and from the antrum and/or body distant from the tumour area in 238 cases. A representative sample of an endoscopically and bioptically examined Finnish population consisting of 431 subjects was used as control material. In patients with IGC the prevalence of atrophic gastritis in the gastric area affected by the tumour was higher and that of superficial gastritis lower than expected, and the age-group scores of gastritis and IM were situated above the age-dependent line of gastritis scores of controls in all age groups studied. This was seen to indicate a more rapid progression of gastritis in IGC patients than in the population at large. In the opposite area of the stomach, i.e. in the tumour-free area, the progression of gastritis and IM was virtually similar to that in controls. No such differences were seen with regard to DGC. It is concluded that IGC is dynamically closely linked to gastritis and IM, while in DGC no such relationship is demonstrable.
Adenocarcinoma↗
[Gastritis and stomach cancer--epidemiologic correlation].
This association between chronic gastritis and gastric carcinoma has been reasonably well established, however the nature of this association is still not clear and is probably very complex. Thus the intestinal type of carcinoma shows a higher prevalence and more rapid than expected progression of atrophic gastritis in the antrum and body, and the available evidence suggests that atrophic gastritis with metaplasia and dysplasia precedes the occurrence of signs of malignancy. In the diffuse type, however, no direct relationship can be demonstrated between gastritis and gastric carcinoma. On the other hand, the diffuse type of gastric carcinoma, too, shows some association with atrophic gastritis in that the histochemical characteristics of diffuse carcinoma cells are as a rule similar to those of the surrounding epithelium. Thus the intestinal type of gastric carcinoma seems to be directly and the diffuse type more likely only morphogenetically related to atrophic gastritis.
Chronic Disease↗
The development of atrophic gastritis in antrum and body in relatives of gastric carcinoma patients and in controls.
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.
Adolescent↗
Progression of antral and body gastritis in patients with active and healed duodenal ulcer and duodenitis.
The dynamics of the antral and body mucosa has been studied in biopsy specimens obtained during endoscopy of patients with duodenal ulcer (103 cases), patients with duodenal ulcer scars (108 cases), and patients with duodenitis (44 cases). A representative Finnish population sample consisting of 434 subjects was used as reference material. The antral mucosa of all patient series showed an increase in the severity and prevalence of gastritis similar to that of the general population, whereas virtually no progression of gastritis with age was seen in the body mucosa, which remained normal or at the stage of superficial gastritis up to geriatric age. In contrast, in the present controls and in all earlier population samples studied by us so far, there was a significant and steady increase in the severity and prevalence of body gastritis with age. It is concluded that the age behavior of the antral and body mucosa was in duodenal ulcer scars and duodenitis similar to that of patients with active duodenal ulcer. The persistence of normal conditions in the acid-secreting area may serve as one explanation of the strong tendency of the disease to recur. In addition, it is tentatively concluded that in duodenal ulcer disease there are factors that have a 'protecting' influence on the body glands and which are abolished by antrectomy, according to our earlier studies.
Duodenal Ulcer↗
Atrophic chronic gastritis and intestinal metaplasia in gastric carcinoma. Comparison with a representative population sample.
The occurrence of chronic gastritis and intestinal metaplasia (IM) was studied in 257 patients with gastric carcinoma (GC). In all cases biopsies were available from the benign mucosal area adjacent to the tumor, and in 139 patients from the antrum and/or body mucosa outside the tumor. The results were compared with endoscopically and bioptically examined noncancer controls representing a large Finnish population sample. For every GC patient, a control subject was matched by age and sex. In addition, a mean age-adjusted score (AAS) of chronic gastritis, which expresses the progression of gastritis in GC patients as compared with that in the general population, was calculated for GC patients. The prevalences of chronic and atrophic gastritis in the antrum and body mucosa were similar in GC patients and controls when carcinoma cases were not more specifically classified according to histologic type or location of tumors. On the other hand, the location of the tumor showed a significant relation to gastritis: the progression of gastritis was more rapid (high mean AAS value) and the prevalence of atrophic gastritis was higher in the tumor-affected area (i.e., in the antrum in patients with antral [distal] tumors; in the body in patients with body [proximal] tumors), than in the general population, but were similar in the tumor-free area in both GC patients and controls. In the intestinal type of GC (IGC), the prevalence of chronic gastritis was higher and its progression was more rapid than in controls. In the diffuse type of GC (DGC), these correlations were less distinct. In GC patients, the IM adjacent to and outside the tumor area was significantly more common and extensive than in the corresponding area of controls, and a significant positive correlation was present between the location of the tumor and the distribution of IM. Like gastritis, the IM showed a closer relationship to IGC than to DGC. In all cases of GC and particularly of IGC, the antral mucosa tended to be more severely affected by gastritis and IM than the body mucosa, i.e., the prevailing type of gastritis found in this GC series was that morphologically corresponding to the so-called B-type of chronic gastritis.
Age Factors↗
Course of antrum and body gastritis in pernicious anemia families.
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.
Adult↗
The gastric mucosa in stomachs with polyps: morphologic and dynamic evaluation.
Biopsy specimens from the antral and body mucosa of 183 patients with gastric polyps (adenoma, 4; hyperplastic polyp (HP), 52; foveolar hyperplasia (FH), 49; and inflammatory polyp (IP), 78 cases) have been examined. The prevalence of gastritis in the series was compared with that in 183 age- and sex-matched controls. The dynamics (progression) of gastritis was evaluated by means of an age-adjusted gastritic score. In the HP and FH groups the prevalence and progression of body gastritis were significantly higher and more rapid (p less than 0.001) while the prevalence of antral gastritis was lower (p less than 0.05) and its progression less rapid (p less than 0.001) than in controls. It is concluded that the pernicious anaemia type of gastritis (A-type gastritis) is closely related to gastric polyps of hyperplastic origin. The progression of this gastritis type seemed to increase in the order IP, FH, and HP. In addition, we observed an increase in the prevalence of intestinal metaplasia (p less than 0.001) and marked epithelial dysplasia (0.1 greater than p greater than 0.05; chi-square = 3.75) in stomachs with polyps as compared with in controls.
Adenoma↗
Age behaviour of gastric acid secretion in males and females with a normal antral and body mucosa.
In males with a normal gastric mucosa the acid secretion expressed in terms of fat-free body weight (FFB) shows a random distribution with age, whereas in females there is a significant increase. To explain this sex-related discrepancy, we examined maximal pentagastrin-stimulated gastric acid output (AO) and the parietal cell density (P) and thickness (T) in 50 males and 50 females with a normal antral and body mucosa randomly collected from a representative Finnish population sample. Two alternatives were considered: 1) the parietal cell reactivity remains constant, and the age variation in females is due to an increase in the total parietal cell mass, 2) the age variation in females is due to an increase in the reactivity of parietal cells, the total parietal cell mass (P X T X body area (A)) remaining constant. Starting from the first alternative, P and T were measured and showed no correlation with age in males and a decrease in females. The variable A is, according to the formula, expressed by the ratio AO/P X T, and this ratio shows an expected significant correlation with AO in both males and females. However, the variable A showed a significant increase with age in females but not in males. In view of the results of Cox that A should not vary with age, the present results suggest that the ratio AO/P X T in females must include, in addition to body area, other variables, such as the reactivity of parietal cells.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Morphology and dynamics of the gastric mucosa in duodenal ulcer patients and their first-degree relatives.
The prevalence of antral and body gastritis was determined in 30 duodenal ulcer patients and in 143 of their first-degree relatives, and compared by conventional mathematical and stochastic analyses with data on gastritis in a representative Finnish population sample. For conventional analysis, the controls for the duodenal ulcer patients and for the duodenal ulcer relatives, were matched for age and sex. For stochastic analysis, the duodenal ulcer patients and their 99 siblings were compared with the total control population of 434 subjects. The prevalence of gastritis affecting mainly the antral mucosa, and both antral and body mucosa to a similar extent was significantly higher in duodenal ulcer patients than in both controls and in relatives. The prevalence of antral and body gastritis in DU relatives and their controls was similar. However, the prevalence of subjects with normal antral and body mucosa was significantly lower. Stochastic analysis revealed more rapid progression of antral gastritis with age in the duodenal ulcer patients than in their siblings or controls and less rapid progression of body gastritis. The overall progression of antral and body gastritis was similar in DU siblings and their controls, but a dichotomy in the mean antral gastritis score of DU sibships was found, indicating high and low antral gastritis liability subgroups. The mean score of DU sibships having a mean age of less than 50 years behaved dynamically like DU patients, while the mean scores of sibships with a higher mean age had a low liability to develop antral gastritis. Most duodenal ulcer siblings who themselves had a duodenal ulcer, ulcer scar or duodenitis were found in the "high antral gastritis liability" subgroup.
Adult↗