Clinical, serological and morphological manifestations at patients with chronic atrophic gastritis
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StatusThe thesis was presented on the 13 May, 2021Approved by NCAA on the 4 October, 2021 Abstract – 1.22 Mb / in romanian – 1.18 Mb / in romanianThesisCZU 616.33-002.27-07(043.2)
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Keywords
chronic atrophic gastritis, atrophy of the gastric mucosa, intestinal metaplasia, gastric epithelial dysplasia, advanced upper digestive endoscopy, morphological examination, Helicobacter pylori.Summary
The public defense will take place on 13.05.2021, at 14:00, online: https://meet.google.com/agu-yogv-bqf
Actuality and importance of the research: Although the incidence of gastric cancer (GC) has decreased significantly in the last century, partly due to effective eradication and reduced prevalence of H. pylori (HP), the disease is still one of the leading causes of cancer death worldwide [ 13, 24, 44]. In the latest global cancer statistics, the disease ranks 5th after incidence (8% of the total number of cancers) and is the 2nd leading cause of cancer death in both sexes (10% of total deaths caused by neoplasms) [32, 43]. In Romania, gastric cancer is the 6th malignant localization in both sexes, with an incidence of 5.2% [32]. Only 1-3% of people infected with HP develop GC [44].
Upper digestive endoscopy (UDE) with biopsy is the "gold standard" for the diagnosis of GC and precancerous gastric lesions (chronic atrophic gastritis (CAG), intestinal metaplasia (IM), gastric epithelial dysplasia (GED)), but their use population-based screening is limited due to the invasiveness of the method and the cost, but for high-risk patients it remains the only strategy available [10, 21, 26, 38]. While many aspects of gastritis pathology remain to be elucidated, consistent information indicates that CAG is the only, strongest predictor of the onset of intestinal IM and GC [10]. Early diagnosis of gastric precancerous lesions in the general population and surveillance of these patients are important considerations for early identification and reduction of GC mortality, increased survival rate and improved quality of life of patients [8, 9, 13]. However, at this moment, premalignant changes in the gastric mucosa are often ignored in clinical practice or result in a variable frequency of surveillance or treatment [31].
Thus, based on the above, the purpose of this study is to elucidate the clinical/para-clinical manifestations in patients with chronic atrophic gastritis depending on the morphological type of existing gastric lesion.
In order to achieve the goal, the following general research objectives were stipulated:
1. Evaluation of clinical features in patients with chronic atrophic gastritis.
2. Determination the correlation between the severity of gastric mucosal damage in chronic endoscopic atrophic gastritis and the stage of gastric mucosal atrophy according to the OLGA and OLGIM systems.
3. Estimation of the role and value of non-invasive serological diagnosis in the prognosis of chronic atrophic gastritis.
4. Study of the relationship between morphological examination and functional activity of the gastric mucosa by determining the concentration of serological markers, followed by comparison of morphological and serological data.
5. Elaboration of a diagnostic algorithm for patients with chronic atrophic gastritis.
The general research methodology was developed based on the publications of local authors [10, 17, 19] and abroad [7, 28]. In this cross-sectional cohort clinical trial, patients were selected according to inclusion and exclusion criteria. For the research and solution of the problems approached in the thesis we used the methods: analytical epidemiological, investigation, clinical examination, para-clinical investigations, statistical, mathematical procedures, monitoring and evaluation tools.
Scientific novelty of the obtained results: The clinical, serological and morphological features of CAG were highlighted depending on the degree of damage to the gastric mucosa. The
correlation between invasive and non-invasive tests in the diagnosis of CAG was evaluated, with the estimation of the role of HP, the severity of the clinical picture and the foveolar pattern of the gastric mucosa. Physiological, morphological and clinical research has deepened data on the characteristics of gastric precancerous conditions in relation to the inflammatory activity of the gastric mucosa, streamlined the diagnosis of the disease and increased the specificity of screening for patients at high risk of developing gastric precancerous pathology.
The applicative value of the study consists in the elaboration of an algorithm for early diagnosis of CAG in order to prevent gastric cancer. Recommendations have been proposed for the examination of patients infected with HP (immunological testing and histological staging of CAG) to isolate cohorts with a high risk of developing GC.
Approval of the thesis results. The results of the study were presented and discussed in the following national and international scientific forums:
1. Annual Conference of the University of Medicine and Pharmacy of Iasi "Gr T. Popa" "Contemporary aspects in chronic atrophic gastritis", March 4-06, 2016, Iasi, Romania.
2. The third Congress of Internal Medicine "News in gastric precancerous lesions", October 24-25, 2017, Chisinau, Republic of Moldova.
3. Centenary Symposium of Romanian Internal Medicine in Cluj “Premalignant lesions and gastric cancer”, October 24-26, 2019, Cluj-Napoca, Romania.
4. Meeting of the Romanian Society of Neurogastroenterology “Identifying precancerous lesions - an important step in gastric cancer prevention”, 07-09 November 2019, Iași, Romania.
5. University Days and Annual Scientific Conferences of collaborators and students of USMF IP “Nicolae Testemiţanu”, 2014, 2017, 2018, 2019, Chisinau, Republic of Moldova.
6. III Russian Gastroenterology Congress with international participation "Gastroenterology of Russia from birth to old age (pediatric, therapeutic, surgical and medico-social aspects)", "Precancerous diseases and stomach cancer". 29-30 October 2020, Saint-Petersburg, Russia.
The positive opinion of the Research Ethics Committee for the study was received on June 17, 2019 (the act nr. 38).
Keywords: chronic atrophic gastritis, atrophy of the gastric mucosa, intestinal metaplasia, gastric epithelial dysplasia, advanced upper digestive endoscopy, morphological examination, Helicobacter pylori.
Thesis publications. The materials of the thesis were reflected in 13 scientific papers, including 3 articles without co-authors and 8 articles in reviewed editions, 11 active participations with communications and posters at international and national scientific forums, a patent.
The volume and structure of the thesis. The paper is presented on 155 pages of text, consists of introduction, 4 chapters, general conclusions, practical recommendations and bibliographic index with 237 references. The illustrative material includes 39 figures, 25 tables, 4 statistical formulas and 6 annexes.
Council's Members
- Ghenadie Curocichin, president
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova - Angela Peltec, member
doctor, associate professor (docent) - Nicolae Bodrug, member
doctor habilitat, professor - Eugen Tcaciuc, member
doctor habilitat, associate professor (docent), Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova - Gheonea Dan, membru
doctor în științe medicale, profesor universitar,
Theses
