Metaplastic Changes of Esophagus mucosa and Stomach in Gluten Enteropathy Disease and Chronic Nonspecific Duodenitis

Metaplastic Changes of Esophagus mucosa and Stomach in Gluten Enteropathy Disease and Chronic Nonspecific Duodenitis.

Authors: dr. med.,Phd Kilessa A.V. gastroenterologist-endoscopist,

dr. med. Phd Filonenko T.G. pathomorphologist.

Chair of internal medicine No. 2 (manager of chair, professor V.A.Beloglazov), chair of pathological anatomy with a section course (the acting manager, associate professor N.Yu.Novikov) Crimean State Medical University by Georgiyevskiy S.I.

SUMMARY

This research presents morphological comparisons of occurrence of a stomach mucosa metaplasia and a specialized metaplasia of esophagus in patients with gluten enteropathy and chronic nonspecific duodenitis. It is established fact that metaplastic changes of stomach mucosa are more spread in patients with a gluten enteropathy.

Keywords: metaplasia, gluten enteropathy, chronic nonspecific duodenitis.

The specialized metaplasia of esophagus (SME) is a pathology in which the flat epithelium of esophagus is transformed to the cylindrical. Patients with SME have a ris of dysplastic processes development in-25%. Probability of development Adenocarcinoma of esophagus is 2-5% that is 30-150 times above all-population indexes [2]. It is conventional to consider an intestinal metaplasia as precancerous pathology. The role of intestinal metaplasia in development of intestinal type cancer was described in 1992 by Correa P. [3] . The risk of carcinoma development with intestinal metaplasia reaches 10% and depends on many factors, including Helicobacter Pillory infection [4, 5]. There are enteric metaplasia (existence of all cells inherent to a small bowel), colic metaplasia (with cells reminding colonocytes), pyloric metaplasia (with formation of mucous glands instead of main), ciliary metaplasia (with ciliary cells in gastric glands) and pancreatic metaplasia (with acidophilic graininess of cytoplasm in apical part and basophilic on counter part) [6].

The conventional concept of interrelation of metaplastic changes of stomach mucosa (M) and a Helicobacter Pillory infection and other possible reasons of metaplasia development remain low-studied. There are fetal and genetic features of mucosa structure of esophageal - gastric transition, contributing to development of metaplastic changes [7, 8]. There is interrelation between mikrobiocenosis of oral cavity and development of precancerous changes of esophagus mucosa and a stomach [6]. There are food and ecological factors promoting development of intestinal metaplasia and carcinoma of the stomach, such as the use of smoked products, alcohol, the low use of a fat, nitrites, smoking[9]. However, today the final reasons of development of metaplastic and dysplastic changes of esophagus mucosa and a stomach are not defined. It is known that the risk of development of esophagus cancer in a gluten enteropathy (GEP) is in 20-380 times more often in comparison with all-population indexes and cancer of small bowel is in 83-250 times [6].

It was offered in the sixties last century [10] to consider the GEP as a precancerous disease. It is established that genetic predisposition to the GEP is about 40% of common population [11].

Research of objectiveis to make pathomorphologic comparisons of changes of esophagus mucosa and a stomach at a gluten enteropathy (GEP) and the chronic nonspecific duodenitis (CND) and to study possible interrelations of emergence of metaplastic changes in mucosa of esophagus in different stages of GEP and CND of the II degree.

Material and research techniques: Endoscopic research was made to the patient with symptoms of diseases of gastrointestinal path and malabsorbtion symptoms. Target biopsy of changed esophageal mucosa, stomach and mucosa of duodenum was taken from patients with GEP (n=67) and CND (n=50).Video endoscopic Olympus Evis Exera II system with use of functions of high-resolution and increase was used in esophagogastroduodenoscopy. The mode of Narrow Band Imagine was used in all cases of biopsy. The mode of Narrow Band Imagine with simultaneous use of high digital increase allows identifying changed parts of mucosa of stomach and esophagus with high reliability.

Endophotogramm (picture. 1) presents of mucosa of esophagus bottom (in the field of the gear line) having the reference villiferous structure.

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Picture1. Enteric metaplasia in esophageal -gastric transition (shooters). Video endoscopy. NBI.

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Picture. 2.Mucosa of esophagus.Specializedintestinalmetaplasia(shooters).Coloring of hematoxylin and eosine,х200.

The specialized metaplasia of esophagus (SME) – (picture. 2) was diagnosed in the subsequent histological research of biopsy received from mucosa of esophagus. Loci of metaplastic changed mucosa of body and antrum of stomach (picture. 3) 2-4in size are visible in endoskopy with modes of Narrow Band Imagine.

Colic metaplasia was revealed in histological research of biopsies of changed mucosa parties (picture. 4).

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Picture. 3. Multiple parts of focal colic metaplasia of stomach body (shooters). Video endoscopy. NBI.

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Picture. 4. Mucosa of antral department of stomach. Colic metaplasia (shooters). Dysplasia of epithelium low degree (*). Coloring of hematoxylin and eosine,х200

An isolated part (size 3мм) of metaplastic mucosa was revealed in subcardial part of stomach. (Picture 5)

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Picture. 5 Simple part of colic metaplasia of subcardial department of stomach (shooters). Video endoscopy. NBI.

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Picture. 6. Mucosa of subcardial department of a stomach. Focal colic metaplasia (shooters). Coloring of hematoxylin and eosine, х200.

Mucosa around it had no atrophy signs in histologic research, the part of changed mucosa was presented by colic metaplasia.