J.Jpn. Surg. Soc.. 59(1): 63-93, 1958

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INTESTINAL METAPLASIA OF THE GASTRIC MUCOSA IN CHRONIC GASTRITIS

Many reports have been published on gastritis associated with stomach cancer and gastroduodenal ulcers. Between 1949-1955, we have made a study of 125 cases of gastrectomized primary gastritis of which 78 cases were studied histopathologically. Attention was paid to the area and degree of intestinal metaplasia and its relation to the clinical picture, especially to the acidity of gastric secretion and to gastric cancer were studied.
The stomach was divided into three areas (posterior wall, lesser curvature and anterior wall). The degree of metaplasia in the corpus and antrum of each was divided into five grades (0, +, ++, +++, ++++) and by substituting this into a point system the degree of each area could be shown by (total No. of points) / (No. of observations.)
1. Histopathological findings :
i.) Gastritis simplex (R. Waser) five cases, ii.) Gastritis atrophicans-hyperplastica seventy three cases, of which with metaplasia sixty one cases and without metaplasia twelve cases, gastric polyp three cases, atypical cell nest one case and adenocarcinoma one case.
2. Metaplasia increases with age and becomes quite evident after fifty years of age.
3. There is no relation among the duration of the complaints, clinical signs, hematological picture and the metaplasia, though there is more metaplasia in cases of bleeding as compared to the nonbleeding.
4. There is a definite relation between the acidity and metaplasia. In cases with much metaplasia the acidity is decreased. Note should be taken to the nineteen hypo and anacid cases of which there were three cases of polyp, one case of atypical cell nest, and one case of cancer
5. There is a correlation between the degree of metaplasia and postoperative results.
6. Metaplasia increases with the severity of gastritis and has a close relation with cancer formation.
7. The severity of gastromucosal atrophy and metaplasia can be estimated by quantitation of gastric acidity and therefore this test is not to be overlooked.
Cases of chronic gastritis with hypo-acidity which have been treated medically over a long period of time with no beneficial results should definately be subjected to operation.
(author's abstract)

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