Enkhdolgor G., Galtsog L., Bira N., Oyuntsetseg Kh. Results of development and trial of the diagnostic methodology for detection of pre-tumor state stomach pathologies / Mongolian medical sciences in 2004. Ulaanbaatar, 2005, p. 118-119.

Results of development and trial of the diagnostic methodology for detection of pre-tumor state stomach patologies

Goal. The purpose of this study was to develop the diagnostic methodology to detect pre-tumor stomach pathologies.

Objectives.

1. To study gastric pH, alkaline capacity and histopathological changes during chronic gastritis and stomach ulcer caused by Helicobacter pylori,
2. To study morphology of polyps in upper digestive tract,
3. To develop diagnostic methodology to detect pre-tumor stomach pathologies, which occur frequently in population of Mongolia.

Innovativeness. The “Gastroscan-24” pH test was performed in 30 relatively healthy people to establish reference values for gastric acidic and alkaline capacity and confirm the observation that pH was more acidic during empty state and more alkaline during digestion.

The changes of mucosa during gastritis and stomach ulcer in Mongolian people were studied using endoscope and histopathological methods with examining relationship between morphological changes of mucosa, generation of gastric acid and alkaline capacity.

Specific morphology of polyps of the upper digestive tract in Mongolian population, HP infection, markers of pretumor pathologies and degree of dysplastic changes were determined.

Theoretical and practical significance. Structure, physiological function and reference values for instrumental tests of upper digestive tract in different groups of Mongolian population were determined; the new laboratory methods such as “pH meter test of esophagus, stomach and duodenum” and “Mon-helicobacter pylori urease test” were introduced into clinical practice; and diagnostic methodology to detect pre-tumor stomach pathologies was developed.

Materials and methods. 110 patients with B type chronic gastritis (56 females and 24 males, average age of 42.5±2.05), 195 patients with stomach ulcer (78 females and 117 males, average age of 41.25±1.34), 163 patients with polyps of upper digestive tract (aged 15-82, 87 females and 76 males, average age of 52±3.5) and 30 relatively healthy persons examined at the Department of Gastroenterology, Health Sciences University of Mongolia and Endoscopy Unit, Diagnostics Department, Central Clinical Hospital during 2002-2004 were involved in the study. All patients covered by this study were diagnosed by undergoing general clinical tests, test for gastric pH, endoscopy of esophagus, stomach and duodenum, urease test for determining Helicobacter pylori in biopsy material of gastric mucosa, and cytology and histological tests of mucosa.

Results and discussion. From the total number of patients with chronic gastritis caused by H.pylori, 44% had been detected with atrophic gastritis and intestinal metaplasia.

Decreased acidity (3.6±0.46) during disseminated atrophic gastritis was detected in 55.6% of the cases, and no acidity (5.6±0.26) in 44.4%; decreased acidity (3.4±0.28) was detected in 66.6% of patients with atrophic gastritis with intestinal metaplasia and no acidity (5.9±0.27) in 33.3% of the patients.

51.5% of total number of patients with stomach ulcer had atrophy. 28.4% of the patients had disseminated atrophy, 16.2% had atrophy predominantly in the mucosa of the pylorus, and 7.0% had atrophy in the stomach corpus (χ²=64.68, p<0.0001).

When ulcer was located in the cardia and fundus of the stomach, the gastric acidity was low with more dominant dysplastic changes.

The dysplasia of II and III degree, which are serious pathological changes, was in 17.5% of stomach ulcer cases, while ulcer located in duodenum was occurred in 4.3% of cases, a 3.65 fold decrease (p<0.001).

These serious morphological changes did not depend on the patients’ age and ulcer size (χ²=64.68, p<0.0001).

Polyps of upper digestive tract were mainly located in the pylorus compared to other parts of the stomach. The average age of 52±3.5 was lower compared to other countries.

While the microstructure of polyps was dominantly of hyperplasia which was comparable to data of foreign researchers, then we observed 2.7 times higher occurrence of dysplasia and higher percentage of cases transforming into tumors (4.8) which were specific to our country. 54% of patients with polyps had H. pylori.

Conclusion.

1. During B type chronic gastritis, the gastric acid pH is more dependent on the pathological changes of mucosa.
2. In the cote of ulcer located in the cardia and fundus of the stomach, the gastric acid was decreased, with more manifested mucosa atrophy, intestinal metaplasia and dysplastic changes.
3. H.pylori was found to cause pre-tumor conditions such as superficial inflammation, abrasion, wounds, atrophic inflammation and intestinal metaplasia.
4. Importance of gastric secretion and H. pylori tests, endoscopy and histopathology investigations in detection of pre-tumor stomach pathologies such as chronic gastritis and ulcer was confirmed.
5. As location of polyps is considered, they occurred predominantly in antrum with average age of 52±3.5, which is lower compare to other countries.
6. While the microstructure of polyps was dominantly of hyperplasia, compare to data of foreign researchers, then we observed 2.7 times higher occurrence of dysplasia and higher percentage of cases transforming into tumors (4.8) which were specific to our country. 54% of patients with polyps had H. pylori.
7. Taking biopsy from every polypous change locating in upper digestive tract, carrying out complete diagnosis and treatment under constant follow-up are important in preventing of transformation of these pathologies into cancer.

Keywords. Pre-tumor stomach pathology, gastric mucosa atrophy, intestinal metaplasia, atrophy, MALT lymphoma, pH test, “Mon-HP” urease test, bacterial infection, gastric polyp, diagnostics, and prevention

Version of the Mongolian language:

Энхдолгор Г., Галцог Л., Бира Н., Оюунцэцэг Х. Ходоодны хавдрын урьтал үеийн эмгэгийг илрүүлэх оношлогооны аргачлал / Монголын анагаах ухаан 2004 онд. Улаанбаатар хот, 2005, 90-92.