Información del artículo
Abstract
Helicobacter pylori (Hp) is the main trigger of chronic gastric atrophy and the main leading cause of gastric cancer. Hp infects the normal gastric mucosa and can lead to chronic inflammation, glandular atrophy, intestinal metaplasia, dysplasia and finally adenocarcinoma. Chronic inflammation and gastric atrophy associated with Hp infection appear initially in the distal part of the stomach (the antrum) before progressing to the proximal part (the corpus–fundus). In recent years, endoscopic developments have allowed for the characterization of various gastric conditions including the normal mucosa (pyloric/fundic gland pattern and regular arrangement of collecting venules), Hp-related gastritis (Kyoto classification), glandular atrophy (Kimura–Takemoto classification), intestinal metaplasia (Endoscopic Grading of Gastric Intestinal Metaplasia), and dysplasia/adenocarcinoma (Vessel plus Surface classification). Despite being independent classifications, all these scales can be integrated into a single model: the endoscopic model for gastric carcinogenesis. This model would assist endoscopists in comprehending the process of gastric carcinogenesis and conducting a systematic examination during gastroscopy. Having this model in mind would enable endoscopists to promptly recognize the implications of Hp infection and the potential patient's risk of developing gastric cancer.
Keywords:
Helicobacter pylori
Gastric cancer
Gastric atrophy
Intestinal metaplasia
Gastroscopy
Resumen
El Helicobacter pylori (Hp) es el principal desencadenante de atrofia gástrica y la principal causa de cáncer gástrico. Hp infecta la mucosa gástrica normal y puede conducir a inflamación crónica, atrofia glandular, metaplasia intestinal, displasia y, finalmente, adenocarcinoma. La inflamación crónica y la atrofia gástrica producida por la infección por Hp aparecen inicialmente en la zona distal del estómago (el antro) y luego progresan a zonas proximales (como el cuerpo-fundus). En los últimos años, los avances endoscópicos han permitido caracterizar diferentes cambios a nivel de la mucosa gástrica, incluyendo los hallazgos de normalidad (el patrón de glándulas pilóricas/fúndicas y la distribución regular de las vénulas colectoras), la inflamación crónica relacionada con la infección por Hp (clasificación de Kyoto), la atrofia glandular (clasificación de Kimura-Takemoto), la metaplasia intestinal (clasificación Endoscopic Grading of Gastric Intestinal Metaplasia) y la displasia/adenocarcinoma gástrico (clasificación Vessel plus Surface). Aunque parecen clasificaciones independientes, todas estas escalas pueden ser integradas en un solo modelo: el modelo endoscópico de la carcinogénesis gástrica. Este modelo facilitaría el entendimiento del proceso de la carcinogénesis gástrica y ayudaría al endoscopista durante la exploración endoscópica de la mucosa gástrica. El conocimiento de este modelo nos permitiría reconocer inmediatamente el papel del Hp y el potencial riesgo de cáncer gástrico del paciente.
Palabras clave:
Helicobacter pylori
Cáncer gástrico
Atrofia gástrica
Metaplasia intestinal
Gastroscopia
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