As in previous years, Inform Diagnostics was again honored by the acceptance
of multiple abstracts at DDW. This year’s research, performed by
Inform Diagnostics investigators and their collaborators, resulted in a platform presentation,
as well as in data that may influence clinical management in several areas
of gastroenterology: Barrett’s esophagus, colon cancer screening,
and proper detection and treatment of H. pylori. A summary of this work
is described below; the full posters may be viewed online at
A study of H. pylori’s role in age-related changes of the gastric
mucosa was chosen for a platform presentation. The results show that most
age-related histopathologic findings in the stomach are a result of H.
pylori infection. In addition to chronic active H. pylori gastritis, these
changes comprise chronic inactive gastritis and intestinal metaplasia
(reactive gastropathy and H. pylori-negative chronic active gastritis
occur independently of H. pylori infection). Interestingly, a comparison
of high and low prevalence H. pylori regions revealed that in low prevalence
areas, 50% of subjects up to the age of 78 had normal gastric mucosa.
In contrast, in high prevalence areas, only at the much younger age of
47 years did 50% of subjects maintain normal mucosa.
An abstract with potentially important implications for colon cancer screening
examined the relationship between the presence of hyperplastic polyps
and the subsequent development of adenomatous polyps. The data revealed
that the presence of hyperplastic polyps during the first colonoscopy
is associated with a significant risk of adenomatous polyps on follow-up
colonoscopy. The odds ratios for developing adenomas after a diagnosis
of hyperplastic polyp(s) were 3.06 for any type of adenoma, 2.14 for “advanced”
adenoma, and 6.85 for sessile serrated adenoma.
Another study may have implications for surveillance in patients with Barrett’s
esophagus. This abstract examined the prevalence of the “null staining
pattern” of p53 immunohistochemistry in Barrett’s esophagus.
This pattern, which has been previously under recognized and underreported,
was found to represent 15.4% of all p53 mutations in Barrett’s esophagus
(as opposed to the more common point mutation pattern, which was found
in 84.2% of cases with a p53 mutation). The recognition of this pattern
is extremely important, as patients who harbor p53 mutations have been
shown in several studies to be at increased risk for neoplastic progression.
Also of note was the finding that this “null” pattern is disproportionately
higher in high grade dysplasia in Barrett’s, as compared with low-grade
dysplasia, atypia indefinite for dysplasia, and non-dysplastic Barrett’s mucosa.
An abstract that may have clinical relevance regarding the detection and
treatment of H. pylori infection found that half of all H. pylori infected
patients, at least in this study group, were also proton pump inhibitor
(PPI) users. More importantly, the investigators demonstrated that PPI
use in patients with Helicobacter gastritis is associated with a higher
prevalence of sequelae of this infection. Indeed, among patients with
H. pylori, corpus-predominant H. pylori gastritis was found in 43.1% of
patients on PPI therapy for longer than one month, but only in 17.6% of
short-term or non-PPI users. Intestinal metaplasia within the corpus was
also increased in patients taking PPIs for greater than one month (25.9%
versus 9.8% in non-PPI- using patients). These findings suggest that greater
efforts should be made to promote awareness of the Maastrich guidelines,
which recommend testing and eradication of H. pylori before the initiation
of long-term PPI therapy.
The remaining abstracts this year were primarily epidemiologic in nature.
One revealed that in patients with gastroparesis, H. pylori gastritis
is approximately 50% less prevalent than in patients with no known history
or diagnosis of gastroparesis. Another study examined the epidemiology
of microscopic (i.e. lymphocytic and collagenous) colitis. The data support
well-known findings from prior studies, in that both entities were found
to be more common in older patients, more common in women, to exhibit
similar geographic distributions, and to be strongly associated with the
symptoms of diarrhea and weight loss. However, this work also found that
patients with either form of microscopic colitis are significantly less
likely to harbor colonic adenomas than the population without microscopic
colitis (overall odds ratio 0.11). The final study accepted this year
investigated DNA mismatch repair (MMR) deficiency in colorectal carcinomas
arising in the setting of inflammatory bowel disease (IBD). Immunohistochemical
staining for MMR proteins revealed deficiencies in 11% of IBD- associated
cancers, a much lower percentage than is seen in non-IBD carcinomas. All
cases with abnormal MMR staining were deficient in the proteins MLH1 and
PMS2, while MSH2 and MSH6 were always intact. The pattern of MMR deficiency,
as well as the demographic characteristics of the study patients, suggests
that MMR-deficient cancers in IBD are likely due to MLH1 promoter methylation.
However, additional studies are needed to further define the mechanism
of MMR deficiency in these tumors.
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