Interest of Upper Digestive Endoscopy in the Monitoring of Biermer Disease: Experience of a Moroccan Unit
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 11
Abstract
Abstract: Biermer's disease is an autoimmune disease leading to chronic atrophic gastritis of the fundus. It is a precancerous condition that can lead to the development of carcinoid tumors and gastric adenocarcinoma. Indeed, stomach cancer is the second most common digestive cancer in Morocco. Its prognosis is poor with a survival at 5 years of about 15%, which requires regular endoscopic monitoring of Biermer disease. In this study, we report 239 cases of Biermer disease among 22531 esophagogastroduodenal endoscopies (EGDE) collected between January 2007 and December 2017 in the EFD-HGE department of the Ibn Sina Hospital in Rabat. Epidemiological, clinical, endoscopic and therapeutic aspects were analysed. The anatomopathological study determined the histological type of the polyps, its degree of dysplasia and the presence of Hp, intestinal metaplasia or gastric atrophy. All our patients with Biermer's disease had received an EGDE with antral and fundal biopsies every 3 years as part of their follow-up. In this work, the frequency of Biermer's disease was 1.06%. The average age of the patients was 40 years (20-81 years) with a slight male predominance (56.5%). The EGDE found congestive funditis with rarefaction of fundic folds in 162 patients (67.7%), small polypoid fundic lesions in 51 patients (21.3%), hyperplastic polyps in 10 patients (4.2%) with antral site in 9 patients and subcardial in one patient. EGDE was normal in 16 patients (6.7%). The anatomo-pathological study of biopsies concluded that there was chronic atrophic funditis with intestinal metaplasia without enterochromaffin-like (ECL) cell hyperplasia or dysplasia in 72 patients (32.3%), chronic atrophic funditis with intestinal and pyloric metaplasia and ECL cell hyperplasia without dysplasia in 90 patients (40,3%), a neuroendocrine tumor with ECL cell hyperplasia in 35 patients (15.7%), hyperplastic polyps in 20 patients (8.9%), a high-grade dysplasia tubular polyadenoma in six patients (2.7%). Hp infection was present in 75% of hyperplasic polyps, 50% of gastric adenomas and 50% of gastric neuroendocrine tumors (NETs). Biermer's disease is a precancerous pathology that can lead to fundic neuroendocrine tumours and gastric adenocarcinoma. In our study, 18.4% of patients had tumor degeneration, what requires a regular endoscopic and anatomo-pathological sollow-up.
Authors and Affiliations
M. Loutfi, A. Bargach, N. Kabbaj
Keywords
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