Histomorphological Evaluation of Chronic Gastritis and an Attempt to Prognosticate Gastric Intestinal Metaplasia with Selective Mucin Gene Expressions in Indian Population

Abstract

Introduction Intestinal metaplasia (IM) is a well-established precancerous lesion. MUC2 and MUC5AC are mucin genes that have been studied in gastric IM to classify and determine which type of metaplasia will progress to malignancy. H.pylori, an important causative organism for gastric carcinoma, can be detected using anti-H. pylori antibodies (AHA) in case of suspicion when routine histochemical stains are negative. Aim This study aims to determine the expression of MUC2 and MUC5AC in gastric IM in chronic gastritis to differentiate complete and incomplete IM and to predict and prognosticate its role in the possible evolution of malignancy. This study also aims to determine the expression of AHA in Giemsa negative cases with mild to severe activity. Materials & Method A total of 345 gastric biopsy cases were included in the study. About 35 cases with IM on histology were subjected to Alcian Blue (AB) at pH 2.5 and markers MUC2 and MUC5AC to classify IM. To further subclassify the type II and type III IM, AB with periodic acid–Schiff at pH 1.5 was used. About 45 out of 171 Giemsa negative cases with activity were subjected to AHA. Results 51.43% cases had complete IM and 48.57% had incomplete IM. And, 25.7% were type II and 22.8% were type III IM. About 20 out of 45 Giemsa negative cases showed AHA positivity, indicating sensitivity as high as 70.15%. Conclusion MUC2 and MUC5AC expression are good parameters in the progression of IM togastric cancer (GC) and can be used as a good prognostic marker for GC. Detection and eradication of H.Pylori using AHA with appropriate treatment will reduce the risk of developing gastric carcinoma.