Is Gastric Xanthelasma an Alarming Endoscopic Marker for Advanced Atrophic Gastritis and Intestinal Metaplasia?

• Published in: Digestive diseases and sciences 2016-10, Vol.61 (10), p.2949-2955
• Main Authors: Köksal, Aydın Şeref, Suna, Nuretdin, Kalkan, İsmail Hakkı, Eminler, Ahmet Tarık, Sakaoğulları, Şükran Ziyşan, Turhan, Nesrin, Saygılı, Fatih, Kuzu, Ufuk Barış, Öztaş, Erkin, Parlak, Erkan
• Format: Article
• Language: English
• Subjects: Aged; Biochemistry; Case-Control Studies; Dysplasia; Endoscopy; Female; Gastritis; Gastritis, Atrophic - complications; Gastritis, Atrophic - pathology; Gastroenterology; Gastroscopy; Helicobacter Infections - complications; Hepatology; Humans; Male; Medical colleges; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Metaplasia - complications; Middle Aged; Oncology; Original Article; Pneumoviridae; Risk Factors; Stomach - pathology; Stomach Diseases - complications; Stomach Diseases - pathology; Transplant Surgery; Xanthomatosis - complications; Xanthomatosis - pathology
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-016-4210-6

Background/Aim The clinical significance of gastric xanthelasmas is unknown. We conducted a case–control study in order to evaluate whether gastric xanthelasma is an indicator of advanced atrophic gastritis and intestinal metaplasia. Material and Method The study was conducted among 1400 patients who underwent elective upper endoscopy. Patients with gastric xanthelasma and atrophy and/or intestinal metaplasia constituted the study group ( n  = 55). The control group involved patients with only atrophic gastritis and/or intestinal metaplasia ( n  = 50). Histopathologic findings of the groups including the distribution of atrophic gastritis and/or intestinal metaplasia, operative link on gastritis assessment score, operative link on gastritis intestinal metaplasia assessment (OLGIM) score, and presence of dysplasia and malignancy were compared. Subgroup analysis was performed in order to establish the relation between the characteristics (size, number, and localization) of xanthelasmas, atrophy, and intestinal metaplasia. Results Multifocal atrophic gastritis was significantly more common in patients with a gastric xanthelasma (41.8 vs. 26.0 %, p  = 0.03). Patients with multiple xanthelasmas had a significantly higher rate of intestinal metaplasia ( p  = 0.02) and a higher OLGIM score ( p  = 0.02) compared to those with a single xanthelasma. Dysplasia was detected in 8 (14.5 %) patients with a xanthelasma and 4 (8.0 %) patients without a xanthelasma ( p  = 0.2). Conclusion Gastric xanthelasma(s) is a warning endoscopic sign for the presence of multifocal atrophic gastritis and advanced intestinal metaplasia.