ORIGINAL ARTICLE

Histopathological features of mucosa atrophy

in atrophic body gastritis
Caractersticas histopatolgicas da atrofia da mucosa na gastrite atrfica do corpo
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ABSTRACT
Introduction:
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NVDPTB
BUSPQIZ
CFDBNF
B
NBKPS
JTTVF
JO
HBTUSJD
QBUIPMPHZ
CFDBVTF
PG
JUT
DPOOFDUJPO
XJUI
SJTL
MFTJPOT
GPS
HBTUSJD

DBODFS
"MUIPVHI
HBTUSJD
BUSPQIZ
JT
GSFRVFOUMZ
BTTPDJBUFE
XJUI
EJGGFSFOU
EJTFBTFT
JU
IBT
CFFO
JODMVEFE
JO
NBOZ
TUVEJFT
TJNQMZ
BT
B
HFOFSJD

QBUIPMPHJDBM
DPOEJUJPO
BOE
EJGGFSFOU
DBVTFT
PG
HBTUSJD
BUSPQIZ
BSF
PNJUUFE
Objective:
5P
TUVEZ
UIF
IJTUPQBUIPMPHJDBM
GFBUVSFT
PG
HBTUSJD

NVDPTB
BUSPQIZ
JO
H. pylori-OFHBUJWF
QBUJFOUT
XJUI
BUSPQIJD
CPEZ
HBTUSJUJT
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Material and methods:
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DBTFT
PG
QBUJFOUT

EJBHOPTFE
XJUI
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BOE
QSFTFOUJOH
OPSNBM
PS
KVTU
MJHIUMZ
JOnBNFE
BOUSBM
NVDPTB
XFSF
TUVEJFE
1BUJFOUT
XJUI
HBTUSPJOUFTUJOBM
DBODFS
BOE

UIPTF
XJUI
IJTUPSZ
PG
QSJPS
HBTUSPJOUFTUJOBM
TVSHFSZ
XFSF
FYDMVEFE
5IF
QSFTFODF
PG
JOUFTUJOBM
NFUBQMBTJB
BOE
QTFVEPBOUSBM
14"

NFUBQMBTJB

JO
BUSPQIJD
CPEZ
NVDPTB
XBT
BTTFTTFE
Results:
%VSJOH
UIF
QFSJPE
PG

B
UPUBM
PG
 
QBUJFOUT
VOEFSXFOU
HBTUSPFTPQIBHFBM

FOEPTDPQZ
XJUI
CJPQTJFT
PG
UIF
HBTUSJD
NVDPTB
 


XFSF
NBMFT
BOE
 


GFNBMFT
"NPOH
UIFN

IBE
UIF
EJBHOPTJT

PG
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DPOmSNFE
XJUI



NBMFT
BOE



GFNBMFT
p



*OUFTUJOBM
NFUBQMBTJB
BOEPS
14"
NFUBQMBTJB
XFSF
JEFOUJmFE

JO
BMM
QBUJFOUT
"T
JTPMBUFE
MFTJPOT
14"
NFUBQMBTJB
XBT
NPSF
GSFRVFOU
UIBO
JOUFTUJOBM
NFUBQMBTJB
SFTQFDUJWFMZ



WT
GPVS



DBTFT
*O
NPTU
QBUJFOUT


CPUI
UZQFT
PG
NFUBQMBTJB
PDDVSSFE
TJNVMUBOFPVTMZ
BOE
OP
EJGGFSFODFT
XFSF
PCTFSWFE
BNPOH
HFOEFST
p =


Conclusion:
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NVDPTB
BUSPQIZ
JO
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TIPXT
EJTUJODUJWF
IJTUPQBUIPMPHJDBM
GFBUVSFT
XIJDI
TIPVME
CF
DPOTJEFSFE
JO
TUVEJFT
PO

UIF
SFMBUJPOTIJQ
CFUXFFO
HBTUSJD
NVDPTB
BUSPQIZ
BOE
HBTUSJD
DBODFS
Key words:
HBTUSJUJT
BUSPQIJD
HBTUSJUJT
TUPNBDI
TUPNBDI
EJTFBTFT

INTRODUCTION
(BTUSJD
NVDPTB
BUSPQIZ
IBT
OPX
CFDPNF
B
NBKPS
JTTVF
JO
UIF

DIBQUFS
PG
HBTUSPJOUFTUJOBM
QBUIPMPHZ
JO
WJFX
PG
JUT
DMPTF
DPOOFDUJPO

XJUI
SJTL
MFTJPOT
GPS
HBTUSJD
DBODFS()
5IF
mSTU
PCKFDUJWF
EFTDSJQUJPOT

PG
UIJT
BTTPDJBUJPO
XFSF
SFQPSUFE
JO
UIF
T()
5IJT
QFSJPE
PG
UJNF

DPJODJEFE
XJUI
UIF
BEWFOU
PG
FOEPTDPQZ
PG
UIF
EJHFTUJWF
USBDU
VOEFS

EJSFDU
WJTJPO
UIBU
IBT
TQSFBE
SBQJEMZ
BT
B
NFUIPE
PG
HSFBU
WBMVF
GPS

UIF
EJBHOPTJT
PG
HBTUSPEVPEFOBM
MFTJPOT
&OEPTDPQJD
PCTFSWBUJPO

PG
UIF
HBTUSPJOUFTUJOBM
NVDPTB
IBT
CFDPNF
DPNQMFNFOUFE
CZ
UIF

IJTUPQBUIPMPHJD
BOBMZTJT
PG
NVDPTBM
GSBHNFOUT
SFNPWFE
EVSJOH

FOEPTDPQJD
QSPDFEVSFT
)JTUPMPHJDBM
FYBNJOBUJPO
PG
UIFTF
UJTTVF

TQFDJNFOT
CFDBNF
B
WFSZ
VTFGVM
UPPM
GPS
UIF
mOBM
DPNQMFUJPO
PG

UIF
HBTUSPJOUFTUJOBM
FOEPTDPQZ
5IF
EJBHOPTJT
PG
HBTUSJD
BUSPQIZ
BOE
JOUFTUJOBM
NFUBQMBTJB
CPUI

PG
UIFN
DPOTJEFSFE
SJTL
GBDUPST
GPS
HBTUSJD
DBODFS
IBT
BMXBZT
CFFO
B

TPVSDF
PG
DPODFSO
BT
B
SFTVMU
PG
UIF
IJTUPQBUIPMPHJDBM
FYBNJOBUJPO

PG
FOEPTDPQJD
CJPQTJFT
"T
EJGGFSFOU
UZQFT
PG
JOUFTUJOBM
NFUBQMBTJB

BSF
NPSQIPMPHJDBMMZ
XFMMEFmOFE
UIF
IJTUPQBUIPMPHJDBM
EJBHOPTJT

PG
UIFTF
MFTJPOT
JT
NBEF
XJUI
EVF
QSFDJTJPO()
)PXFWFS
UIF
TBNF

EPFT
OPU
PDDVS
JO
SFMBUJPO
UP
IJTUPQBUIPMPHJDBM
SFDPHOJUJPO
PG
UIF

EJGGFSFOU
EFHSFFT
PG
HBTUSJD
NVDPTB
BUSPQIZ()
5IJT
JT
USVF
JO

SFMBUJPO
UP
IJTUPQBUIPMPHZ
BT
XFMM
BT
JO
SFMBUJPO
UP
DPOWFOUJPOBM

FOEPTDPQJD
FWBMVBUJPO
OFWFSUIFMFTT
TFWFSF
BUSPQIZ
PG
UIF
HBTUSJD

NVDPTB
DBO
CF
WFSZ
FBTJMZ
SFDPHOJ[FE
CZ
IJTUPMPHZ
BOE
XJUI

TJHOJmDBOU
GSFRVFODZ
CZ
DPOWFOUJPOBM
FOEPTDPQZ()
"MUIPVHI
UIF
IJTUPQBUIPMPHJD
EJBHOPTJT
PG
UIF
FWPMVUJPOBSZ

TVCEJWJTJPOT
PG
HBTUSJD
BUSPQIZ
IBT
CFFO
SFQPSUFE
UP
CF
VOSFMJBCMF

NPTU
HBTUSJD
BUSPQIZ
SBUJOHT
VTFE
JO
UIF
QSBDUJDF
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UP
QFSTJTU

XJUI
UIFTF
TVCEJWJTJPOT
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UIF
UFSN
iBUSPQIJD
HBTUSJUJTw
JT
PGUFO

VTFE
HFOFSJDBMMZ
FTQFDJBMMZ
JO
FQJEFNJPMPHJDBM
TUVEJFT
SFMBUFE
UP

HBTUSJD
DBODFS
UIF
MJOL
iHBTUSJD
BUSPQIZHBTUSJD
DBODFSw
TPNFUJNFT

DPOWFZFE
JNQMJDJUMZ
DBOOPU
BMXBZT
CF
DPOTJEFSFE
B
SFMJBCMF
CPOE

'JSTU
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PO

MBTU
TVCNJTTJPO
PO

BDDFQUFE
GPS
QVCMJDBUJPO
PO

QVCMJTIFE
PO


50



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5IJT
RVFTUJPO
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NPSF
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XIFO
DPOTJEFSJOH
UIBU

HBTUSJD
BUSPQIZ
NBZ
CF
UIF
SFTVMU
PG
EJGGFSFOU
EJTFBTFT
XIJDI
JO

UVSO
NBZ
IBWF
EJGGFSFOU
EFHSFFT
PG
JNQPSUBODF
BT
SJTL
GBDUPST
GPS

gastric cancer()
(JWFO
UIFTF
BTTVNQUJPOT
UIJT
TUVEZ
XBT
BJNFE
BU
BOBMZ[JOH

UIF
NPSQIPMPHJDBM
DIBSBDUFSJTUJDT
PG
BUSPQIZ
PG
UIF
HBTUSJD
NVDPTB

SFTUSJDUFE
UP
UIF
HBTUSJD
CPEZ
BOE
JO
BCTFODF
PG
H. pylori
JOGFDUJPO

5IFTF
IJTUPQBUIPMPHJDBM
DIBSBDUFSJTUJDT
HFOFSBMMZ
DPOTUJUVUF
UIF

VTVBM
QBUUFSO
FYQSFTTFE
JO
UIF
BEWBODFE
TUBHFT
PG
BVUPJNNVOF

HBTUSJUJT
BOE
UIFSFGPSF
B
EJGGFSFOU
EJTFBTF
GSPN
UIF
BUSPQIJD

HBTUSJUJT
BTTPDJBUFE
XJUI
H. pylori
JOGFDUJPO
5PXBSET
UIJT
FOE
BOE

JO
PSEFS
UP
JNQSPWF
BDDVSBDZ
JO
UIF
EJBHOPTJT
PG
HBTUSJD
BUSPQIZ

POMZ
UIF
DBTFT
PG
BUSPQIJD
CPEZ
HBTUSJUJT
"#(

XJUI
TFWFSF
CPEZ

NVDPTBM
BUSPQIZ
XFSF
DPOTJEFSFE
JO
UIJT
QBQFS

MATERIAL AND METHODS

TABLE 1 Gender distribution of total patients who underwent esophagogastric

endoscopy with biopsy and patients with the final diagnosis of ABG
Gender

Total patients (%)

ABG (%)

Female
Male
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*Q < 0,001; ABG: atrophic body gastritis.

TABLE 2 Prevalence of intestinal metaplasia and pseudoantral

metaplasia in atrophic gastric mucosa of patients (n = 105) with ABG
Subjects

only IM (%)

only PSA (%)

IM + PSA (%)

Total (%)

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*Q = 0.67; ABG: atrophic body gastritis; IM: intestinal metaplasia; PSA: pseudoantral
metaplasia.

TABLE 3 Patients (n = 59) with atrophic body gastritis presenting

simultaneously intestinal metaplasia and PSA in atrophic gastric mucosa.
Comparative amount of metaplastic glands

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PG
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PG
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JO
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B
mOBM
IJTUPQBUIPMPHJDBM

EJBHOPTJT
PG
"#(
XF
TVSWFZFE
BMM
DBTFT
PG
VQQFS
HBTUSPJOUFTUJOBM

FOEPTDPQZ
XJUI
CJPQTZ
TBNQMJOH
PG
HBTUSJD
BOUSVN
BOE
HBTUSJD

CPEZ
QFSGPSNFE
GSPN

BU
UIF
FOEPTDPQZ
VOJU
PG

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PG
 
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BOE
 


GFNBMFT
VOEFSXFOU

HBTUSPFTPQIBHFBM
FOEPTDPQZ
XJUI
HBTUSJD
CJPQTJFT
PG
BOUSBM

BOE
CPEZ
NVDPTB
5IF
SPVUJOF
HBTUSPTDPQZ
TFSWJDF
BU
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PG
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OFX
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GPS
H. pylori
EJBHOPTJT
5IF

QSFTFODF
BNPVOU
BOE
EJTUSJCVUJPO
PG
JOUFTUJOBM
NFUBQMBTJB
BOE

QTFVEPBOUSBM
14"

NFUBQMBTJB
XFSF
FYBNJOFE
JO
UIF
IJTUPMPHJD

TFDUJPOT
PG
UIF
BUSPQIJD
CPEZ
NVDPTB
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UIFTF
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QSFTFOUFE

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OPSNBM
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KVTU
NJME
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lamina propria
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DBODFS
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XFSF
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Tables 1 and 2

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p


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TUBUJTUJDBMMZ
TJHOJmDBOU

51

Subjects

PSA > IM (%)

PSA < IM (%)

PSA IM

Total (%)

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.BMF
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*Q = 0.3; PSA: pseudoantral metaplasia; IM: intestinal metaplasia.

RESULTS
4FWFSF
CPEZ
BUSPQIZ
XBT
QBUFOU
JO
BMM
IJTUPMPHJDBM
QSFQBSBUJPOT

GSPN
UIF

TUVEJFE
QBUJFOUT
XJUI
UPUBM
PS
TVCUPUBM
EJTBQQFBSBODF

PG
PYZOUJDQFQUJD
HMBOET
XIJDI
XFSF
SFQMBDFE
CZ
NFUBQMBTUJD

HMBOET
BDDPNQBOJFE
CZ
EJGGFSFOU
EFHSFFT
PG
DPOEFOTBUJPO
PG
UIF

mCSPVT
DPNQPOFOUT
PG
UIF
lamina propria (Figures 1 and 2

"NPOH
UIF

QBUJFOUT
XJUI
"#(
UIF
QSFWBMFODF
PG
XPNFO

XBT
NPSF
UIBO
UXP
UJNFT
IJHIFS
UIBO
UIBU
PG
NFO
SFTQFDUJWFMZ


WT

5BCMF


*OUFTUJOBM
NFUBQMBTJB
BOEPS
14"

NFUBQMBTJB
SFHBSEMFTT
PG
HFOEFS
XFSF
JEFOUJmFE
JO
BUSPQIJD
CPEZ

NVDPTB
PG
BMM
QBUJFOUT
"T
JTPMBUFE
MFTJPOT
14"
NFUBQMBTJB
XBT

NPSF
GSFRVFOUMZ
TFFO
UIBO
JOUFTUJOBM
NFUBQMBTJB
SFTQFDUJWFMZ




WT
GPVS


DBTFT
*O
NPTU
QBUJFOUT

<>


JOUFTUJOBM
NFUBQMBTJB
BOE
14"
NFUBQMBTJB
JO
UIF
BUSPQIJD

NVDPTB
PG
UIF
HBTUSJD
CPEZ
PDDVSSFE
TJNVMUBOFPVTMZ
*O
UIPTF


DBTFT
JO
XIJDI
JOUFTUJOBM
NFUBQMBTJB
BOE
14"
NFUBQMBTJB

PDDVSSFE
TJNVMUBOFPVTMZ
UIF
MBUUFS
PDDVQJFE
MBSHFS
BSFBT

UIBO
UIF
GJSTU
SFHBSEMFTT
PG
QBUJFOUT
HFOEFS
*O
POMZ




QBUJFOUT
UIF
SFMBUJWF
QSPQPSUJPOT
PG
JOUFTUJOBM
NFUBQMBTJB
BOE

14"
XFSF
BQQBSFOUMZ
UIF
TBNF
5BCMFT

BOE



)JTUPQBUIPMPHJDBM
GFBUVSFT
PG
NVDPTB
BUSPQIZ
JO
BUSPQIJD
CPEZ
HBTUSJUJT

BOBMZTJT
PG
UIF
HBTUSJD
NVDPTB
IPXFWFS
JU
IBT
CFFO
VOBCMF
UP

BMMPX
SFMJBCMF
DPODMVTJPOT
BCPVU
UIF
EFWFMPQNFOUBM
TUBHFT
PG

HBTUSJD
BUSPQIZ
&WFO
GPS
UIF
NPTU
JOUFOTF
EFHSFFT
PG
HBTUSJD

BUSPQIZ
UIF
DPOWFOUJPOBM
FOEPTDPQZ
NBZ
CF
nBXFE(
)
*O
UVSO

IJTUPMPHZ
TIPXT
HPPE
MFWFMT
PG
BDDVSBDZ
JO
UIF
EJBHOPTJT
PG
TFWFSF

HBTUSJD
BUSPQIZ
CVU
JU
JT
BMTP
OPU
SFMJBCMF
UP
EFmOF
UIF
JOUFSNFEJBUF

QIBTFT
PG
UIJT
JOKVSZ
"MUIPVHI
IJTUPMPHJDBM
SFDPHOJUJPO
PG
UIFTF

FWPMVUJPOBSZ
TUBHFT
PG
HBTUSJD
NVDPTBM
BUSPQIZ
EJTQMBZT
B
HSFBU
EFBM

PG
TVCKFDUJWJUZ
JU
JT
VTFE
JO
BMNPTU
BMM
IJTUPMPHJDBM
DMBTTJmDBUJPOT

PG
DISPOJD
HBTUSJUJT
QBSUJDVMBSMZ
JO
UIPTF
DBTFT
BTTPDJBUFE
XJUI
H.
pylori()
*O
BEEJUJPO
JU
IBT
CFFO
VTFE
BT
B
DPNNPO
EFOPNJOBUPS

BNPOH
UIF
SJTL
MFTJPOT
GPS
HBTUSJD
DBODFS
SFHBSEMFTT
PG
UIF
EJGGFSFOU

EJTFBTFT
BTTPDJBUFE
XJUI
HMBOEVMBS
BUSPQIZ(


)
*O
UIF
QSFTFOU
BTTFTTNFOU
PG
QBUJFOUT
XJUI
TFWFSF
BUSPQIZ
PG

UIF
HBTUSJD
CPEZ
NVDPTB
BOE
JO
UIF
BCTFODF
PG
H. pylori JOGFDUJPO
JU
XBT
OPU
QPTTJCMF
UP
mOE
BOZ
DBTF
PG
OPONFUBQMBTUJD
BUSPQIZ

BT
JU
JT
GSFRVFOUMZ
EFTDSJCFE
JO
DBTFT
PG
NVMUJGPDBM
BUSPQIJD
HBTUSJUJT

BTTPDJBUFE
XJUI
H. pylori
JOGFDUJPO
*O
BEWBODFE
TUBHFT
PG
H. pylori
JOGFDUJPO
HMBOEVMBS
BUSPQIZ
VTVBMMZ
PDDVST
CPUI
JO
BOUSBM
BOE
CPEZ

NVDPTB
XJUI
PS
XJUIPVU
JOUFTUJOBM
NFUBQMBTJB
JO
UIF
MBUUFS
POMZ
UIF

mMMJOH
PG
DPOOFDUJWF
UJTTVF
DBO
CF
GPVOE
JO
UIF
BSFBT
PG
NJTTFE
HMBOET

FIGURE 1 Severe glandular atrophy of the gastric corpus. Presence of few remaining
oxyntic glands presenting regressive changes (short arrows), and numerous mucous
secreting glands, named PSA (long arrows). HE, original magnification 100
PSA: pseudoantral metaplasia; HE: hematoxylin and eosin.

FIGURE 2 Severe atrophy of the body mucosa presenting in: A) areas of intestinal
metaplasia (long arrows) and of PSA (short arrows); B) endocrine-like nodules immersed
in MBNJOB
QSPQSJB (arrow). This latter finding is indicative of mucosa atrophy associated
with autoimmune disease. HE, original magnification 100
PSA: pseudoantral metaplasia; HE: hematoxylin and eosin.

DISCUSSION
5IF
UFSN
iHBTUSJD
NVDPTB
BUSPQIZw
IBT
CFFO
PGUFO
VTFE

HFOFSJDBMMZ
XJUIPVU
B
QSFDJTF
EFmOJUJPO
PG
JUT
NFBOJOH
BOE
JUT
MJNJUT

.PSFPWFS
JO
SFDFOU
ZFBST
UIJT
HBTUSJD
NVDPTB
DIBOHF
SFBDIFE
UIF

TUBUVT
PG
iSJTL
GBDUPSw
GPS
HBTUSJD
DBODFS
CFDBVTF
PG
JUT
DMPTF
BTTPDJBUJPO

XJUI
UIF
JOUFTUJOBM
UZQF
TUPNBDI
DBSDJOPNB
BOE
BMTP
XJUI
UIF
TP
DBMMFE
iSJTL
MFTJPOTw
BTTPDJBUFE
XJUI
UIJT
OFPQMBTJB(

)
&OEPTDPQZ
XJUI
CJPQTZ
PG
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RESUMO
Introduo: A atrofia da mucosa gstrica tornou-se captulo importante da patologia gstrica devido ao seu estreito relacionamento
com as leses de risco para o cncer gstrico. Embora a atrofia gstrica possa estar associada a diferentes doenas, ela tem sido
abordada como um processo genrico, omitindo-se suas diferentes causas. Objetivo: Estudar as caractersticas histopatolgicas
da atrofia da mucosa gstrica em pacientes com gastrite atrfica do corpo (ABG). Material e mtodos: Foram estudados casos
consecutivos de pacientes com diagnstico de ABG que apresentavam mucosa antral normal ou apenas alteraes inflamatrias
mnimas. Pacientes submetidos a cirurgia gastrointestinal prvia ou portadores de cncer gastrointestinal foram excludos. Nas
preparaes histopatolgicas, estudou-se a presena de glndulas que exibiam metaplasia intestinal e metaplasia pseudoantral (PSA).
Resultados: No perodo 2004-2006, 7.309 pacientes foram submetidos endoscopia esofagogstrica com bipsias, sendo 3.556
(48,6%) homens e 3.753 (51,4%) mulheres. Entre eles, 105 pacientes )
QZMPSJ negativos tiveram o diagnstico de ABG confirmado,
sendo 32 (30,5%) homens e 73 (69,5%) mulheres (Q < 0,001). Glndulas com metaplasia intestinal e/ou metaplasia PSA foram
identificadas em todos os pacientes. Isoladamente, a metaplasia PSA foi mais frequente que a metaplasia intestinal, respectivamente
42 (40%) WT quatro (3,8%). Os dois tipos de metaplasia ocorreram simultaneamente na maioria (56,2%) dos pacientes, no
se observando diferenas entre os gneros (Q = 0.67). Concluso: A atrofia da mucosa gstrica na ABG mostra caractersticas
histopatolgicas prprias que devem ser consideradas nos estudos sobre o relacionamento da atrofia gstrica com o cncer gstrico.
Unitermos: gastrite; gastrite atrfica; estmago; gastropatias.

53

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CORRESPONDING AUTHOR

Alfredo J. A. Barbosa
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54