What are the other Names for this Condition? (Also known as/Synonyms)

• Gastric Intraepithelial Neoplasia
• Intraepithelial Neoplasia of Stomach
• Stomach Dysplasia

What is Gastric Dysplasia? (Definition/Background Information)

• Gastric Dysplasia is a condition wherein the gastric epithelium shows neoplastic changes without definitive evidence of a stromal invasion. In other words, the stomach tissue shows features that can become invasively malignant over time, if left untreated
• The condition is considered to be a precursor lesion for gastric adenocarcinoma (a malignant condition)
• Gastric Dysplasia most commonly occurs in the stomach antrum region
• It is usually asymptomatic and detected during endoscopy as an incidental finding
• The subtypes of Gastric Dysplasia include:
  • Intestinal-type dysplasia
  • Foveolar-type (gastric-type) dysplasia
  • Gastric pit/crypt dysplasia
  • Serrated dysplasia

Gastric Dysplasia is broadly classified as intestinal type dysplasia and foveolar gastric type dysplasia.   Occasionally, areas of dysplasia can be found in fundic gland polyps and hyperplastic polyps of the stomach.

Incidence:

• Both males and females can be affected by the condition, although a male predominance is noted
• The condition is found worldwide, but with a higher incidence in certain parts of Asia

Risk factors:

• Longstanding and untreated Helicobacter pylori infection
• Autoimmune gastritis; chronic active gastritis
• Gastric atrophy
• Presence of precursor or premalignant (gastric) lesions
• Intestinal metaplasia
• Lifestyle factors such as smoking and consuming high amount of salted and/or smoked foods
• Working in rubber manufacturing industry
• Radiation exposure
• Increase in bile reflux

Cause:

The cause of Gastric Dysplasia is similar to the cause of gastric adenocarcinoma.

• Molecular profiling of areas of Gastric Dysplasia have revealed chromosomal instability, microsatellite instability, and abnormal methylation in the chromosomes
• Studies have also shown a loss of p53 gene function in the areas of dysplasia
• APC gene mutation has also been detected

Signs and symptoms:

• Many are asymptomatic and do not cause any significant signs and symptoms
• Uncommonly, the condition is associated with the gastric bleeding, anemia and indigestion, especially if the areas of dysplasia are large and present ulceration

Diagnosis:

• It is diagnosed incidentally when an endoscopy is performed for other health conditions. On an endoscopy, it can be flat or may appear as a polyp
• The diagnosis is confirmed on a tissue biopsy. Gastric Dysplasia can be graded either as low-grade Gastric Dysplasia or high-grade Gastric Dysplasia depending on the degree of nuclear atypia noted on gastric biopsies when examined by a pathologist under the microscope
• The following differential diagnoses may be considered:
  • Reactive atypia
  • Chemotherapy/radiation therapy related atypia

Complications: Increased risk for the development of stomach cancer is noted.

Treatment:

• A complete removal of the area of dysplasia can result in a cure 
• There is an increased risk for the development of invasive adenocarcinoma, and hence, close follow-up is recommended

Prevention: Presently, it is not possible to prevent the formation of Gastric Dysplasia.

Prognosis:

• The prognosis depends on several factors and can vary from one individual to another
• Gastric Dysplasia is associated with increased risk of development of gastric adenocarcinoma in future. Hence, close follow-up (endoscopy procedures) is recommended
• The risk for malignancy is higher with high-grade Gastric Dysplasia when compared to low-grade Gastric Dysplasia