Clinical manifestations of precancerous lesions of the stomach: characteristics and warnings

Abstract

Background. Chronic gastritis is largely associated with clinical manifestations such as dyspepsia, but often, even in a severe form, it is asymptomatic, which causes difficulties in its timely diagnosis. The relationship of the clinical manifestations of functional dyspepsia and chronic gastritis still causes a number of contradictions due to the uncertainty of the form of comorbidity. Objective: to study the clinical manifestations in patients with precancerous lesions of the stomach, taking into account the symptoms of gastroesophageal reflux (GER) and functional dyspepsia — epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). Materials and methods. Seventy-nine patients were examined. According to the results of a morphological study, they were divided into groups: group 1 (n = 13) — atrophic changes in the gastric mucosa; group 2 (n = 20) — intestinal metaplasia only in the antrum; group 3 (n = 33) — diffuse intestinal metaplasia; group 4 (n = 13) — patients with dysplasia. We analyzed the basic characteristics of the presence, frequency and severity of the main complaints of patients. The severity was determined on a 5-point Likert scale. All symptoms were grouped into the sets of symptoms characteristic of GER and functional dyspepsia with the definition of PDS and EPS according to the Rome criteria. Results. Manifestations of functional dyspepsia in all cases were combined with the clinical symptoms of GER. Symptoms of functional dyspepsia with a predominance of PDS were most intensive in all examined people. For patients with multifocal intestinal metaplasia, the maximum symptomatology of GER is characteristic, which is three times more intensive than in patients with atrophy (p < 0.05). Also, with multifocal intestinal metaplasia, the maximum frequency of both symptoms of PDS (71.4 %) and EPS (63.6 %) is observed. With gastric dysplasia, the manifestations of PDS are of leading importance — the maximum number of symptoms was in 63.6 % of cases, while the frequency of EPS is much lower than in patients of other groups (45.4 %). Individuals with dysplasia are characterized by the maximum intensity of complaints of bitter taste in the mouth, compared to patients with intestinal metaplasia in the antrum (p < 0.01), and the maximum severity of nausea, which is significantly higher compared to people with intestinal metaplasia in the antrum (p < 0.01) and with multifocal metaplasia (p < 0.01). In patients with dysplasia, the intensity of the negative effect of symptoms on day work was expressed, which was significantly higher than in those with atrophy (p < 0.05) and multifocal intestinal metaplasia (p < 0.01). Conclusions. Our data suggest that clinical symptoms in patients with precancerous lesions and changes in the stomach are characterized by a variety of clinical manifestations of functional dyspepsia and do not exclude manifestations of GER, which casts doubt on the assessment of the patient’s condition without upper endoscopy and histological examination for proper verification of the diagnosis. Particular attention is required for patients with symptoms of GER, which do not exclude atrophic changes, intestinal metaplasia and dysplasia in the gastric mucosa.