Light blue crest sign, a favorable marker for predicting the severity of gastric atrophy in the entire stomach

Recently, Uedo et al. showed that observation of a light blue crest on the epithelial surface of the gastric mucosa when using narrow band imaging with magnifying endoscopy, is a highly accurate sign of the presence of histological intestinal metaplasia [1]. Since then, intestinal metaplasia has been shown to be a risk factor for developing gastric cancer, especially the intestinal type. We have investigated whether the light blue crest sign could be used as a marker for identifying patients at high risk of developing gastric cancer.

Among 60 Helicobacter pylori sero-positive patients, including 10 with intestinal gastric cancer, we prospectively investigated the presence of the light blue crest sign in noncancerous gastric mucosa of the greater curvature in the antrum and in the corpus. The presence of the sign was assessed in relation to endoscopic gastric atrophy according to the Kimura–Takemoto classification [2] and to serum pepsinogen (PG), a serum marker for gastric atrophy and gastric cancer risk [3] [4] [5].

Table 1 Light blue crest sign and serum Helicobacter pylori titer, serum pepsinogens, endoscopic atrophy, and gastric cancer incidence (n = 60) PGI, ng/mL* PGII, ng/mL PGI/II ratio† Endoscopic atrophy score‡ Incidence of gastric cancer§, n (%) LBC negative (n = 43) 70.3 ± 40.4 23.0 ± 11.2 3.3 ± 1.6 2.8 ± 1.8 5 (11.6) LBC antrum (n = 13) 45.3 ± 23.0 18.1 ± 8.5 2.5 ± 1.1 4.3 ± 1.7 3 (23.1) LBC corpus (n = 4) 37.0 ± 51.1 16.6 ± 10.9 1.6 ± 1.3 5.5 ± 0.6 2 (50.0) All statistical analyses were performed by ANOVA. Presence of LBC in both antrum and corpus was included in LBC corpus.Endoscopic atrophy of CL ∼ 0.6 was scored as 1 ∼ 6.LBC, light blue crest sign; PG, pepsinogen.*R = – 0.31, P = 0.02; †R = – 0.32, P = 0.02; ‡R = 0.44, P = 0.0004; §R = 0.26, P = 0.04

It was revealed that presence of this sign is significantly associated with serological and endoscopic severity of gastric atrophy and the occurrence of gastric cancer ([Table 1]). In particular, patients who had the light blue crest sign in the corpus showed a low PGI, and PGI/II ratio, severe endoscopic gastric atrophy, and high gastric cancer occurrence. It is not only the appearance of the light blue crest that is useful for identifying intestinal metaplasia, but the sign may also be a favorable marker for predicting the severity of gastric atrophy in the entire stomach.

Competing interests: None

References

• 1 Uedo N, Ishihara R, Iishi H. et al . A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy.  Endoscopy. 2006;  38 819-824
• 2 Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis.  Endoscopy. 1973;  5 21-26
• 3 Kekki M, Samloff I M, Varis K. et al . Serum pepsinogen I and serum gastrin in the screening of severe atrophic corpus gastritis.  Scand J Gastroenterol. 1991;  186 Suppl 109-116
• 4 Asaka M, Kimura T, Kudo M. et al . Relationship of Helicobacter pylori to serum pepsinogens in an asymptomatic Japanese population.  Gastroenterology. 1992;  102 760-766
• 5 Yanaoka K, Oka M, Yoshimura N. et al . Risk of gastric cancer in asymptomatic, middle-aged Japanese subjects based on serum pepsinogen and Helicobacter pylori antibody levels.  Int J Cancer. 2008;  123 917-926