In chronic stomach ulcer disease, the stomach’s prismatic epithelium gradually changes to precancerous lesions. One of these precancerous lesion is dysplasia. When the dysplastic changes involve the entire thickness of gastric epithelium, this situation may called carcinoma in situ and it is certainly a precancerous lesion. Dysplasia is not synonymous with the idiopathic cancer. That have mild-to-moderate severitys forms. If the disease have not present throughout the entire thickness of the epithelium, it can completely normalized, especially when the causative agents or situation stops (eg, stop smoking).
Ethnic origin is important, This disease is more common in Japan, Korea and Vietnam. Those who migrate from genetically high-risk regions to low-risk regions the risk will not change. But in the next generation the risk will increase. This findings shows that dysplasia and gastric cancer may affected by environmental factors also. High salt consumption, smoked foods, nitrates and nitrites and secondary amines have blamed for this disease. With it, increased consumption of carbohydrate foods increases cancer risk also. In addition, intake of salty foods increases the development of dysplasia and cancer by causing atrophic gastritis and nitrosamine compounds. With it, the consumption of fresh vegetables and fruits and use of frozen foods have reduced the development of this disease also.
The result of Helicobacter pylori infection is chronic gastritis. Therefore, the presence of HP infection have considered for an another risk factor. Genetic susceptibility have considered also among the risk factors, as like as almost in all other diseases.
Dysplasia is the previous stage of cancer. For this reason, diagnosing and histopathological grading is very important. Generally, in endoscopic and histopathologic follow-up, low-grade dysplasia disappears %40-75 after spontaneous regression. In %25-50 cases it turns to high grade disease. For this reason, lesions larger than 2 cm in diameter and having flat features should be followed strictly by frequent endoscopic examination. %25 of high grade lesions progress to invasive neoplasia within 1 year. For this reason, it may advisable to treat these lesions at least with mucosal resection.
Surgical excision is necessary if high grade dysplasia is observed in the first gastroscopy.
Endoscopic excision and strict follow-up are necessary in the presence of low grade Dysplasia. If it changes to high grade disease surgical excision may planned immediately also.