AGE AND SITES-SPECIFIC PREVALENCE RATES OF PRECANCEROUS GASTRIC LESIONS AT A HIGH-RISK POPULATION OF STOMACH CANCER

A population-based screening for stomach cancer (SC) and its precancerous lesions was conducted in Linqu County, Shandong, China, one of the highest SC rates found in China and the world. An analysis of precancerous stomach lesions revealed that chronic atrophic gastritis (CAG) was a universal common among people aged 35-64 (96-98%). For 52% and 20% of the residents in this age group had Intestinal metaplasia (IM) or dysplssia (DYS). These more advanced lesions were more pronounced in the antrum for both males and females. Age-specific prevalence rates in different anatomic locations sshowed that CAG, developed in the antrum, particularly along the lesser curvature earter than other sites and spread to fundus. IM and DYS accrued under the background of CAG with a leading time in the antrum than the other part of the stomach. Although CAG, IM and DYS prevalence rates were higher in the antrum than In the fundus, the prevalence rates showed a similar smoothly slope, a result of accumulated somatic genetic     

Comparison of the Anatomic Distribution of Stomach Cancer and Precancerous Gastric Lesions

The anatomic distribution of precancerous gastric lesions among 3,400 residents in Linqu, Shandong Province of China, was compared with the anatomic distribution of stomach cancer (SC) among 959 patients in Tokyo, Japan. The incidence of SC is high in both areas, and locations within the stomach of the precancerous and malignant lesions were classified using similar criteria. Chronic atrophic gastritis (CAG) affected 98% of the population in Linqu, with intestinal metaplasia (IM) the most severe diagnosis in 33% and dysplasia (DYS) in 20%. Neither the SC nor precancerous lesions were uniformly distributed in the stomach. Among the DYS 3% were along the greater curvature of the body, 15% along the lesser curvature of the body, 25% in the angulus, 22% along the lesser curvature of the antrum, and 34% elsewhere in the antrum. Among the SC the corresponding percentages were 2, 16, 28, 25 and 29. The similarity to the SC distribution increased gradually from CAG to IM to DYS, providing further evidence for the multistage progression of precancerous gastric lesions.     

Comparison of the anatomic distribution of stomach cancer and precancerous gastric lesions.

The anatomic distribution of precancerous gastric lesions among 3,400 residents in Linqu, Shandong Province of China, was compared with the anatomic distribution of stomach cancer (SC) among 959 patients in Tokyo, Japan. The incidence of SC is high in both areas, and locations within the stomach of the precancerous and malignant lesions were classified using similar criteria. Chronic atrophic gastritis (CAG) affected 98% of the population in Linqu, with intestinal metaplasia (IM) the most severe diagnosis in 33% and dysplasia (DYS) in 20%. Neither the SC nor precancerous lesions were uniformly distributed in the stomach. Among the DYS 3% were along the greater curvature of the body, 15% along the lesser curvature of the body, 25% in the angulus, 22% along the lesser curvature of the antrum, and 34% elsewhere in the antrum. Among the SC the corresponding percentages were 2, 16, 28, 25 and 29. The similarity to the SC distribution increased gradually from CAG to IM to DYS, providing further evidence for the multistage progression of precancerous gastric lesions.     

Evolution of precancerous lesions in a rural Chinese population at high risk of gastric cancer.

The pathogenesis of gastric cancer (GC), particularly of the intestinal type, is thought to involve a multistep and multifactorial process. Our objective was to determine the rates of transition from early to advanced gastric lesions in a population in Linqu County, China, where the GC rates are among the highest in the world. An endoscopic screening survey was launched in 1989-1990 among 3,399 residents aged 34-64 years with precancerous lesions diagnosed from biopsies taken from 7 standard locations in the stomach and from any suspicious sites. The cohort was subsequently followed, with endoscopic and histopathologic examinations conducted in 1994. Logistic regression analysis was used to estimate odds ratios (ORs) of progression to advanced lesions of various levels of severity as a function of age, sex and baseline pathology. The rates of progression were higher among older subjects, among men and among subjects with more extensive gastric lesions. 34 incident GCs were identified during the follow-up period. The ORs of GC, adjusted for age and sex, varied from 17.1, for those with baseline diagnoses of superficial intestinal metaplasia (IM), to 29.3, for those with deep IM or mild dysplasia (DYS) or IM with glandular atrophy and neck hyperplasia, to 104.2, for those with moderate or severe DYS, as compared with subjects with superficial gastritis (SG) or chronic atrophic gastritis (CAG) at baseline. Our prospective study of a high-risk population revealed sharp increases in the risk of GC and advanced precursor lesions according to the severity of lesions diagnosed at the start of follow-up. Int. J. Cancer, 83:615-619, 1999. Published 1999 Wiley-Liss, Inc.     

癌前病变Caspase-3表达下调与胃黏膜癌变的关联

目的观察Caspase-3蛋白在胃癌及其癌前病变组织中的表达,分析它与细胞凋亡和细胞增殖的关系,探讨Caspase-3蛋白在胃癌发生过程中的生物学意义及相关分子病理学机制。方法选取184例胃黏膜活检和手术切除组织标本,其中胃癌20例,慢性萎缩性胃炎6例,萎缩性胃炎伴肠上皮化生(简称肠上皮化生)31例,萎缩性胃炎伴不典型增生(简称不典型增生)114例;正常对照13 例。采用SABC法检测Caspase-3蛋白的表达;通过图像域值分析计算其阳性指数,分析其与细胞增殖(Ki67蛋白阳性指数)和凋亡(TUNEL指数)的相关关系。结果 Caspase-3蛋白在重度不典型增生组织中的阳性指数(29．8％±3．9％)显著低于轻度(58．3％±4．2％)和中度不典型增生(50．4％± 4．8％)及萎缩性胃炎(68．3％±3．3％)或肠上皮化生(70．9％±4．3％),差异有统计学意义(P<0．05); 而与胃癌(26．9％±3．0％)相比,差异无统计学意义(P>0．05)。Caspase-3蛋白表达与细胞凋亡呈显著正相关(r=0．94,P<0．05),Caspase-3蛋白阳性组细胞增殖指数(18．3％±2．2％)显著低于阴性组(48．9％±3．1％;P<0．05)。结论 Caspase-3蛋白在萎缩性胃炎、肠上皮化生和(或)轻中度不典型增生黏膜中表达上调,而在重度不典型增生及胃癌组织中表达下调,且这种变化与细胞凋亡呈显著正相关。Caspase-3失活或表达下调相关的细胞凋亡和增殖紊乱可能在胃黏膜损伤及癌变过程中起某种作用。     

Cancer precursor lesions in intact stomach Helicobacter pylori gastritis and in resected stomach gastritis

Hemigastrectomy for benign disease and Helicobacter pylori infection are risk conditions for the development of gastric cancer. Aim of the study was to compare gastric histology and precursor lesions of malignancy in these two conditions. The hemigastrectomy group included 351 consecutively endoscoped subjects operated for gastroduodenal benign disease. Six to ten biopsy specimens were routinely taken from the residual gastric mucosa. The intact stomach group included 2097 consecutively endoscoped symptomatic subjects, who did not receive eradication therapy against H. pylori. The histological findings were classified as normal mucosa (NM), chronic non atrophic gastritis (CNAG), chronic atrophic gastritis (CAG), intestinal metaplasia (IM) and dysplasia (DYS). One thousand and three intact stomachs were H. pylori negative, and 1094 showed H. pylori colonization. The age over fifty was a significant risk factor for the occurrence of IM (OR 2.52, P < or = 0.001) and DYS (OR 3.46, P < or = 0.001), while Hp-positivity was a risk factor for CNAG (OR 1.81, P < or = 0.001) and CAG (OR 3.88, P < or = 0.001). Gastroresection was associated to higher risk for CNAG (OR 1.53, P < or = 0.001) and DYS (OR 4.31, P < or = 0.001) and to a lower risk of CAG (OR 0.49, P < or = 0.001). Both in males and females the risk for CNAG was significantly higher in Hp-positive (males OR 1.92, P=0.000; females OR 1.70, P=0.000) and gastrectomized subjects (males OR 2.06, P=0.000; females OR 2.43, P=0.000). Gastrectomized males, furthermore, showed an increased risk for DYS (OR 5.82, P=0.000). The aged Hp-negative and Hp-positive subjects evidenced a significant risk for IM (respectively OR's 3.42, P=0.000 and 4.85, P=0.000); the risk for DYS was significant in aged Hp-negative subjects (OR 4.09 P < or = 0.020). The Hp-positive individuals evidenced a significant risk for metaplastic mucosal changes (OR 38.17, P=0.000). Subjects aged over forty at the time of surgery and those with a longer postoperative follow up endoscopy presented an increased risk for CNAG of the residual mucosa (respectively OR's 2.75, P=0.000 and 5.25, P=0.000). CNAG and IM were the most frequently observed mucosal lesions both in subjects operated for duodenal and gastric ulcer (respectively OR's 4.02, P=0.000 and 3.00, P=0.000). Our data support that hemigastrectomy for benign disease and H. pylori infection may induce an increased incidence for histological precursor lesions for gastric malignancy and suggest that carcinogenesis in a resected stomach may be different from that in the intact stomach.     

Determinants of gastric CDX2 expression: a study in Mozambique

As CDX2 expression precedes the occurrence of gastric preneoplastic lesions in the intestinal differentiation pathway, study of these steps of gastric carcinogenesis may contribute toward understanding the early effects of gastric cancer determinants. Our aim was to quantify the association between Helicobacter pylori infection and other environmental factors and the gastric expression of CDX2. Dyspeptic patients undergoing an upper digestive endoscopy (Gastroenterology Department, Maputo Central Hospital) were consecutively invited to participate in this study and classified as having normal stomach/chronic nonatrophic gastritis (NS/CNAG), chronic atrophic gastritis (CAG), or intestinal metaplasia (IM). For all patients with CAG or IM and a subsample of NS/CNAG patients (sex-matched and age-matched, 1?:?2), H. pylori infection and CDX2 gene expression were assessed by histology and PCR and by immunohistochemistry, respectively. Age-adjusted, sex-adjusted, education-adjusted, and H. pylori infection-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were computed. CDX2 expression was observed in 56 NS/CNAG (49.1%), 39 CAG (86.7%), and all IM patients (n=12). It was more frequent among the H. pylori-infected patients (OR=2.26, 95% CI: 1.00-5.15). Infection with high-virulence strains was associated with CDX2 expression in patients with CAG (cagA, OR=3.20, 95% CI: 1.35-7.52) and IM (vacA m1, OR=5.86, 95% CI: 1.08-31.62). Patients with a lower frequency of vegetable consumption had a higher risk of marked CDX2 expression (OR=3.64, 95% CI: 1.02-12.95). The virulence of the infecting strains and vegetable consumption were associated with CDX2 expression and may play a role in the progression to more advanced lesions.     

ING2和mP53蛋白在胃癌组织中的表达及临床病理意义

目的 检测生长抑制因子2(ING2)蛋白在正常胃组织、胃癌及其癌前病变组织中的表达,分析ING2与突变型P53(mP53)在胃癌中表达的关系,并探讨ING2与胃癌发生发展的关系及临床病理学意义.方法 免疫组织化学PV9000二步法检测188例胃癌及128例配对正常胃黏膜、35例慢性萎缩性胃炎、87例肠上皮化生及36例异型增生组织中ING2的表达.取其中的40例胃癌组织同时检测mP53蛋白的表达.结果 ING2蛋白在慢性萎缩性胃炎(74.29%)、肠上皮化生(91.95%)、异型增生(75.00%)和胃癌组织(70.21%)中阳性率均显著高于正常胃黏膜(36.72%),P＜0.001.ING2蛋白在胃癌中的表达与Lauren分型有关,在肠型胃癌中的表达率(80.56%)显著高于弥漫型(64.49%)和混合型胃癌(55.56%),P＜0.05,而且ING2蛋白在高-中分化管状腺癌的表达率(80.60%)显著高于低分化管状腺癌的阳性表达率(62.62%),P＜0.05.胃癌组织中ING2与mP53蛋白表达无相关性,P＞0.05.结论 ING2蛋白的过表达及细胞定位的改变可能参与胃癌的发生和分化,尤其是肠型胃癌的发生.     

454例自然人群的3432份胃粘膜活检观察

自胃癌高发区454例自然人群的3432份胃粘膜活检,检出胃癌5例,慢性浅表性胃炎(CSG)67.28％,慢性萎缩性胃炎(CAG)3.88％,肠上皮化生(IM)14.28％。CSG在胃体部高于窦部,CAG与IM则胃窦部明显高于体部(P<0.05)。支持CAG、IM为癌前状态之观点。     

Expressions of cyclin D1 and p27kip1 in carcinogenesis of stomach mucosa

Objective  To evaluate the relationship between the expressions of cyclin D1 and p27^kip1 in the canceration course of the stomach. Methods  The immunohistochemical staining technique (SP method) was used to detect the expressions of cyclin D1, p27^kip1 in chronic superficial gastritis (CSG), chronic atrophic gastritis (CAG), intestinal metaplasia (IM), dysplasia (DYS), gastric carcinoma (GCA) biopsy specimens. Results  The positive cyclin D1 expression rates increased with the progressing from CAG→IM→DYS→GCA respectively, and those in IM, DYS and GCA were different from those in CSG, P < 0.05, while DYS group was indifferent from GCA group, P > 0. 05. The positive p27^kip1 expression rates decreased with the mucosa progressing from CAG→IM→DYS→GCA. There was a negative correlation between the expression cyclin D1 and p27^kip1 (Y = −0.53, P = 0.000). Conclusion  Expression rates of cyclin D1 in the canceration course of the stomach mucosa trend were increased and those of p27^kip1 were decreased; the abnormal expressions of them were found in the early term of the canceration course of the stomach mucosa, and the inverse expression suggests there may be a negative feedback regulatory loop between cyclin D1 and p27^kip1.     

Frequent mutation related with overexpression of DNA polymerase beta in primary tumors and precancerous lesions of human stomach

To explore whether DNA polymerase beta (pol beta) contributes to the malignant transformation of gastric mucosa, we examined pol beta in gastric tumor cell lines, primary tumors and precancerous lesions. Point mutations of pol beta were detected in 6 of 13 cell lines and 23 of 104 tissues including 35.0% (14/40) of gastric cancer (GC), 30.0% (3/10) of dysplasia (Dys), 28.6% (4/14) of intestinal metaplasia (IM) and 10.5% (2/19) of chronic atrophic gastritis (CAG), respectively. A frequent mutation was a T to C transition at nucleotide 889, which was observed in 4 GC cell lines, 7 GC, 2 Dys, and 2 IM. The level of pol beta expression in tumors was higher than that of their matched normal tissues and gradual changes from GC, Dys, CAG to IM. These results indicate that the mutation and overexpression of pol beta may influence the progression during gastric carcinogenesis.     

胃泌素和Ki-67在胃癌及其癌前病变中的表达

目的研究不同胃黏膜病变组织中胃泌素和Ki-67的表达,探讨胃泌素在胃癌发生中的作用。方法96例不同胃黏膜病变组织来自胃镜活检标本。采用免疫组织化学染色技术检测胃泌素和Ki-67表达。结果胃泌素在浅表性胃炎（CSG）、萎缩性胃炎（CAG）、肠化生（IM）、异型增生（Dy）和胃癌（GC）中表达的阳性率分别为58.8 %、30.0%、57.9 %、68.2%和77.8%,CAG组与GC组比较,差异有统计学意义(P<0.05);从CSG→GC,Ki 67增殖指数（PI）呈逐渐递增趋势,且从CAG→GC,胃泌素的表达与PI呈正相关（P<0.05）。结论胃泌素在萎缩性胃炎中呈低表达,在胃黏膜肠化生、异型增生及胃癌中,表达异常增高;胃泌素与胃癌的发生有关。     

Serum micronutrients in relation to pre-cancerous gastric lesions

Serum levels of retinol, beta-carotene, ascorbic acid, alphatocopherol, selenium, ferritin, copper, and zinc were assayed for approximately 600 adults aged 35 to 64 with pre-cancerous gastric lesions in an area of China with one of the world's highest rates of stomach cancer. Previous studies have shown that the cancers generally are preceded by chronic atropic gastritis (CAG), intestinal metaplasia (IM) and dysplasia. Concentrations of beta-carotene and ascorbic acid were significantly lower among individuals with IM than among those whose most severe lesion was superficial gastritis or CAG. The associations with IM for these nutrients were strong and independent. In combination, the odds of CAG progressing to IM were only 1/6 as high among those with upper tertile levels of beta-carotene and ascorbic acid as among those with lower tertile levels of both nutrients. The serum levels of beta-carotene and ascorbic acid were similar for individuals having IM with or without accompanying dysplasia. Risk of IM was also somewhat increased among those with low serum ferritin, but no significant effects were observed in multivariate analyses for the other nutrients assayed. The findings point to a major influence of specific nutrient deficits in the mechanisms of gastric carcinogenesis in this high-risk area.     

胃癌及癌前病变幽门螺杆菌感染与Ki67、iNO表达关系

[目的]探讨幽门螺杆菌(Hp)感染与Ki67、iNOS表达的关系,以及Hp感染导致胃癌形成的可能分子机制。[方法]应用尿素酶试验和组织切片革兰染色检测115例胃黏膜组织的Hp;用免疫组化SP法检测上述组织的Ki67、iNOS表达,分析Ki67和iNOS及Hp感染三者之间的关系。[结果]在正常黏膜、慢性浅表性胃炎、慢性萎缩性胃炎、肠上皮化生、不典型增生、腺癌组织中Hp检出率分别为0(0/8)、45.5%(5/11)、63.2%(12/19)、70.6%(12/17)、73.3%(11/15)、51.1%(23/45),病变各组中Ki67和iN-OS表达阳性率与浅表性胃炎组比较均有显著性差异(P<0.05)。除胃癌组外,病变各组的Ki67和iNOS的表达阳性率与各组的Hp感染阳性率呈正相关;每一病变组中Hp(+)组的Ki67和iNOS表达阳性率显著高于Hp(-)组,均有显著性差异(P<0.05)。[结论]幽门螺杆菌感染与Ki67和iNOS阳性表达有一定的相关性,Hp可能通过促使细胞增殖加速和凋亡异常而涉及胃癌的发生过程。     

Genetic polymorphism of PSCA and risk of advanced precancerous gastric lesions in a Chinese population

Objective: To evaluate the relationship between the genetic polymorphism of prostate stem cell antigen (PSCA) and the risk of advanced precancerous gastric lesions including intestinal metaplasia(IM) and dysplasia(Dys), a population-based study was conducted in Linqu County, a high-risk area of gastric cancer (GC) in China.Methods: The prevalence of gastric lesions including superficial gastritis(SG), chronic atrophic gastritis(CAG), IM and Dys was determined by histopathologic examination. The genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The effects of PSCA genetic variant on the risks of IM and Dys were calculated by unconditional logistic regression.Results: Multivariate analysis revealed subjects carrying PSCA rs2294008 CT/TT genotype were associated with an increased risk of IM (OR=1.38, 95% CI=1.11-1.71) and Dys (OR=1.75, 95% CI=1.36-2.26), especially for subjects with H.pylori infection (IM: OR=1.34, 95% CI=1.05-1.71; Dys: OR=1.82, 95% CI=1.37-2.42). Furthermore, H. pylori infection and PSCA rs2294008 CT/TT genotype were observed to jointly elevate the risk of 1M (OR=3.32, 95% CI=2.33-4.71) and Dys (OR=4.58, 95% CI=2.99-7.04).Conclusion: This study suggested that PSCA rs2294008 might have an impact on the risk of IM or Dys among the high risk population of GC.     

p16和CDK4在慢性萎缩性胃炎中的表达及其意义

为探讨ｐ１６和ＣＤＫ４在慢性萎缩性胃炎的组织病理学分型中的表达及其意义，对９２例慢性萎缩性胃炎的活检胃粘膜标本进行组织形态观察，以正常胃粘膜和胃腺癌作对照，采用Ｓ－Ｐ免疫组化方法，观察ｐ１６和ＣＤＫ４基因表达，结果ｐ１６在正常胃粘膜和ＣＡＧ的单纯型、增生型、肠化型中均有较高的表达，ＣＤＫ４则多不表达或弱阳性表达，而ＣＡＧ的异型性型中ｐ１６阳性表达明显减少，ＣＤＫ４阳性表达明显增多，ＣＡＧ的异型性型与管状腺癌之间无显著性差异（Ｐ＞０．０５）。结果表明ｐ１６与ＣＤＫ４在胃粘膜良恶性病变中有相反的阳性表达，但在胃癌前病变中有相关关系，两者联合检测有助于胃癌前病变的诊断；ＣＡＧ的异型性型是重要的癌前病变     

Changes in p53 and cyclin D1 protein levels and cell proliferation in different stages of human esophageal and gastric-cardia carcinogenesis

The objective of this study was to quantify the changes in p53 and cyclin DI protein levels in different stages of human esophageal and gastric cardia carcinogenesis in a high-risk population in Henan, China. Immunoreactivity of p53, cyclin DI and proliferating-cell nuclear antigen (PCNA) was observed in the cell nuclei of esophageal and gastric cardia biopsies. The number of p53-immunostaining-positive cells was low in normal epithelia, slightly increased in basal-cell hyperplasia (BCH), markedly increased in dysplasia (DYS) (10-fold), and further increased in squamous-cell carcinoma (SCC) (40-fold). This pattern of change was similar to that of cell proliferation as indicated by PCNA immunostaining. On the other hand, the number of cyclin DI-immunostaining-positive cells did not increase from BCH to DYS, although a slight increase from DYS to SCC was noted. In the gastric cardia, again, the pattern of change of p53-positive cells in different stages of lesions paralleled the pattern of cell proliferation. The number of p53-positive cells was very low, much lower than that of PCNA-positive cells, in normal, chronic superficial gastritis (CSG) and chronic atrophic gastritis (CAG); therefore, the increase of p53-positive cells from CAG to DYS was more dramatic (100-fold). From DYS to adenocarcinoma (AC), the p53-positive and the PCNA-positive cells increased 4-fold. On the other hand, the number of cyclin DI-positive cells did not increase in pre-cancerous lesions, but increased slightly in AC. This study demonstrates that p53 protein accumulation increased with the progression of pre-cancerous lesions, especially in the genesis of dysplasia, both in the esophagus and in the gastric cardia. Our approach of quantitative immunohistochemistry sheds light on the mechanisms of genesis of esophageal and gastric-cardia cancers, which frequently occur together in many highincidence areas. © 1994 Wiley-Liss, Inc.     

肠特异性转录因子CDX2在不同亚型肠化生及胃癌组织中的表达

背景与目的：肠化生被认为是胃癌的癌前病变,而肠特异性转录因子CDX2在肠上皮的形成、分化及肠表型的维持方面有重要作用。近年来研究发现CDX2在慢性萎缩性胃炎（chronic atrophic gastritis,CAG）相关的肠化生中呈高水平表达,在部分胃癌组织中也有表达,提示其可能与胃粘膜上皮由胃表型向肠表型的转化,以及胃癌的发生有关。本研究旨在探讨CDX2在胃粘膜肠化生发生、进展及胃癌发生中的作用,进一步明确肠化生与胃癌发生的关系。方法：选择46例CAG伴肠化生、40例胃癌及32例对应癌旁肠化生,构建组织芯片。分别用高铁二铵／爱先蓝（HID／AB）及HE染色对肠化生及胃癌进行分型．然后用免疫组化和原位杂交检测不同亚型肠化生及胃癌中CDX2蛋白及mRNA的表达。结果：癌旁肠化生中Ⅲ型肠化生的比例显著高于CAG伴肠化生（分别为56．25％和21．74％,P〈0．01）。CDX2蛋白阳性率在CAG伴肠化生、癌旁肠化生和胃癌中分别为69.56％、53．13％和42．50％：CDX2 mRNA阳性牢分别为63．04％、46．87％和35．00％。胃癌中显著低于CAG伴肠化生（P〈0．01）,而与癌旁肠化生无显著性差异（P〉0．05）。CDX2表达与胃癌组织类型有关联,肠型胃癌显著高于弥漫型（P〈0．05）。Ⅲ型肠化生中CDX2蛋白表达显著低于Ⅰ型（P〈0．05）。结论：CDX2在胃粘膜肠化生发生及进展为胃癌过程中可能有重要作用。     

甘肃省胃癌死亡率不同的两地区胃癌及癌旁病变病理的比较性观察

A pathologic comparative study on gastric carcinoma and lesions in peri-cancerous mucosa was done in 222 resected specimens of gastric carcinoma from two districts with different mortality rates in Gansu province. The adjusted mortality rates were 46.41 per 100,000 and 21.64 per 100,000 respectively. There were no significant difference in the histologic type and the gastric, intestinal and mixed types classified according to mucin histochemical stain and no significant difference in the detection rate of chronic atrophic gastritis (CAG), intestinal metaplasia (IM) and dysplasia in peri-cancerous mucosa either. These findings suggest that the type of gastric carcinoma be not related to the mortality rates either high or low and neither was there any apparent correlation between the CAG, IM and gastric carcinoma.