The saga of gastric corpus atrophy.

The loss of gastric oxyntic glands (corpus atrophy) is emerging as a marker of gastric cancer risk as indicated by low Pepsinogen I (PGI) levels 1 2. There is a need to take into account the natural history and temporal dynamics of such an entity in order to better understand its significance and especially its implications for cancer prevention and screening. Atrophy of the gastric corpus was recognized, described and illustrated by European authors in the 19th and early 20th centuries. Fennwick provided a classical description in 1870, emphasizing its clinical and physiopathologic aspects 3. He linked the loss of oxyntic mucosal function with severe anemia. Other authors confirmed those findings and identified corpus atrophy as the basic anatomical substratum of pernicious anemia, an autoimmune disease 4-6. The clinical syndrome, the anatomic lesion and their association with gastric carcinoma were prevalent in those days, especially in northern European populations. The type of adenocarcinoma then described as associated with the syndrome was typically limited to the gastric corpus and papillary in its histopathologic pattern 7. Drastic changes have taken place in the ecology of European and other populations in which those original observations were made. Prominent among them are improvements in home sanitation and in the diet. The modern ecology is characterized by a more “sanitized” environment and by the year round availability of fresh fruits and vegetables, thanks to refrigerated storage and transportation. These ecological changes have been associated with drastic changes of disease occurrence. Gastric carcinoma has been declining in frequency in many countries, especially North America and Europe for several decades. The classical corpus-limited gastric atrophy (illustrated in Figure 1 by Strickland and Mackay) associated with pernicious anemia 8, is no longer frequent. Corpus-limited papillary adeno-carcinoma is presently a rare event. The pernicious anemia genes have obviously not disappeared and continue to be carried by susceptible individuals. But their consequences in terms of gastric atrophy and gastric cancer may not be as common today as once thought. It has been proposed that the gastric manifestations of pernicious anemia are triggered by Helicobacter pylori infection 9. The classical descriptions of corpus atrophy, originally associated with pernicious anemia, seem to have persisted in some modern-day pathologists and clinicians. It is time to re-asses atrophic gastritis and its association with gastric carcinoma.