Findings in exudates can help distinguish benign gastric ulcers from ulcerated adenocarcinomas

Abstract

Aims

Most gastric carcinomas develop in association with mucosal atrophy and hypochlorhydria, whereas benign peptic ulcers are acid-related. Given that acid sterilizes gastric contents, we hypothesized that ulcerated gastric cancers may be associated with increased luminal microbes compared with peptic ulcers, and that this feature may represent a helpful diagnostic clue to the presence of malignancy. We performed this study to determine whether features of luminal debris, including microorganisms, from ulcerated gastric cancers were significantly different from those of debris associated with benign ulcers.

Methods and Results

We retrospectively identified 50 ulcerated adenocarcinomas and 50 site-matched peptic ulcers. Luminal debris was evaluated for nature of inflammation, necrosis, and presence of mixed bacterial colonies or yeast. Non-lesional mucosa was assessed for chronic gastritis, Helicobacter pylori, chemical gastropathy, and intestinal metaplasia. Patients in both groups were adults (mean age: 69 and 62 years, respectively) with similar amounts of inflammation and cellular necrosis in biopsy material. However, 76% of ulcerated cancers harbored non-H.pylori bacterial colonies, compared with only 22% of peptic ulcers (p<0.01). Filamentous bacteria and fungi were highly specific for carcinoma (98% and p=0.02 for both comparisons). Background intestinal metaplasia was more common among gastric cancers compared with peptic ulcers (50% vs. 26%, p=0.02), whereas chemical gastropathy was more commonly associated with the latter (50% versus 10%, p<0.01).

Conclusion

Gastric cancers may be colonized by non-H. pylori microbes. Detection of numerous bacterial colonies, filamentous bacteria, or fungi in biopsy material obtained from ulcerated gastric lesions should raise suspicion for underlying malignancy.

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