Relationship between gastric mucosal atrophy by endoscopy and non-ampullary duodenal epithelial tumors

Table 1 Classification of the mucin phenotype according to immunohistochemical stains

	CD10 (+) or MUC2 (+)	CD10 (-) or MUC2 (-)
MUC5AC (+) or MUC6 (+)	Gastrointestinal type	Gastric type
MUC5AC (-) or MUC6 (-)	Intestinal type	Unclassified

Each mucin phenotype was defined as expressed when the cell count was more than 10% positive. If none of these cell counts were positive, then, the mucin phenotype was defined as unclassified.

Table 2 Patient characteristics, n (%)

Variable	Category or unit	Gastric atrophy		P value
		Type C, n = 105	Type O, n = 29
Age	Year	65.15 (11.29)	71.93 (6.60)	0.002
Sex	Female	36 (34.3)	4 (13.8)	0.039
	Male	69 (65.7)	25 (86.2)
Position	Part 1	17 (16.2)	7 (24.1)	0.014
	Part 2	44 (41.9)	18 (62.1)
	Part 3	44 (41.9)	4 (13.8)
Form	0-I	17 (16.2)	10 (34.5)	0.018
	0-IIa	55 (52.4)	17 (58.6)
	0-IIc	31 (29.5)	2 (6.9)
	Advanced	2 (1.9)	0 (0.0)
Therapy	ER	99	27	0.810
	Surgery	6	2
Tumor maximum length, mm		11.9 (9.5)	9.8 (7.6)	0.281
Vienna classification	Category 3	40 (38.1)	14 (48.3)	0.393
	Category 4 or 5	65 (61.9)	15 (51.7)
Depth	M	100 (95.2)	29 (100.0)	1.000
	SM	3 (2.9)	0 (0.0)
	≥ MP	2 (1.9)	0 (0.0)
Mucin phenotype	Gastric type	16 (15.2)	0 (0.0)	0.032
	GI type	30 (28.6)	7 (24.1)
	Intestinal type	59 (6.2)	22 (75.9)
Helicobacter pylori	Previous	32 (30.5)	8 (27.6)	< 0.001
	Current	8 (7.6)	21 (72.4)
	Uninfected	65 (61.9)	0 (0.0)
PPI	Dose (yes)	26 (24.8)	6 (20.7)	0.807
	Dose (no)	79 (75.2)	23 (79.3)

Type C: No or mild endoscopic gastric mucosal atrophy; Type O: Severe endoscopic gastric mucosal atrophy; ER: Endoscopic resection; GI: Gastrointestinal; M: Mucosa; MP: Muscularis propria; PPI: Proton pump inhibitor; SM: Submucosa.

Table 3 Relationship between the non-ampullary duodenal epithelial tumors position and mucin phenotype, n (%)

NADET position		Part 1			Part 2			Part 3
Variable	Category	Gastric atrophy		P value	Gastric atrophy		P value	Gastric atrophy		P value
		Type C, n = 17	Type O, n = 7		Type C, n = 44	Type O, n = 18		Type C, n = 44	Type O, n = 4
Mucin phenotype	Gastric type	11 (64.7)	0 (0.0)	0.006	4 (9.1)	0 (0.0)	0.158	1 (2.3)	0 (0.0)	1
	GI type	4 (23.5)	3 (42.9)		15 (34.1)	3 (16.7)		11 (25.0)	1 (25.0)
	Intestinal type	2 (11.8)	4 (57.1)		25 (56.8)	15 (83.3)		32 (72.7)	3 (75.0)

Part 1 comprises the bulb. Part 2 comprises the region from the superior duodenal angle to the papilla. Part 3 comprises the region from the anal side of the papilla to the horizontal part. Type C comprises no or mild endoscopic gastric mucosal atrophy. Type O comprises severe endoscopic gastric mucosal atrophy. Type C and gastric-type non-ampullary duodenal epithelial tumors (G-NADETs) were independently associated with non-ampullary duodenal epithelial tumors in part 1. All 16 G-NADETs were type C. G-NADET: Gastric-type non-ampullary duodenal epithelial tumor; GI: Gastrointestinal; NADET: Non-ampullary duodenal epithelial tumor.

Table 4 Relationship between the Helicobacter pylori infection status and gastric-type non-ampullary duodenal epithelial tumors position, n (%)

Variable	Category	Helicobacter pylori		P value
		Previous or current, n = 8	Uninfected, n = 8
Atrophy	C-0 to C-3	8 (100.0)	8 (100.0)
	O-1 to O-p	0 (0.0)	0 (0.0)
Position	Part 1	8 (100.0)	3 (37.5)	0.026
	Part 2	0 (0.0)	4 (50.0)
	Part 3	0 (0.0)	1 (12.5)

C0 to C3: No or mild endoscopic gastric mucosal atrophy from the antrum to the cardia; O1 to Op: Severe endoscopic gastric mucosal atrophy extending from the cardia to the greater curvature; Part 1: Bulb; Part 2: Region from the superior duodenal angle to the papilla; Part 3: Region from the anal side of the papilla to the horizontal part.