Frecuencia de lesiones histológicas premalignas del estómago en un hospital de segundo nivel del Ecuador, Hospital IEES de Milagro; abril 2019-abril 2020.

Abstract

Introduction: The endoscopy units of tertiary care hospitals have high-resolution upper digestive endoscopy video equipment (VEDA), and usually receive patients with premalignant histological lesions of the stomach in order to carry out a more detailed endoscopic follow-up. Thus, it is likely that when determining the prevalence of CAG/MI from samples from tertiary hospitals, its frequency is overestimated. Objective: to estimate the frequency of premalignant histological lesions of the stomach in a second level hospital in Ecuador. Methodology: Observational, descriptive, cross-sectional, prevalence-type study. It was carried out in patients in whom a diagnostic VEDA had been performed regardless of the clinical reason. Patients with gastrointestinal bleeding, tumors or who had not had a biopsy were excluded. Results: 4454 cases were recovered, of which 115/4454 (2.6%, CI 2.2 – 3.1) had CAG. The presence of CAG was concentrated in adults (48.7%) and older adults (43.5%), with direct contributions (47.8% vs. 64.9%, P<0.001) and more symptoms of dyspepsia (35.7% vs. 19.9%; P< 0.001). In patients with CAG, there were almost twice as many cases with positive H. pylori (47.8% vs. 25.6%; P<0.001). The presence of H. pylori exposes almost three times the risk of CAG diagnosis (OR 2.666; 95% CI 1.838 – 3.869; P<0.001). Conclusion: In a second level hospital, the prevalence of premalignant histological lesions (CAG/MI) is significantly lower than that reported by local studies carried out in third level hospitals. Among the factors associated with the presence of CAG and older age, lower health coverage or H. pylori infection. In the sample studied, no cases of autoimmune gastritis, gastritis caused by other germs or gastro-duodenal Crohn's disease were identified.