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Gastric Cancer Screening in Common Variable Immunodeficiency

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Abstract

Individuals with common variable immunodeficiency (CVID) have an increased risk of gastric cancer, and gastrointestinal lymphoma, yet screening for premalignant gastric lesions is rarely offered routinely to these patients. Proposed screening protocols are not widely accepted and are based on gastric cancer risk factors that are not applicable to all CVID patients. Fifty-two CVID patients were recruited for screening gastroscopy irrespective of symptoms or blood results and were compared to 40 controls presenting for gastroscopy for other clinical indications. Overall, 34% of CVID patients had intestinal metaplasia (IM), atrophic gastritis or moderate to severe non-atrophic gastritis, which can increase the risk of gastric cancer, compared to 7.5% of controls (p < 0.01). Focal nodular lymphoid hyperplasia, a precursor lesion for gastrointestinal lymphoma, was seen in eight CVID patients (16%), one of whom was diagnosed with gastrointestinal lymphoma on the same endoscopy. High-risk gastric pathology was associated with increased time since diagnosis of CVID, smoking, Helicobacter pylori, a low-serum pepsinogen I concentration, and diarrhea, but not pepsinogen I/II ratio, iron studies, vitamin B12 levels or upper gastrointestinal symptoms. There was a lower rate of detection of IM when fewer biopsies were taken, and IM and gastric atrophy were rarely predicted by the endoscopist macroscopically, highlighting the need for standardized biopsy protocols. The prevalence of premalignant gastric lesions in patients with CVID highlights the need for routine gastric screening. We propose a novel gastric screening protocol to detect early premalignant lesions and reduce the risk of gastric cancer and gastric lymphoma in these patients.

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Abbreviations

CVID:

common variable immunodeficiency

FNLH:

focal nodular lymphoid hyperplasia

GI:

gastrointestinal

H. pylori :

Helicobacter pylori

Ig:

immunoglobulin

IM:

intestinal metaplasia

N/A:

not applicable

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Acknowledgments

The authors thank the patients and their families for their participation.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia

    David K. van der Poorten & Bilel Jideh

  2. Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia

    David K. van der Poorten, Golo Ahlenstiel, Sandhya Limaye, Ming Wei Lin, Dan Suan, Sanjay Swaminathan, Sean D. Riminton & Lucinda J. Berglund

  3. Department of Anatomical Pathology, Westmead Hospital, Sydney, NSW, Australia

    Duncan McLeod

  4. NSW Health Pathology, Sydney, NSW, Australia

    Duncan McLeod, Suzanne Culican, David Campbell, Sue W. J. Wong, Catherine Toong & Lucinda J. Berglund

  5. Blacktown Clinical School, School of Medicine, Western Sydney University, Penrith, NSW, Australia

    Golo Ahlenstiel

  6. Department of Gastroenterology and Hepatology, Blacktown Hospital, Blacktown, NSW, Australia

    Golo Ahlenstiel

  7. Storr Liver Centre, Westmead Institute of Medical Research, Westmead, NSW, Australia

    Golo Ahlenstiel & Scott Read

  8. Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, NSW, Australia

    Avelyn Kwok & Cositha Santhakumar

  9. Department of Gastroenterology and Hepatology, Liverpool hospital, Sydney, NSW, Australia

    Milan Bassan

  10. Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia

    Milan Bassan, Louise Evans & Catherine Toong

  11. Department of Immunology, Liverpool Hospital, Sydney, NSW, Australia

    Louise Evans, Alisa Kane, Jessie A. Lee, Ari Murad & Catherine Toong

  12. Department of Immunology, Campbelltown Hospital, Campbelltown, NSW, Australia

    Constance H. Katelaris & Karuna Keat

  13. Faculty of Medicine, Western Sydney University, Sydney, NSW, Australia

    Constance H. Katelaris & Karuna Keat

  14. Department of Immunology, Concord Repatriation General Hospital, Sydney, NSW, Australia

    Yanna Ko, Sandhya Limaye, Martina Rafferty, Sean D. Riminton & Catherine Toong

  15. Departments of Immunology and Immunopathology, Westmead Hospital, Hawkesbury Rd, Westmead, Sydney, NSW, 2145, Australia

    Ming Wei Lin, Dan Suan, Sanjay Swaminathan & Lucinda J. Berglund

  16. Garvan Institute of Medical Research, Sydney, NSW, Australia

    Dan Suan

Authors
  1. David K. van der Poorten
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  2. Duncan McLeod
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  3. Golo Ahlenstiel
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  4. Scott Read
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  5. Avelyn Kwok
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  6. Cositha Santhakumar
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  7. Milan Bassan
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  8. Suzanne Culican
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  9. David Campbell
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  11. Louise Evans
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  12. Bilel Jideh
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  14. Constance H. Katelaris
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  15. Karuna Keat
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  16. Yanna Ko
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  17. Jessie A. Lee
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  18. Sandhya Limaye
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  19. Ming Wei Lin
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  20. Ari Murad
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  21. Martina Rafferty
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  22. Dan Suan
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  23. Sanjay Swaminathan
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  24. Sean D. Riminton
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  25. Catherine Toong
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  26. Lucinda J. Berglund
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Corresponding author

Correspondence to Lucinda J. Berglund.

Ethics declarations

The study was approved by the Western Sydney Local Health District Human Research Ethics Committee, with local governance approval at each site.

Competing Interests

The authors declare that have no competing interests.

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van der Poorten, D.K., McLeod, D., Ahlenstiel, G. et al. Gastric Cancer Screening in Common Variable Immunodeficiency. J Clin Immunol 38, 768–777 (2018). https://doi.org/10.1007/s10875-018-0546-3

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  • DOI: https://doi.org/10.1007/s10875-018-0546-3

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