What is gastritis? What is gastropathy? How is it classified? (original) (raw)
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Gastritis: Terminology, etiology, and clinicopathological correlations: Another biased view
Human Pathology, 1994
The histological approach to gastritis, especially the chronic forms, has undergone a series of re-evaluations by different experts over the past decade, mainly because of the recognition of individual disease patterns that have specific clinical and epidemiological implications. The most spectacular of these was the discovery of Helicobackrpylmi and its common gastritis, its relation to almost all duodenal peptic ulcers and to most gastric peptic ulcers, its potential as a precursor of first multifocal atrophic gastritis and later tubule-forming gastric carcinomas, and its status as a cause of gastric mucosal lymphomas. During this same decade other classes of gastric reaction and inflammations have been recognized, including chemical injury and lymphocytic gastritis. Also in the same decade the importance of non-steroidal anti-inflammatory drugs (NSAIDs) has emerged as a cause of gastric mucosal injuries. To add emphasis to all these discoveries, biopsies are being performed on stomachs in almost epidemic numbers and each biopsy specimen has the potential of having the features of one or more of these injuries as well as injuries that have yet to be described. To cope with tbis rapidly expanding gastric inflammatory informational extravaganza, pathologists need some way of dealing with the various entities comfortably and some method of cataloging them in ways that are understandable both to them and to the endoscopists with whom they work. However, if emerging data about the chronic gastritides are correct, it is conceivable that the need to diagnose them, from a strictly clinical standpoint, is limited. Either we may know what is in the biopsy specimen before we see it or what we see may not be important, although it may be intellectually challenging. HUM PATHOL 25:1006-1019.
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Helicobacter pylori(HP) infection is a major cause of various gastroduodenal pathologies. The objective of our study is to evaluate various histopathological parameters of chronic gastritis using the updated Sydney system and to correlate it with presence of HP. Materials and Method: Total 250 cases of chronic gastritis was evaluated retrospectively from January 2015 to December 2015 in a tertiary care centre. Histopathological examination of all antral gastric biopsies using Hematoxylin and Eosin, and Giemsa stain for grading of various parameters and for detection of HP was carried out. Result: Chronic inflammation was identified in 100% of cases with varying intensity. Intensity of activity showed an incremental trend with density of HP. Forty percent of cases with intestinal metaplasia showed the presence of HP. Atrophy was documented in only one case. A strong association between chronic inflammation, activity, intestinal metaplasia and lymphoid follicle with HP was established. Conclusion: The updated Sydney classification provides an objective mean of classifying chronic gastritis and increases the likelihood of detection of HP. Presence of intense grade of inflammation, activity and lymphoid follicle should hint the histopathologist to search for HP. And also the presence of one of these features is a strong indicator for the presence of the other.
International Journal of Internal Medicine, 2015
AIM AND OBJECTIVE: Endoscopists make judgements on the presence or absence of gastritis on the basis of endoscopic appearances of the gastric mucosa. Most studies in literature have shown poor concordance between endoscopic and histologic diagnosis of gastritis with concordance rates of between 54-63%. The aim of this study was to evaluate the rate of concordance between endoscopic and histologic diagnosis of gastritis at our facility given the variable but generally poor concordance reported in literature. MATERIALS AND METHODS: One hundred and seventy three consecutive patients who underwent upper gastrointestinal endoscopy and biopsy for dyspepsia at Ekiti State University Teaching Hospital (EKSUTH), Ado Ekiti, Nigeria were recruited into this study. Ethical approval for the study was obtained from the hospital's Research and Ethics Committee and all the patients gave their individual written consent. RESULTS: The mean age of the studied population was 53.02±16.28 years (age range 17-87 years). Epigastric pain was the main (86.7%) indication for referral for upper gastrointestinal endoscopy, distantly followed by belching (5.8%), early satiety (5.2%) and bloating (2.3%) respectively. At endoscopy; diffuse erythema was found in 38.7% (67/173), followed in the descending order by linear erythema in 28.3% (49/173), atrophic gastritis in 13.9% (24/173), patchy erythema in 12.7% (22/173) respectively and normal findings in 6.4% (11/173). At histology; superficial chronic active gastritis was the most common findings 74.6% (129/173) of the patients, followed by chronic atrophic gastritis 15.6% (27/173) and normal findings in 9.8% (17/173). Of the 162 that were endoscopically diagnosed as gastritis, 153 were histologically confirmed (concordance rate of 94.4%). Also, of the 156 histologically diagnosed as gastritis, 153 were endoscopically diagnosed (concordance rate of 98.1%). In all, 153 of the 173 patients were both endoscopically and histologically diagnosed as gastritis (concordance rate of 88.4%). 76.3% (119 /156) of those that were diagnosed as gastritis histologically were found to be H.pylori associated gastritis. CONCLUSIONS: In conclusion, endoscopy is a reliable predictor of histological gastritis in a population with a severe form of gastritis. We equally agreed with other authors that histology is the goal standard and mandatory for accurate diagnosis of gastritis in all cases.
Journal of Evidence Based Medicine and Healthcare
BACKGROUND Chronic gastritis is a common condition in general population. Of the many aetiological factors, Helicobacter pylori is one of the primary cause of chronic gastritis. AIMS To study the histopathological features of chronic gastritis associated with H. pylori infection. To find out the relationship between severity of inflammatory reaction in gastritis and intensity of H. pylori. MATERIALS This cross sectional study was carried out in Regional Institute of Medical Sciences (RIMS) Hospital from October 2013 to September 2015. Patients with symptoms suggestive of chronic gastritis attending RIMS OPD were subjected to upper gastrointestinal endoscopy. One of the biopsy specimens was used for rapid urease test using RUT dry test kit and others were processed for histopathological examination as per standard protocol. All the slides were stained with Haematoxylin and Eosin (H&E) stain and Giemsa stain. Histological variable grading was done using the "Updated Sydney System 1994". All the data thus collected were analysed. RESULTS A total of 60 patients (39 males and 21 females) were included in the study with age ranging from 19 to 82 years. Among the 60 patients, maximum endoscopic findings were ulcer (33.3%) followed by erythematous findings (26.7%). The results of Rapid Urease Test (RUT) were positive in 30% (18/60). The histopathology reports for H. pylori detection were positive in 35% (21/60). The majority (81.7%) of the cases were inflammatory on histopathology followed by neoplasia (8.3%), dysplasia (5%) and normal finding (5%). Neutrophilic activity was present in all cases of chronic gastritis, in which 15, 5 and 11 numbers of cases showed mild, moderate and severe grading respectively. Mononuclear cell infiltration also was present in all cases of chronic gastritis and 8, 16, 7 numbers of cases were found to have mild, moderate and severe grading respectively. Only five mild atrophy, four mild Intestinal metaplasia (IM) and one moderate Intestinal metaplasia (IM) were found in gastritis cases. Correlation coefficient of neutrophilic activity with H. pylori density was 0.725 (p=0.000), which was statistically significant. CONCLUSION In our study, histopathological features of H. pylori associated chronic gastritis have shown H. pylori density, neutrophilic activity, mononuclear cell infiltration, glandular atrophy and intestinal metaplasia. We also have observed the association between neutrophilic activity and H. pylori density.
Interobserver variability in application of the revised sydney classification for gastritis*1, *2
Human Pathology, 1999
dance (H pylori 0.77, acute inflammation 0.50, intestinal metaplasia 0.70, and atrophy 0.64). We presumed that use of the Sydney classification would result in minimal interpretational differences achieving ideal kappas greater than 0.80. Because pathology results are based on subjective interpretation of this classification, complete diagnostic agreement is practically impossible. Concordance by general surgical pathologists after joint review of cases was similar to that obtained by gastrointestinal pathologists. HUM PATHOL 30:1431-1434. This is a US government work. There are no restrictions on its use.
Diagnosis of gastritis by means of a combination of serological analyses
Clinica Chimica Acta, 2002
Background: Gastroscopy and examination of biopsy is normally required for diagnosis of gastritis. This is costly and inconvenient for the patient, and there is a need for a simple pregastroscopic screening method to reduce the endoscopy workload. Our aim was to develop a serological screening test for gastritis. Methods: Sera from subjects examined with gastroscopy and biopsy were analyzed for H,K-ATPase antibodies, Helicobacter pylori antibodies and pepsinogen I. The diagnoses were normal gastric mucosa (n = 50), duodenal ulcer (n = 53) and atrophic corpus gastritis, with (n = 50) or without pernicious anemia (n = 46). Results: An evaluation scheme was constructed to optimize the diagnostic agreement between serology and gastric mucosal morphology. The sensitivity to detect gastritis was 98% (146/149) (95% CI 94 -100%) and the specificity 84% (42/50) (95% CI 71 -93%). Additional sera from 483 subjects from the general population were analyzed. There was a good agreement between serology and gastric mucosal morphology. Conclusions: Assays of multiple serum analytes are useful for the initial screening of gastritis. They are complementary to upper gastroscopy by identification of subjects with a normal gastric mucosa, those who qualify for eradication of H. pylori, and those who have developed atrophy and are at risk of developing malignancy and, therefore, require gastroscopic examination. D