A STUDY OF CONCORDANCE BETWEEN ENDOSCOPIC GASTRITIS AND HISTOLOGIC GASTRITIS IN AN AREA WITH HIGH BACKGROUND PREVALENCE IF H.PYLORI IN A TERTIARY CARE HOSPITAL SETTING

Abstract

BACKGROUND: Gastritis is a term covering a broad spectrum of entities that induce inflammatory changes in the gastric mucosa. The presence of inflammation in the gastric mucosa is recognized morphologically by changes in cellularity, vascularity, and epithelial integrity. Acute gastritis is transient and seldom needs biopsy. Chronic gastritis is very common and worldwide the epidemiology of gastritis overlaps with that of Helicobacter Pylori infection, which affects approximately 50 % of world population and 63.5 % of Indian population. Helicobacter Pylori is the leading cause of chronic gastritis, Peptic ulcer disease, Gastric Adenocarcinoma and primary Gastric lymphoma.

OBJECTIVES: 1. To study the concordance between endoscopic gastritis and histological gastritis.

1. To evaluate the histopathological parameters of gastritis according to the Updated Sydney System.

STUDY DESIGN: A cross-sectional prospective study of 2 years duration.

PARTICIPANTS: 311 patients above 18 years of age who underwent upper gastrointestinal endoscopy and biopsy for dyspepsia were included in this study.

METHODOLOGY: In this prospective study the specimens were obtained after upper gastrointestinal endoscopy and studied microscopically and evaluated, graded and scored as per revised Sydney System by Aydin et al.

RESULTS: 311 patients were included in the study with a mean age of 45.8 years. Comparison of endoscopic findings with histology showed 11 (3.5%) discordant cases and 300 (96.4%) concordant cases. The discordant cases included 11 cases with normal endoscopy but abnormal histology. For the diagnosis of gastritis the sensitivity and PPV of endoscopy was 96.4% and 100 %. Pre- malignant conditions like gastric gland atrophy and intestinal metaplasia were not reliably diagnosed with endoscopy.

CONCLUSION: Endoscopy can reliably diagnose various forms of gastritis but is not a good modality to rule out gastritis in the absence of visible gastric mucosal lesions and for the diagnosis of pre-malignant conditions in the stomach. Biopsy is the gold standard method for gastritis diagnosis and for the diagnosis of various pre-malignant lesions in stomach