Gastrit Tanısı Alan Hastaların Endoskopik Biyopsilerindeki Histomorfolojik Değişikliklerin Kesitsel Olarak Retrospektif Değerlendirilmesi

Abstract

Sular Özge, Cross-Sectional Retrospective Evaluation of Histomorphologic Changes in Endoscopic Biopsies of Patients Diagnosed with Gastritis, Hacettepe University Faculty of Medicine, Department of Pathology, Ankara, 2023. Acute and chronic gastritis describes inflammatory changes in the gastric mucosa. Many factors such as autoimmunity, diet, drug use, alcohol and, especially Helicobacter pylori infection, play a role in the etiology of acute and chronic gastritis. Gastritis is diagnosed by endoscopic visualization of the stomach and light microscopic examination of endoscopic biopsies. Accurate diagnosis of active and/or chronic gastritis and, if possible, elucidation of its etiology is important not only for the treatment of the patient but also for the malignancies that may be caused by these etiologic factors (e.g. H. pylori infection, autoimmune gastritis). Proton pump inhibitors (PPIs), one of the most commonly prescribed drug groups worldwide, are known to alter the gastric mucosa and the topography of H. pylori gastritis, which typically causes antrum-dominant chronic active gastritis. In addition, long-term PPI use has been associated with many side effects. Therefore, it is important to recognize these changes in patients diagnosed with gastritis. The updated Sydney System, which aims to provide a comprehensive, universal and reproducible endoscopic and pathologic classification of gastritis, recommends sampling of the antrum, corpus and incisura angularis for optimal evaluation of the stomach. In this study, gastric endoscopic biopsies of 400 patients diagnosed with gastritis in 1995 and 2015 at Hacettepe University Hospital, Department of Pathology, were retrospectively re-evaluated under light microscope. As a result of this evaluation, the number of cases in which only the antrum region was sampled in 1995 was 155 (77.5%); the number of cases in which only the corpus region was sampled was 18 (9%); and the number of cases in which both antrum and corpus regions were sampled was 27 (13.5%). In 2015, only the antrum was sampled in 85 cases (42.5%); only the corpus was sampled in 23 cases (11.5%); both the antrum and corpus were sampled in 92 cases (46%). In 2015, the number of cases in which both antrum and corpus region were sampled increased compared to 1995 (p<0.05). Of the 200 cases in 1995, 152 (76%) were H. pylori gastritis (HP), 1 (0.5%) autoimmune gastritis (OIG), 5 (2.5%) H. pylori gastritis and OIG (HP+OIG), 30 (15%) chronic gastritis (KG), 7 (3.5%) chemical gastritis/gastropathy (KimG), 3 (1.5%) gastric ulcer (GU), 1 (0.5%) lymphocytic gastritis (LG) and 1 (0.5%) natural-appearing gastric mucosa (MM); In 2015, out of 200 cases, 87 (43.5%) were consensus diagnosed as HP, 8 (4%) as OIG, 10 (5%) as HP+OIG, 79 (39.5%) as KG, 12 (6%) as KimG, 2 (1%) as GU and 2 (1%) as MM. In 2015, the number of cases with a consensus diagnosis of H. pylori gastritis decreased compared to 1995 (p<0.05). There was no statistically significant difference between 1995 and 2015 when cases with consensus diagnosis of OIG and HP+OIG were compared (p=0.7). In 2015, the number of cases with the morphologic finding of prominent parietal cells increased compared to 1995 (p<0.05). As a result of our study, (i) both antrum and corpus sampling in gastric endoscopic biopsies have increased over time but have not yet become a routine practice; (ii) the rate of H. pylori gastritis rate decreased significantly in 20 years (78.5% vs. 48.5%); (iii) the rate of autoimmune gastritis cannot be given without proper sampling, but there was no statistically significant difference between 1995 and 2015; (iv) PPI use showed a significant increase in 2015 compared to 1995. The decreasing prevalence of H. pylori gastritis worldwide has brought the diagnosis of autoimmune gastritis back to the agenda. There are many studies on the possible short and long term consequences of the increasing use of PPIs in recent years. Gastroenterologists and pathologists should be aware of these issues.