Clue of Diagnosis for Autoimmune Gastritis

Digestion ◽  
2021 ◽  
pp. 1-8
Author(s):  
Toshihiro Nishizawa ◽  
Shuntaro Yoshida ◽  
Hidenobu Watanabe ◽  
Akira Toyoshima ◽  
Yosuke Kataoka ◽  
...  
Keyword(s):  
Detection Rate ◽  
Pathological Diagnosis ◽  
Autoimmune Gastritis ◽  
Detection Rates ◽  
Pathological Evaluation ◽  
Sydney System ◽  
Updated Sydney System ◽  
Greater Curvature ◽  
H Pylori ◽  
Parietal Cell Antibody

<b><i>Background:</i></b> The diagnostic clues for autoimmune gastritis (AIG) can be classified into 2 categories: endoscopic findings and pathological diagnosis. We believe that research on the AIG detection rate by endoscopists could provide a better understanding of the diagnosis of AIG. This study aimed to clarify the ratio of the endoscopic and the pathological diagnoses of AIG. <b><i>Methods:</i></b> We retrospectively reviewed consecutive patients who underwent esophagogastroduodenoscopy (EGD). During their first EGD, the gastric mucosa with C2 atrophy or more was biopsied for pathological evaluation based on the updated Sydney system. A gastric biopsy was also performed after <i>Helicobacter pylori</i> eradication, obtaining specimens from at least 2 sites, the greater curvature of the corpus and the antrum. We enrolled patients who were positive for the anti-parietal cell antibody and were diagnosed with AIG, histologically and/or endoscopically. The detection rates of AIG were compared between endoscopic diagnosis and pathological diagnosis. <b><i>Results:</i></b> A total of 10,822 patients underwent EGD during the study period. Finally, 41 patients with AIG were enrolled, leading to an AIG prevalence of 0.38% in this study. As for the clue leading to AIG detection, 31.7% (13/41) were diagnosed through endoscopy (proximal-predominant atrophy), and 68.3% (28/41) were diagnosed pathologically. The AIG detection rate by endoscopists in the posteradication group was significantly lower than in <i>the H. pylori-negative</i> group (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> Endoscopists frequently overlooked AIG, especially in posteradication cases. Pathological assessment using the updated Sydney system after <i>H. pylori</i> eradication might be a promising strategy to detect AIG better.

Inflammatory cell numbers in the stomach of Japanese subjects with endoscopically normal mucosa without H. pylori infection

2021 ◽  
Author(s):  
Naoki Sumi ◽  
Ken Haruma ◽  
Tomoari Kamada ◽  
Mitsuhiko Suehiro ◽  
Noriaki Manabe ◽  
...  
Keyword(s):  
Inflammatory Cells ◽  
Normal Mucosa ◽  
Mucosal Inflammation ◽  
Upper Gastrointestinal Endoscopy ◽  
Fundic Gland ◽  
Eosinophilic Gastritis ◽  
Pyloric Mucosa ◽  
Sydney System ◽  
Updated Sydney System ◽  
H Pylori

Introduction: Since inflammatory cells, such as lymphocytes and plasma cells, normally inhabit the stomach, the border between normal and mild inflammation is difficult to visually determine using the updated Sydney system scale of gastritis. Additionally, eosinophils in the gastric mucosa must be counted to diagnose eosinophilic gastritis. We aimed to determine the normal number of inflammatory cells in patients with endoscopically normal mucosa and without H. pylori infections. Methods: We assessed patients aged 20–79 years, who had undergone upper gastrointestinal endoscopy at Kawasaki Medical School Hospital between January 2010 and December 2014. Inflammatory cells were counted in 1,000 μm2 fields of pyloric and fundic gland mucosal biopsy specimens. We finally included 325 (male, n = 141; female, n = 184; average age = 49.3 years) patients without inflammation who had H. pylori-negative endoscopic results and negative histological findings interpreted based on the updated Sydney System and the Kyoto classification of gastritis. Results: The average numbers of nucleated cells were 83.3 ± 14.2/mm2 and 65.4 ± 12.6/mm2 in the pyloric and fundic gland mucosae, respectively. Inflammatory cells were significantly more abundant in the pyloric mucosa than the fundic gland mucosa (p < 0.05). Age and sex distribution did not significantly differ. Eosinophils were absent or scanty in the gastric mucosae of both glands in all patients. Conclusion: We determined the absolute values of inflammatory cells, including eosinophils, in normal mucosae of pyloric and fundic glands. These findings could be important in defining gastric mucosal inflammation, including eosinophilic gastritis diagnosis.

scholarly journals The Distribution of Incomplete Gastric Intestinal Metaplasia (GIM) Subtype among Biopsy Sites according to the Updated Sydney System and Its Association with GIM Extension

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Duc Trong Quach ◽  
Huy Minh Le ◽  
Trung Sao Nguyen ◽  
Toru Hiyama
Keyword(s):  
High Risk ◽  
Intestinal Metaplasia ◽  
Periodic Acid ◽  
Risk Marker ◽  
Gastric Intestinal Metaplasia ◽  
Biopsy Specimens ◽  
Sydney System ◽  
Updated Sydney System ◽  
Greater Curvature ◽  
Lesser Curvature

Background. Current guidelines recommend that extensive gastric intestinal metaplasia (GIM) be considered as a high-risk marker for the development of gastric cancer (GC). But there is emerging evidence that the incomplete GIM subtype is also a high-risk marker. Aims. To evaluate the performance of biopsy sites according to the updated Sydney system on detecting the incomplete GIM subtype and to assess its association with GIM extension. Patients and methods. A cross-sectional study was conducted on 280 Vietnamese patients with nonulcer dyspepsia. Biopsy specimens were taken from gastric sites according to the updated Sydney system, and sections were routinely stained with Giemsa and hematoxylin and eosin. Biopsy specimens with intestinalization were further evaluated for GIM subtypes with alcian blue 2.5 and periodic acid Schiff stainings. Two experienced pathologists jointly examined all the specimens and reached consensus. Results. The rates of patients with GIM and the incomplete GIM subtype were 81 (28.9%) and 24 (8.4%), respectively. There was no GIM in specimens taken from the greater curvature of corpus. The proportions of the incomplete GIM subtype detected at the incisura angularis, lesser curvature of corpus, lesser curvature of antrum, and greater curvature of antrum were 34.3% (12/35), 34.5% (10/29), 40.5% (17/42), and 31.6 (6/19), respectively, which were not significantly different (p=0.89). The presence of an incomplete GIM subtype was associated with multifocal GIM (i.e., ≥3 out of 5 biopsy sites with GIM) (OR=4.02, CI 95%, 1.33–12.16, p=0.022) and extensive GIM (i.e., GIM in specimens from both of corpus and antrum) (OR=2.89, CI 95% 1.04–8.02, p=0.045). Conclusions. The proportions of an incomplete GIM subtype were not significantly different among gastric biopsy sites with intestinalization. The association between an incomplete GIM subtype and GIM extension, therefore, may be due to an sum accumulation effect.

scholarly journals Distribución de estadios de OLGA y OLGIM según edad y estado del Helicobacter pylori en un hospital público nivel III en Lima, Perú

2021 ◽  
Vol 51 (1) ◽  
Author(s):  
Andrea Carlin Ronquillo ◽  
Alex Ventura León ◽  
Jorge L Espinoza Ríos ◽  
Eduar A Bravo Paredes ◽  
Paúl Gómez Hinojosa ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
High Risk ◽  
Upper Gastrointestinal Endoscopy ◽  
Gastric Intestinal Metaplasia ◽  
Endoscopic Control ◽  
Staging Systems ◽  
Sydney System ◽  
Group 5 ◽  
Updated Sydney System ◽  
H Pylori

Introduction. The operative link for gastritis assessment (OLGA) and the operative link on gastric intestinal metaplasia assessment (OLGIM) staging systems have been suggested to provide risk of assessment for gastric cancer. Objective. To evaluate the distribution of OLGA and OLGIM staging by age and Helicobacter pylori status. Material and methods. We studied 197 subjects undergoing elective upper gastrointestinal endoscopy. The presence of the H. pylori and histological changes were evaluated using the updated Sydney system. Stages III and IV of OLGA/OLGIM were considered high risk stages. Results. The H. pylori rate was 56.85% (112/197). High-risk OLGA/OLGIM cases were rare: 7/112 (6.5%) cases of OLGA in the H. pylori positive group and 6/85 (7%) in the H. pylori negative group; 5 (4.4%) cases of OLGIM in the H. pylori positive and 6 (7%) in the H. pylori negative. The proportion of advanced stages of OLGA and OLGIM increased with age (p < 0.001). High-risk OLGA was not found before age 40 regardless of the presence of H. pylori, but increased to 16.2%, 10.3%, 17.3% and 40.8% in subjects in the fourth, fifth, sixth and seventh decade of life respectively. The OLGIM high risk showed a similar trend: 0% before 40 years and up to 22.6% in people of 70 years. Conclusions. High-risk OLGA/OLGIM cases are infrequent before age 40 and increase significantly with age. No relation was found with the presence of the H. pylori. According to these protocols, only a fifth of the patients would strictly require endoscopic control.

scholarly journals Rebamipide Improves Chronic Inflammation in the Lesser Curvature of the Corpus afterHelicobacter pyloriEradication: A Multicenter Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Tomoari Kamada ◽  
Motonori Sato ◽  
Tadashi Tokutomi ◽  
Tetsuo Watanabe ◽  
Takahisa Murao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Chronic Inflammation ◽  
Epidemiologic Studies ◽  
Untreated Group ◽  
Primary Endpoints ◽  
Sydney System ◽  
Updated Sydney System ◽  
H Pylori ◽  
Lesser Curvature

Background and Aim. Although many epidemiologic studies have shown thatHelicobacter pylorieradication has prophylactic effects on gastric cancer, it does not completely eliminate the risk of gastric cancer. We aimed to investigate the changes in histological gastritis in patients receiving rebamipide treatment afterH. pylorieradication.Methods. 206 patients who had undergoneH. pylorieradication were evaluated. Of these, 169 patients who achieved successful eradication were randomly allocated to 2 groups: the rebamipide group (n= 82) and the untreated group (n= 87). The primary endpoints were histopathological findings according to the updated Sydney system at the start of the study and after 1 year.Results. Final assessment for histological gastritis was possible in 50 cases from the rebamipide group and 53 cases from the untreated group. The activity and atrophy improved in both the rebamipide and untreated groups, and no significant intergroup differences were observed. Chronic inflammation affecting the lesser curvature of the corpus was significantly improved in the rebamipide group compared to in the untreated group (1.12±0.08versus1.35±0.08;P= 0.043).Conclusions. Rebamipide treatment afterH. pylorieradication alleviated chronic inflammation in the lesser curvature of the corpus compared to that in the untreated group. This trial is registered withUMIN000002369.

scholarly journals Evaluation of gastric histology in children and adolescents with Helicobacter pylori gastritis using the Update Sydney System

2009 ◽  
Vol 46 (4) ◽  
pp. 328-332 ◽  
Author(s):  
Marini Langner ◽  
Rodrigo S. Machado ◽  
Francy R. S. Patrício ◽  
Elisabete Kawakami
Keyword(s):  
Helicobacter Pylori ◽  
Children And Adolescents ◽  
Mononuclear Cell ◽  
Bacterial Density ◽  
Cell Infiltrate ◽  
Chronic Active Gastritis ◽  
Sydney System ◽  
Greater Curvature ◽  
H Pylori ◽  
Helicobacter Pylori Gastritis

CONTEXT: Although Helicobacter pylori infection is prevalent in our country, there are few studies evaluating the associated histological abnormalities in children. OBJECTIVE: To evaluate the histological features of the gastric mucosa in children and adolescents with Helicobacter pylori gastritis. METHODS: One hundred and thirty two gastric biopsies from 22 symptomatic patients infected with H. pylori (14F/8M, median age 10 y 5 mo, age range 2 y 11 mo to 16 y 9 mo) were evaluated. Evaluated gastric regions included: antrum (lesser and greater curvature), corpus (lesser and greater curvature), incisura angularis and fundus. Histological examination was performed according to the Updated Sydney System, and regional scores for polymorphonuclear and mononuclear cell infiltrate as well as bacterial density were generated. RESULTS: Fifteen (68.2%) patients presented H. pylori-chronic active gastritis, six (27.3%) presented antrum-predominant H. pylori-chronic active gastritis, and one (4.5%) presented corpus-predominant H. pylori-chronic active gastritis. Polymorphonuclear cell infiltrate and mononuclear cell infiltrate were observed in 93.9% and 98.5% of the biopsy specimens, respectively. Higher histological scores for polymorphonuclear infiltrate, mononuclear infiltrate, and bacterial density were observed in the gastric antrum. Intestinal metaplasia and gastric atrophy were not identified in any patient. Lymphoid aggregates and lymphoid follicles were observed in the gastric antrum of three (13.6%) and seven (31.8%) patients, respectively, but they were not related to antral nodularity. CONCLUSIONS: Chronic active gastritis was observed in all patients with H. pylori infection. However, antral or corporeal predominance was not observed in most patients.

scholarly journals Evaluation of chronic gastritis with Helicobacter pylori using updated Sydney system

2021 ◽  
Vol 9 (9) ◽  
pp. 2728
Author(s):  
Anjana M. L. ◽  
Kavitha Yevoor
Keyword(s):  
Helicobacter Pylori ◽  
Chronic Gastritis ◽  
Histological Evaluation ◽  
Statistical Association ◽  
Histopathological Changes ◽  
Biopsy Specimens ◽  
Sydney System ◽  
Updated Sydney System ◽  
H Pylori ◽  
Significant Statistical Association

Background: Helicobacter pylori has been established as a major etiological factor in the pathogenesis of chronic gastritis. The aim of the study was to interpret the histopathological changes in chronic gastritis using updated Sydney system and the association with H. pylori infection.Methods: This was a 3 years study in which 62 gastric endoscopic mucosal biopsies taken from patients presenting with dyspepsia were included. Slides were stained with routine H and E and Giemsa for H. pylori detection in chronic gastritis cases. Grading of the variables were done with reference to Sydney system of classification.Results: Out of 62 gastric biopsy specimens, 55 cases (88.7%) were histopathological diagnosed as chronic gastritis. Among chronic gastritis, 21 (38%) cases showed H. pylori and majority of these being moderately (2+) positive. 27 (49%) cases showed neutrophilic activity with most of them showed mild (1+) activity. Chronic inflammation was seen 52 (94.5%) with majority of these graded as moderate (2+). Intestinal metaplasia was seen in 8 (14.5%) of cases with majority being mild (1+). Atrophy was seen only in 3 (5.4%) of cases with majority being mild (1+). Significant statistical association was found between H. pylori and neutrophilic activity (p<0.001).Conclusions: Histological evaluation of chronic gastritis using updated Sydney system of classification helps in detection of H. pylori infection and prevents further progression of the disease. 

RAD51 G135C genetic polymorphism and their potential role in gastric cancer induced byHelicobacter pyloriinfection in Bhutan

2015 ◽  
Vol 144 (2) ◽  
pp. 234-240 ◽  
Author(s):  
T. T. H. TRANG ◽  
H. NAGASHIMA ◽  
T. UCHIDA ◽  
V. MAHACHAI ◽  
R.-K. VILAICHONE ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Genetic Polymorphism ◽  
Intestinal Metaplasia ◽  
Polymorphism Analysis ◽  
Genotype Distribution ◽  
High Prevalence ◽  
The Status ◽  
Sydney System ◽  
Updated Sydney System ◽  
H Pylori

SUMMARYIn order to evaluate the role of the RAD51 G135C genetic polymorphism on the risk of gastric cancer induced byHelicobacter pyloriinfection, we determined allele frequency and genotype distribution of this polymorphism in Bhutan – a population documented with high prevalence of gastric cancer and extremely high prevalence ofH. pyloriinfection. The status of RAD51 G135C was examined by restriction fragment length polymorphism analysis of PCR amplified fragments and sequencing. Histological scores were evaluated according to the updated Sydney system. G135C carriers showed significantly higher scores for intestinal metaplasia in the antrum than G135G carriers [mean (median) 0·33 (0)vs.0·08 (0),P= 0·008]. Higher scores for intestinal metaplasia of G135C carriers compared to those of G135G carriers were also observed inH. pylori-positive patients [0·3 (0)vs.0·1 (0),P= 0·002] andH. pylori-positive patients with gastritis [0·4 (0)vs.0·1 (0),P= 0·002] but were not found inH. pylori-negative patients. Our findings revealed that a combination ofH. pyloriinfection and RAD51 G135C genotype of the host showed an increasing score for intestinal metaplasia. Therefore, RAD51 G135C might be the important predictor for gastric cancer ofH. pylori-infected patients.

scholarly journals The Updated Sydney System: Classification and Grading of Gastritis as the Basis of Diagnosis and Treatment

2001 ◽  
Vol 15 (9) ◽  
pp. 591-598 ◽  
Author(s):  
Manfred Stolte ◽  
Alexander Meining
Keyword(s):  
Helicobacter Pylori ◽  
Distribution Patterns ◽  
Helicobacter Heilmannii ◽  
Chemically Induced ◽  
Topographical Distribution ◽  
Sydney System ◽  
Updated Sydney System ◽  
H Pylori ◽  
First Time ◽  
Morphological Distribution

In recent years, the importance of the histological diagnosis of gastritis on the basis of routinely obtained antral and corpus biopsies has increased enormously, which is owed not least of all to the discovery ofHelicobacter pylori. The introduction of the Sydney system made it possible, for the first time, to grade histological parameters, identify topographical distribution and, finally, make a statement about the etiopathogenesis of the gastritis. Of pathogenetic importance is, in the first instance, the differentiation between gastritis with and gastritis withoutH pyloriinfection. The group ofH pylori-associated gastritis can be further subdivided into forms of gastritis whose morphological distribution patterns usually identify them as sequelae ofH pyloriinfection, while the group of gastritis unassociated withH pylori, can be differentiated into autoimmune, chemically induced reactive gastritis, ex-H pylorigastritis,Helicobacter heilmanniigastritis, Crohn's gastritis and a number of special forms of gastritis.

scholarly journals Helicobacter pylori infection and chronic gastritis; use of the Updated Sydney System in histopathological evaluation of gastritis

2019 ◽  
Author(s):  
Nushka Ubhayawardana ◽  
Manjula Weerasekera ◽  
Kamani Samarasinghe ◽  
Sameera Premalal ◽  
Deepaka Weerasekera ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Chronic Gastritis ◽  
Variable Number ◽  
Ulcer Disease ◽  
Chronic Active Gastritis ◽  
Sydney System ◽  
Histologic Lesion ◽  
Updated Sydney System ◽  
H Pylori

Abstract Objective Helicobacter pylori is a major cause for chronic gastritis and further it is associated with development of peptic ulcer disease and gastric cancer. Therefore, the objective of this study was to classify gastritis according to the updated Sydney system guidelines and find the association of H. pylori with each of graded variable. Number of 152 dyspeptic patients who underwent upper gastro-intestinal endoscopy at a Teaching Hospital were enrolled. Of the 2 biopsies collected one was used for PCR to detect H. pylori. The other biopsy was fixed in formalin followed by paraffin embedding and stained with H&E stain. Gastritis was classified microscopically according to the updated Sydney system. Results : Gastritis was reported over a wide age group ranging from 18-84 years with a mean age of 51 years. Based on histological findings, 12% of patients were diagnosed as H. pylori associated chronic active gastritis. There was no significant association between each graded variable and H. pylori positivity. Of the 152 dyspeptic patients 34 were positive by PCR for H. pylori infection. All the dyspeptic patients with H. pylori infection had chronic active gastritis, suggesting an etiologic role of the bacterium in the histologic lesion.

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