Turkiye Klinikleri Journal of Internal Medicine

.: ORIGINAL RESEARCH
Evaluation of Histopathological Correspondence of Atrophic Gastritis Observed in Endoscopy: Systematic Review
Endoskopik Atrofik Gastrit Görünümünün Histopatolojik Karşılığının Değerlendirilmesi: Sistematik İnceleme
Bilger ÇAVUŞ a, Aslı ÇİFTÇİBAŞI ÖRMECİ a, Raim İLİAZ a, Alp ATASOY a , Gülçin YEGENb, Özge TEPE b, Çetin KARACA a, Kadir DEMİR a , Selman Fatih BEŞIŞIK a, Sabahattin KAYMAKOĞLU a , Filiz AKYÜZ a
aDepartment of Gastroenterohepatology, İstanbul University İstanbul Faculty of Medicine, İstanbul, TURKEY
bDepartment of Pathology, İstanbul University İstanbul Faculty of Medicine, İstanbul, TURKEY
Turkiye Klinikleri J Intern Med. 2021;6(2):56-61
doi: 10.5336/intermed.2021-81042
Article Language: EN
Full Text
ABSTRACT
 Objective: Atrophic gastritis (AG), which is defined as the loss of gastric glands, can be precancerous. The objective of this study is examination of histopathological correlation of our patients with AG, considered according to endoscopic findings and determination of the other concomitant pathological findings. Material and Methods: Biopsy was performed in the atrophic areas and/or different areas on a total of 201 patients during gastroscopic evaluation due to the pre-diagnosis of AG between 2013 and 2014 in our clinic. Their pathological evaluation was performed and the cases of these patients were examined retrospectively. Endoscopic diagnosis of AG was made based on observation of the gastric mucosa as pale compared to the normal gastric mucosa and the separation of this area from the normal gastric mucosa, which can be defined as an endoscopic atrophic border with the prominence of submucosal thin vascular structures. Diagnosis of AG was pathologically defined as loss of glands. Results: The average age of the total 201 patients, who were 133 (67%) women and 68 (33%) men, was 69 years. Endoscopic and histological AG correlation in the whole group was 63 (31%). Considering the gastric localisation of the cases with confirmed diagnosis of AG in histopathological examination; it was determined that 89% affect the proximal, 9% the distal and 2% the distal and proximal together. Intestinal metaplasia (IM) was accompanied in 68% of cases with chronic active gastritis (21%) and neuroendocrine cell hyperplasia (NEHD) (14%). Chronic active gastritis was detected in 32% and IM 17% in cases without histopathological AG. While Helicobacter pylori positivity was 6% in those with histopathologically AG, it was 24% in those without AG (p=0.003). When evaluated in terms of accompanying pathological findings, NEHD, IM and lymphoid follicle hyperplasia were found with a higher rate in patients with histopathologically AG, and found statistically significant. Conclusion: Pathological examination must be performed if AG is suspected in endoscopy. While IM and NECH were more commonly concomitantly observed in patients with AG in pathological examination, the rate of H. Pylori was lower compared to the patients who did not have AG.

Keywords: Atrophic gastritis; intestinal metaplasia; neuroendocrine cell hyperplasia
ÖZET
 Amaç: Mide bezlerinin kaybı olarak tanımlanan atrofik gastrit (AG), prekanseröz olabilir. Bu çalışmanın amacı; endoskopik bulgular ile öngörülen AG'li vakalarımızın, histopatolojik korelasyonunun incelenmesi ve eşlik eden diğer patolojik bulguların saptanmasıdır. Gereç ve Yöntemler: 2013-2014 yılları arasında kliniğimizde gastroskopik değerlendirmesi yapılmış olan toplam 201 hastada saptanan atrofik alanlardan ve/veya farklı alanlardan biyopsi yapıldı. Patolojik değerlendirmeleri yapıldı ve bu hastalar retrospektif olarak değerlendirildi. AG tanısı endoskopik olarak; midede mukozanın normal mide mukozasına göre soluk olarak izlenmesi ve bu alanın endoskopik atrofik sınır şeklinde tanımlanabilecek şekilde normal mide mukozasından ayrışması, submukozal ince vasküler yapıların belirgin hâle gelmesi olarak tanımlandı. AG tanısı patolojik olarak gland kaybı olarak tanımlanmıştır. Bulgular: Yüz otuz üçü (%67) kadın, 68'i (%33) erkek olan toplam 201 hastanın ortalama yaşı 69 yıldır. Tüm grupta endoskopik ve histolojik AG korelasyonu 63'tür (%31). Histopatolojik incelemede, AG tanısı kesinleşen vakaların mide lokalizasyonuna bakıldığında; %89'unun proksimali, %9'unun distali, %2'sinin distali ve proksimali birlikte etkilediği tespit edilmiştir. Histopatolojik olarak AG saptanan vakaların %68'inde intestinal metaplazi (İM), %21'inde lenfoid hiperplazi, %21'inde kronik aktif gastrit ve %14'ünde nöroendokrin hücre hiperplazisi (NEHH) eşlik etmektedir. Histopatolojik olarak AG saptanmayan olgularda ise kronik aktif gastrit %32, İM %17 oranında saptanmıştır. Histopatolojik olarak AG saptananlarda Helicobacter pylori pozitifliği %6 iken saptanmayanlarda %24'tür (p=0,003). Eşlik eden patolojik bulgular açısından değerlendirildiğinde NEHH, İM ve lenfoid folikül hiperplazisi, histopatolojik olarak AG saptanan hastalarda daha yüksek oranda mevcut olup, istatiksel olarak da anlamlı bulunmuştur. Sonuç: Endoskopik AG şüphesinde, patolojik inceleme mutlaka yapılmalıdır. Patolojik incelemede, AG vakalarına İM ve NEHH daha sık eşlik ederken, H. pilori sıklığı AG saptanmayan vakalara göre daha düşüktür.

Anahtar Kelimeler: Atrofik gastrit; intestinal metaplazi; nöroendokrin hücre hiperplazisi
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