Z Gastroenterol 2013; 51 - A72
DOI: 10.1055/s-0033-1347447

Endoscopic Diagnosis of Gastritis is Dependant on the Aetiology of Disease – Data from a Prospective Central European Multicenter Study Applying High-Resolution Endoscopy

E Wolf 1, C Langner 1, W Plieschnegger 2, G Höss 3, A Eherer 4, P Rehak 5, M Vieth 6, B Schmack 7, B Wigginghaus 8
  • 1Institut für Pathologie, Graz, Austria
  • 2KH der Barmherzigen Brüder St. Veit/Glan/Abt. f. Innere Medizin, St. Veit/Glan, Austria
  • 3Universitätsklinik für Chirurgie/Abt. f. Allgemeinchirugie, Graz, Austria
  • 4Universitätsklinik für Innere Medizin. Abt. f. Gastroenterologie und Hepatologie, Graz, Austria
  • 5Universitätsklinik für Chirurgie/Forschungseinheit für medizinische Technik und Datenverarbeitung, Graz, Austria
  • 6Klinikum Bayreuth, Institut für Pathologie, Bayreuth, Germany
  • 7Magen-Darm-Zentrum Bayreuth, Bayreuth, Germany
  • 8Gastroenterologischen Fachpraxis, Osnabrück, Osnabrück, Germany

Background and Study aims:

Traditionally, Helicobacter infection is considered to be the most common cause of gastritis. Our study aimed to evaluate the significance of endoscopic diagnoses of gastritis in relation to histological findings, paying special attention to the aetiology of disease.

Patients and Methods:

A total of 1,123 individuals participated in a prospective observational multicenter study. The upper gastrointestinal tract of all participants was examined according to a standardized protocol devised for the study. For endoscopy, high-resolution endoscopes (Olympus Evis Exera II, Fuji EPX-4450HD) were used. Endoscopists had to classify individuals as negative or positive for gastritis and to render the most probable cause of disease, i.e. Helicobacter gastritis, reactive gastropathy, or autoimmune gastritis. Pathologists evaluated biopsy specimens based upon the Updated Sydney System.

Results: Upon histological analysis, 210 (18.7%) individuals were diagnosed with Helicobacter gastritis, 215 (19.1%) with post Helicobacter gastritis, 234 (20.8%) with reactive gastropathy, 26 (2.3%) with autoimmune gastritis, and 6 (0.5%) with focally enhanced gastritis related to Crohn's disease, respectively. Overall, the endoscopic diagnoses of gastritis were significantly associated with the histological diagnoses of gastritis (p < 0.001). In cases endoscopically classified as reactive gastropathy, 73.3% were positive on histology. Agreement, however, was poor for Helicobacter gastritis and post Helicobacter gastritis. Specifically, all histological parameters in favour of a diagnosis of reactive gastropathy, such as foveolar hyperplasia, ascending smooth muscle fibres in the lamina propria, and vasodilatation and congestion were significantly

associated with the endoscopic diagnosis (p < 0.001 each), whereas those related to Helicobacter infection, i.e. chronic and active inflammation, were not.

Conclusion: Reactive gastropathy emerged to be the most common cause of gastritis. This change in prevalence may improve the accuracy of endoscopic diagnoses applying high-resolution magnifying endoscopy, as histological features indicating reactive gastropathy are significantly associated with endoscopic visibility, whereas features indicating Helicobacter infection are not.