Chronic Epigastric Pain Syndrome With Normal Upper Endoscopy: Should We Systematically Biopsy?

Aims The aim of our study was to determine the usefulness of gastric biopsies in case of normal upper endoscopy.

Methods This is a retrospective study gathering all the patients presenting with chronic epigastric pain who underwent upper endoscopy from January to June 2019. Clinical characteristics, H. pylori prevalence, endoscopic and histological findings were collected. The patients were allocated to two comparable groups: Group1 ‘ Significant endoscopic lesion’, Group2 ‘Normal upper endoscopy’. We considered as significant endoscopic lesion: oesophagitis, gastritis, duodenitis, peptic ulcer, upper gastrointestinal tract polyp/cancer. An analytical study was performed using the software SPSS 22.0 (significant p value if < 0.05).

Results Ninety-one patients were included in our study. The average age was 49.71 (±16.5) years, 43.9 % were male. Significant endoscopic lesions were recorded in 76,9 % (Group1). The most frequent findings were antral gastropathy in 59.8 %, fundic gastropathy in 21,7 % and ulcers in 21,7 %. No malignancies were noted. Twenty one patients had normal esophagogastroduodenoscopy (EGD)(23,07 %) (Group 2). In Group 1, the prevalence of H.Pylori was 70 %, gatric atrophia (GA) was found in 14,2 % and intestinal metaplasia (IM) in 11,4 %.In Group 2, H.pylori was found in 52,3 %, GA was found in 33,3 % and IM was noted in 19 %.

In univariate analysis, only H.Pylori was associated with endoscopic lesions (p = 0,05). The PPV of significant endoscopic lesions for H. pylori prevalence, GA and IM were 71,4 %; 15,7 % and 11,4 % respectively. The NPV were 50 %, 70 % and 80 %.

Conclusions In our study, the presence of significant endoscopic lesion was not a good predictors of pathological abnormalities. Even if the EGD is normal, biopsies are essential for endoscopic screening of pre-malignant gastric lesions (GA, IM).

Citation: Ben Farhat F, Bellil N, Sabbah M et al. eP66 CHRONIC EPIGASTRIC PAIN SYNDROME WITH NORMAL UPPER ENDOSCOPY: SHOULD WE SYSTEMATICALLY BIOPSY?. Endoscopy 2021; 53: S117.

Publication History

Article published online:
19 March 2021