Can the Diagnosis of NSAID-Induced or Hp-Associated Gastric Ulceration Be Predicted from Histology?

Zusammenfassung

Wir sind der Frage nachgegangen, ob sich NSAR/ASS-induzierte Ulzerationen in Magenbiopsien anhand des Nachweises einer ischämischen Nekrose unterscheiden lassen.

Biopsien von 208 Patienten mit Magenulzera wurden histologisch ausgewertet. 29 Patienten wurden aus verschiedenen Gründen von der Studie ausgeschlossen. NSAR/ASS-Ulzera wurden immer dann diagnostiziert, wenn eine homogen eosinophile Nekrose nachweisbar war. Helicobacter pylori (Hp)-induzierte Ulzera wurden diagnostiziert, wenn eine nicht-homogene fibrinreiche Nekrose mit Zelldebris und Durchsetzung von neutrophilen Granulozyten vorlag. Die histologische Diagnose wurde mit Daten zum Medikamentengebrauch, der Endoskopie und der Anamnese verglichen.

Bei 121 der 179 eingeschlossenen Patienten ließ sich ein NSAR/ASS-Gebrauch feststellen. Von den 60 Patienten, die NSAR/ASS einnahmen ohne histologischen Nachweis von Hp, wurden alle (100 %) in der Histologie richtig erkannt. Von den 61 Patienten, die NSAR/ASS-Medikationen einnahmen mit Nachweis einer aktiven Hp-Infektion, wurden 40 (66 %) durch die Histologie identifiziert. Von 58 Patienten ohne derartige Medikation waren 41 Hp-positiv und in der Histologie 31 (76 %) richtig diagnostiziert.

Die Sensitivität der histologischen Diagnose von NSAR/ASS-induzierten Ulzerationen lag bei 85 %, die Spezifität bei 53 %.

Die Ergebnisse unserer Studie zeigen, dass es in einem großen Prozentsatz der NSAR/ASS induzierten Ulzerationen des Magens möglich ist, derartige Läsionen in der Histologie richtig zu diagnostizieren. Zusammenfassend kann die zugrunde liegende Ätiopathogenese von Ulzerationen des Magens (NSAR/ASS versus Hp) in einem großen Anteil der Patienten durch die histologische Untersuchung aufgedeckt werden.

Abstract

We studied the question whether NSAID/ASA-induced ulcerations can be identified in human gastric biopsy material on the basis of ischaemic necrosis.

Biopsies of 208 patients with gastric ulcers were assessed histologically. 29 patients were excluded from the study. NSAID/ASA ulcers were diagnosed when a homogeneous eosinophilic ischaemic necrosis was found. Helicobacter pylori-(Hp-) induced ulcers were diagnosed when non-homogeneous fibrinoid necrotic material containing granulocytes and cell debris was noted. The histological diagnosis was compared with the data on medication use, endoscopy and clinical history.

121 of the 179 patients included had a medical history on NSAIDS/ASA. From the 60 patients taking NSAIDS/ASA with no histologic evidence of Hp all (100 %) were identified by the histology of the necrosis. From the 61 patients taking NSAID/ASA and histologic evidence of H. pylori 40 (66 %) were identified by histology. From the 58 patients with no such medication 41 were Hp-positive and correctly identified by histology in 31 cases (76 %).

The sensitivity of the histologic diagnosis of NSAID/ASA-induced ulceration was 85 %, and its specificity 53 %.

The results of our study show that a high percentage of the NSAID/ASA-induced ulcers of the stomach can indeed be correctly diagnosed at histology. In conclusion the underlying aetiopathogenesis of gastric ulcerations (NASID/ASA vs. Hp) can be uncovered in a large proportion of patients based on histological examination.

Schlüsselwörter

Magen - Ulkus - NSAR - ASS - Helicobacter - Histologie

Key words

Stomach - ulcer - NSAID - ASA - helicobacter - histology

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