Endoscopy 2003; 35(11): 946-950
DOI: 10.1055/s-2003-43479
Original Article
© Georg Thieme Verlag Stuttgart · New York

Relationship of Gastroscopic Features to Histological Findings in Gastritis and Helicobacter Pylori Infection in a General Population Sample

S.  Redéen 1 , F.  Petersson 2 , K.-Å.  Jönsson 1 , K.  Borch 1
  • 1 Department of Surgery, University Hospital of Linköping, Sweden
  • 2 Pathology Research Department, Ryhov Hospital, Jönköping, Sweden
Further Information

Publication History

Submitted 17 January 2003

Accepted after Revision 20 June 2003

Publication Date:
07 November 2003 (online)

Background and Study Aim: Various gastroscopic features may be interpreted as signs of gastritis, but the significance of such features in relation to histomorphology is uncertain. The aim of this study was to determine how macroscopic findings were related to histomorphological changes and the presence of Helicobacter pylori in the gastric mucosa, in a sample of the general population.
Subjects and Methods: 488 adult individuals, randomly selected from a general population, were screened with gastroscopy and biopsy. The macroscopic features recorded were erythema (diffuse, spotty, linear), erosions, absence of rugae in the gastric corpus, and presence of visible vessels. Gastritis was classified microscopically according to the Sydney system. The presence of H. pylori was determined histologically and using the urease test on fresh biopsy specimens.
Results: The sensitivity and specificity of absence of rugae for moderate to severe atrophic gastritis in the gastric corpus were 67 % and 85 %, respectively. Corresponding values for severe atrophy were 90 % and 84 %. The sensitivity and specificity of the presence of visible vessels for moderate to severe atrophy in the corpus were 48 % and 87 %, and for severe atrophy the values were 80 % and 87 %, respectively. Considering the antrum, the sensitivity and specificity of the presence of visible vessels for moderate to severe atrophy was 14 % and 91 %, respectively. With regard to chronic inflammation (moderate to severe in the corpus or antrum), none of the features, alone or in combination, showed a sensitivity of more than 56 %. No endoscopic features (alone or in combination) showed a sensitivity of more than 57 % for H. pylori infection.
Conclusions: Except for the absence of rugae and visible vessels in the gastric corpus, macroscopic features as observed during gastroscopy are of very limited value in the evaluation of whether or not gastritis or H. pylori infection are present. This is in accordance with most previous studies in patient populations, and it must be emphasized that the diagnosis of gastritis should be based on histological examination of the gastric mucosa.

References

  • 1 Marshall B J, Warren J R. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration.  Lancet. 1984;  1 1311-1315
  • 2 Borch K, Jonsson K A, Petersson F. et al . Prevalence of gastroduodenitis and Helicobacter pylori infection in a general population sample: relations to symptomatology and life-style.  Dig Dis Sci. 2000;  45 1322-1329
  • 3 Siurala M, Sipponen P, Kekki M. Campylobacter pylori in a sample of Finnish population: relations to morphology and functions of the gastric mucosa.  Gut. 1988;  29 909-915
  • 4 Dooley C P, Cohen H, Fitzgibbons P L. et al . Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons.  N Engl J Med. 1989;  321 1562-1566
  • 5 Sipponen P, Hyvarinen H. Role of Helicobacter pylori in the pathogenesis of gastritis, peptic ulcer and gastric cancer.  Scand J Gastroenterol. 1993;  196 Suppl 3-6
  • 6 Bah A, Saraga E, Armstrong D. et al . Endoscopic features of Helicobacter pylori-related gastritis.  Endoscopy. 1995;  27 593-596
  • 7 Price A B. The Sydney System: histological division.  J Gastroenterol Hepatol. 1991;  6 209-222
  • 8 Dixon M F, Genta R M, Yardley J H. et al . Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994.  Am J Surg Pathol. 1996;  20 1161-1181
  • 9 Lehmann F S, Renner E L, Meyer-Wyss B. et al . Helicobacter pylori and gastric erosions. Results of a prevalence study in asymptomatic volunteers.  Digestion. 2000;  62 82-86
  • 10 Akdamar K, Ertan A, Agrawal N M. et al . Upper gastrointestinal endoscopy in normal asymptomatic volunteers.  Gastrointest Endosc. 1986;  32 78-80
  • 11 Ecclissato C, Carvalho A F, Ferraz J G. et al . Prevalence of peptic lesions in asymptomatic, healthy volunteers.  Dig Liver Dis. 2001;  33 403-406
  • 12 Calabrese C, di Febo G, Brandi G. et al . Correlation between endoscopic features of gastric antrum, histology and Helicobacter pylori infection in adults.  Ital J Gastroenterol Hepatol. 1999;  31 359-365
  • 13 Loffeld R J. Diagnostic value of endoscopic signs of gastritis: with special emphasis to nodular antritis.  Neth J Med. 1999;  54 96-100
  • 14 Prieto G, Polanco I, Larrauri J. et al . Helicobacter pylori infection in children: clinical, endoscopic, and histologic correlations.  J Pediatr Gastroenterol Nutr. 1992;  14 420-425
  • 15 Sakaki N. Endoscopic diagnosis of gastritis in relation to Helicobacter pylori infection and subjective symptoms.  J Clin Gastroenterol. 1995;  21 S135-S139
  • 16 Sipponen P, Ranta P, Helske T. et al . Serum levels of amidated gastrin-17 and pepsinogen I in atrophic gastritis: an observational case-control study.  Scand J Gastroenterol. 2002;  37 785-791
  • 17 Mardh E, Mardh S, Mardh B. et al . Diagnosis of gastritis by means of a combination of serological analyses.  Clin Chim Acta. 2002;  320 17-27

K. Borch, M. D., PhD

Department of Surgery, University Hospital of Linköping

58185 Linköping · Sweden

Fax: +46-13-223570

Email: Kurt.Borch@ibk.liu.se