Endoscopic Recognition of Gastric Mucosal Changes and Their Significance in Evaluating Dyspeptic Patients

Abstract

Introduction: Pyspepsia is a problem related to eating (as pain, nausea, fullness),it remains a common disorder without effective therapy, but these nonspecific symptoms can be indicative of underlying disease as PUD, GERD, and malignancy. Aim: Aim of the study to determine the gastric mucosal changes (histopathology) and endoscopic finding in evaluated dyspeptic patient for further management. Method: a prospective study was conducted in elbida city in endoscopic unite, 62 patients complain of dyspepsia for more than l year, with mean age (50.7%) and Range of 77 years, they evaluated then endoscopy done and biopsies taken (antral, corporal) and examined histopathologically and graded the gastric mucosa by revised Sydney system. Result: with other investigations, endoscopic finding: gastritis n=49(80.3%),reflux esophagitis n=23(37.7%),pan gastritis n=5(8.2%),gastric ulcer n=8(13.1%), gastropathy n=2(3.3%),erosive gastritis n=11(18%),hiatus hernia n=13(21.3%), esophageal varices n=5(8.2%),bile reflux n=4(6.6%),cancer n=2(3.3%),functional dyspepsia n=2(3.3%),duodenal ulcer n=8(13.1%),and duodenitis n=16(26.2%). Biopsies show H. pylori n=42(68.9%),atrophic changes n=5(8.2%),dysplasia n=15(24.6%),lymphoid follicle n=9(14.8%),intestinal metaplasia n=8(13.1%), MALT lymphoma n=2(3.3%),chronicity of the inflammation by lymphocyte infiltrations as mild 26(42.6%), moderate 27(44.3%), sever 8(13.1%), and activity of inflammation as mild 37(60.7%), moderate 18(29.5%) and sever 6(9.8%). Conclusion: we conclude that most of the patient with dyspeptic symptoms during endoscopic studies they have a serious underlying organic lesions as gastritis(most common),functional dyspepsia(less common)and others as mentions befor, with histopathological assessment of biopsies it gives us a clue about activity, chronicity of the inflammatory process in gastric mucosa which is found to be more in antral area with Positive H. pylori infections, and precancerous lesions as dysplasia, atrophy, intestinal Metaplasia and malignant cells also were present.so dyspepsia is not only a convenient descriptor for upper gastrointestinal symptoms, but also a marker for the risk of structural disease, so endoscopy and histopathological study of the biopsies offers the potential for early diagnosis of structural diseases and then for better managment.

Keywords: Dyspepsia; Upper gastrointestinal endoscopy; Gastritis; Helicobacter pylori; Gastric mucosal changes; Histopathology; Gastric dysplasia; Intestinal metaplasia; Gastric atrophy; Gastric malignancy.