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Published on: August 17, 2022
Gastritis and carditis
1University of British Columbia, Vancouver, British Columbia, Canada. dowen@vanhosp.bc.ca
Insights
Dyspepsia investigation often involves gastroscopy, but findings can be misleading. Biopsies are crucial for accurate diagnosis of gastritis and Helicobacter pylori infection, guiding treatment for ulcers and cancer risks.
Area of Science:
- Gastroenterology
- Pathology
- Oncology
Background:
- Dyspepsia is a prevalent clinical issue with diverse causes, including peptic ulcer disease, gastroesophageal reflux, and functional dyspepsia.
- Clinical pain descriptions lack reliability in differentiating dyspepsia causes, leading to frequent gastroscopies (80% for dyspepsia).
- Endoscopic "gastritis" diagnosis is common (59%), yet severe changes are rare (3%), with weak correlation to histologic findings (62-73% abnormalities).
Purpose of the Study:
- To emphasize the necessity of biopsy alongside endoscopy for accurate gastric pathology diagnosis.
- To highlight the link between Helicobacter pylori infection, gastritis progression, and associated diseases.
- To differentiate various forms of gastritis and their clinical implications.
Main Methods:
- Systematic gastric biopsies including antrum and corpus sampling during endoscopy.
- Histopathologic examination of biopsy specimens.
- Review of current evidence linking Helicobacter pylori infection to gastritis progression and sequelae.
Main Results:
- Histologic abnormalities are frequent (62-73%) even when endoscopic findings are minimal.
- Helicobacter pylori infection progresses from superficial gastritis to atrophic gastritis with intestinal metaplasia, increasing risks.
- Persistent superficial gastritis is linked to duodenal ulcers and MALT lymphoma; atrophic gastritis to gastric ulcers and adenocarcinoma.
- Reactive gastropathy is common, associated with duodenal reflux or NSAID use.
- Distinct entities include lymphocytic gastritis, eosinophilic gastritis, and gastritis associated with Crohn's disease.
Conclusions:
- Endoscopic examination for dyspepsia must include systematic biopsies for accurate diagnosis.
- Helicobacter pylori infection is a key factor in gastritis progression, predisposing to ulcers, lymphoma, and adenocarcinoma.
- Understanding different gastritis types and their associations is vital for patient management.
Abstract:
Dyspepsia is a common clinical problem. Its causes include peptic ulcer disease, gastroesophageal reflux, and functional (nonulcer) dyspepsia. A detailed clinical description of pain does not reliably differentiate the cause. Approximately 80% of gastroscopies are performed for the investigation of dyspepsia. "Gastritis" is diagnosed endoscopically in 59% of all stomachs, although in only 3% are the changes severe. Pathologic examination of unselected gastric biopsy specimens reveals that abnormalities are present in 62-73%, but there is only a weak correlation between endoscopic and histologic findings. For these reasons, it is recommended that endoscopic examination should always be accompanied by biopsy. Ideally, biopsies should be taken in a systematic fashion to include sampling of antrum and corpus. Recent evidence suggests that gastric infection by Helicobacter pylori initially presents as a superficial gastritis. Later it may become atrophic with development of intestinal metaplasia. The onset of atrophic changes may be related to the duration of infection, the strain of the infecting organism, associated dietary factors, or as-yet undefined host factors related to immunity. Persistent superficial gastritis predisposes to duodenal ulcer and gastric mucosa-associated lymphoid tissue lymphoma. Atrophic gastritis predisposes to gastric ulcer and adenocarcinoma. Evidence is accumulating that in some patients, pernicious anemia may be an end result of H. pylori-induced atrophic gastritis. Reactive gastropathy is a relatively common finding in gastric biopsies; in most instances it is associated with either reflux of duodenal contents or therapy with nonsteroidal anti-inflammatory drugs. Lymphocytic gastritis, eosinophilic gastritis, and the gastritis associated with Crohn's disease are distinct morphologic entities. Lymphocytic gastritis and eosinophilic gastritis have a variety of clinical associations. Carditis is a controversial topic: currently opinions are divided as to whether it is the result of gastroesophageal reflux or a proximal extension of H. pylori infection from the remainder of the stomach.
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