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Published on: May 18, 2018
Histological changes in patients with chronic upper gastrointestinal ischaemia
Désirée Van Noord1, Katharina Biermann, Leon Mg Moons
1Departments of Gastroenterology and Hepatology Pathology Intervention Radiology Vascular Surgery Internal Medicine, Erasmus MC - University Medical Center, Rotterdam, the Netherlands. d.vannoord@erasmusmc.nl
Insights
Diagnosing chronic upper gastrointestinal ischaemia (CUGI) is difficult. While histology isn't definitive, reactive gastropathy signs in biopsies can support CUGI diagnosis.
Area of Science:
- Gastroenterology
- Pathology
- Vascular Medicine
Background:
- Chronic upper gastrointestinal ischaemia (CUGI) diagnosis is challenging.
- Current diagnostic methods lack established histological criteria for transient CUGI.
- Understanding gastrointestinal histology in CUGI patients is limited.
Purpose of the Study:
- To investigate upper gastrointestinal histology in patients with confirmed CUGI.
- To determine the role of biopsy analysis in diagnosing CUGI.
- To identify potential histological markers associated with CUGI.
Main Methods:
- Prospective study of patients with suspected CUGI.
- Diagnostic work-up included upper endoscopy, tonometry, and angiography (CT/MR).
- Biopsy samples from duodenum and stomach were analyzed using established classifications (Sydney, Vienna, Chiu, Marsh, OLGA) for gastropathy.
Main Results:
- 79 patients were analyzed; 41 (52%) were diagnosed with CUGI.
- A higher prevalence of gastropathy was observed in patients with CUGI (P=0.025).
- No other significant histological differences were found between CUGI and non-CUGI groups.
Conclusions:
- Histological examination of biopsy samples is not definitive for diagnosing CUGI.
- The presence of reactive gastropathy on histology can serve as supportive evidence for a clinical CUGI diagnosis.
- Further research may refine the role of histology in CUGI work-up.
Aims:
Diagnosing chronic upper gastrointestinal ischaemia (CUGI) remains a challenge in clinical practice. Histological examination of biopsy material currently plays no role in the diagnosis of transient CUGI, as little is known about gastrointestinal histology in these patients. The aim of this study was to investigate upper gastrointestinal histology in patients with well-defined CUGI.
Methods And Results:
Consecutive patients suspected of CUGI were included prospectively and underwent a diagnostic work-up existing of upper endoscopy, gastrointestinal tonometry and computed tomography (CT) or magnetic resonance (MR) angiography. Results were discussed in a multidisciplinary team and a consensus diagnosis was made. Endoscopic biopsy samples were taken from the descending duodenum, gastric antrum and corpus, and scored using the Sydney, Vienna, Chiu, Marsh and Operative Link for Gastritis Assessment (OLGA) classifications. Gastropathy was scored present or absent. Seventy-nine patients were analysed in 8months. CUGI was diagnosed in 41 patients (52%): 36 males, mean age 60 (17-86) years. Prevalence of gastropathy was significantly higher in patients with ischaemia (P=0.025). No other differences were found between patients with and without ischaemia.
Conclusions:
Histological examination of biopsy samples plays no definitive role in diagnosing CUGI, but the presence of histological signs of reactive gastropathy can be used to support the clinical diagnosis of ischaemia.
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