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Chronic gastritis according to age and Helicobacter pylori in Thailand: histopathological patterns
Taned Chitapanarux1,2, Panas Jesadaporn3, Nalin Chitapanarux2
1Gastrohepatology Unit, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Insights
Chronic gastritis is prevalent in dyspeptic patients even without visible lesions. Its severity and presence increase with age and Helicobacter pylori infection, with aging playing a key role in gastric mucosal changes.
Area of Science:
- Gastroenterology
- Pathology
- Epidemiology
Background:
- Dyspepsia is a common condition often investigated via upper endoscopy.
- Visible mucosal lesions are not always present in dyspeptic patients.
- Histopathological evaluation of gastric biopsies is crucial for diagnosing chronic gastritis.
Purpose of the Study:
- To evaluate the histopathological features of chronic gastritis in dyspeptic patients without visible mucosal lesions.
- To analyze these features across different age groups and biopsy sites.
- To determine the influence of age and Helicobacter pylori (Hp) infection on chronic gastritis.
Main Methods:
- Retrospective study of 626 dyspeptic patients undergoing upper endoscopy.
- Inclusion criteria: absence of visible mucosal lesions and dyspepsia as sole indication.
- Gastric biopsy analysis using the Update Sydney classification, assessing age, Hp status, and biopsy site.
Main Results:
- 58.2% of patients exhibited chronic gastritis; 41.8% had normal mucosa.
- Prevalence of glandular atrophy, intestinal metaplasia, and Hp infection was 36.7%, 19.3%, and 36.6%, respectively.
- Gastritis severity and prevalence increased with age and Hp infection, with significant antral predominance and higher rates after age 50. Hp positivity decreased in older age groups.
Conclusions:
- Chronic gastritis is common in dyspeptic patients lacking visible endoscopic findings.
- Age and Hp infection are significant factors in the prevalence, grading, and severity of chronic gastritis.
- Aging appears to be a primary driver of temporal gastric mucosal changes, more so than Hp infection alone.
Objectives:
We aimed to evaluate the histopathological characteristics of chronic gastritis in dyspeptic patients without visible mucosal lesions in different age groups and different biopsy sites.
Methods:
Patients who underwent upper endoscopy for the investigation of dyspepsia as the sole indication were recruited. We selected data from patients without visible mucosal lesions for the study. Gastric biopsy specimens were evaluated by Update Sydney classification according to age, Helicobacter pylori (Hp), and biopsy sites.
Results:
A total of 626 patients were retrospectively studied. 58.2% had histopathological features of chronic gastritis, while 41.8% had normal gastric mucosa. The prevalence of glandular atrophy, intestinal metaplasia, and Hp infection was 36.7, 19.3 and 36.6%. Complete and incomplete metaplasia was found to be 17.0 and 2.2%. The mean score of chronic inflammation, neutrophil activity, glandular atrophy, and intestinal metaplasia was significantly higher in the antrum than in the corpus. The positivity of gastritis increases with age; however, Hp positivity decreased considerably with advanced age. Concerning gastritis's topography, antral-predominant gastritis and corpus-predominant gastritis increased with age. The prevalence of glandular atrophy and intestinal metaplasia markedly increased with age, especially after age 50. Gastric atrophy and intestinal metaplasia were significantly higher in patients positive for Hp than in negative patients.
Conclusion:
Overall chronic gastritis is common in dyspeptic patients without visible lesions. Prevalence, grading, and severity of chronic gastritis increase with age and Hp infection. Temporal changes of the gastric mucosa are caused by aging rather than by Hp alone.
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