Gastroduodenitis and Helicobacter pylori in Nigerians: histopathological assessment of endoscopic biopsies.

OBJECTIVE: Morphologic changes seen in the endoscopic biopsies are dynamic and could be predictive of more important sequelae of chronic H. pylori gastritis such as gastric carcinoma and lymphoma. The objective of the study was to review the biopsy appearances of endoscopic gastroduodenal biopsies using the updated Sydney System of classification in order to throw some light on the biology of gastroduodenitis. METHODS: A retrospective review of all endoscopic gastroduodenal biopsies received in the department of Morbid Anatomy of Obafemi Awolowo University Teaching Hospitals Complex between 1994 and 2003 was undertaken. Grading of the chronicity, activity, atrophy, H. pylori density and metaplasia were done using the updated Sydney System of classification and grading. RESULTS: A total of 1047 gastric and 47 duodenal biopsies from 1047 patients were reviewed. There was evidence of significant chronic gastritis in 98.1% of the gastric biopsies and in 78.0% of these, H. pylori was the main identifiable aetiological agent. Marked atrophic changes and intestinal metaplasia that are known to predispose to gastric malignances were seen in 4.9% and 9.3% of our cases respectively. Chronic duodenitis was seen in 83% of the duodenal biopsies and in 29.6%, H. pylori was seen on a background of gastric metaplasia. CONCLUSION: The prevalence of H. pylori was high and it was the single most important aetiological factor responsible for the biopsy changes associated with chronic gastroduodenitis.

Gastroduodenal mucosa in peptic ulcer: endoscopic and histological assessment.

This study aimed to assess the prevalence of endoscopic and histological gastroduodenitis as well as helicobacter-like organisms in patients with peptic ulcer. After diagnostic endoscopy, gastroduodenal biopsy specimens were taken from thirty patients (n = 30) with clinical and endoscopic diagnosis of peptic ulcer (duodenal ulcer = 25, gastric ulcer = 5). Endoscopic gastroduodenitis occurred in 18 patients (60%). Histological gastritis was detected in the gastric body or antrum in 25 (83%) and duodenitis in 17 (57%) patients. There was significant correlation between endoscopic and histological gastritis (p < 0.05). Helicobacter-like organisms occurred in 73% of the patients with peptic ulcer and in 88% of the antral biopsy specimens showing antral gastritis. Presence of helicobacter-like organisms was in particular associated with acute on chronic gastritis compared to chronic gastritis (p < 0.01). Moreover the patients with gastritis were found to belong to the older age group and 81.8% had blood group O +ve (p < 0.01 and p < 0.05 respectively). We conclude that presence of helicobacter-like organisms in patients with peptic ulcer is significantly associated with acute on chronic gastritis.

Coeliac disease with histological features of peptic duodenitis: value of assessment of intraepithelial lymphocytes.

AIMS: To determine if a clinically important polymorphonuclear leucocyte infiltrate and surface gastric epithelial metaplasia occur in the second part of the duodenum in coeliac disease; to evaluate the utility of these morphological criteria in the differential diagnosis of coeliac disease and peptic duodenitis. METHODS: 49 mucosal biopsy specimens of the second part of the duodenum reported as showing inflammation were reviewed. Sections were prepared with haematoxylin and eosin, periodic acid Schiff, and Warthin-Starry stains. Clinical presentation, outcome, and immunological investigations were assessed. RESULTS: Four cases confirmed as coeliac disease on clinical and immunological grounds showed acute inflammation and surface epithelial gastric metaplasia. Increased intraepithelial lymphocytes (IELs) were found in each of the four. CONCLUSIONS: Clinically important polymorphonuclear leucocyte infiltration and surface epithelial gastric metaplasia may occur in the duodenal mucosa in coeliac disease and should not be used as diagnostic features to exclude the diagnosis of coeliac disease in the absence of confirmatory clinical and immunological information.