Remnant gastritis should be evaluated histologically rather than endoscopically.

ABSTRACT

BACKGROUND/AIMS: Many patients who undergo distal gastrectomy develop remnant gastritis. The diagnosis of remnant gastritis is commonly established endoscopically. This report describes the correlation between endoscopic and histological findings of inflammatory changes in the remnant gastric mucosa. METHODOLOGY: Ninety-seven patients who underwent curative distal gastrectomy for gastric cancer, with radical lymphadenectomy, were studied. Endoscopy was performed 12 weeks after surgery. Patients with marked redness, erosion, or edema of the gastric remnant, as seen by endoscopy, were judged to have remnant gastritis, and were divided into group P (positive) and group N (negative). Histological remnant gastritis was evaluated with the neutrophil infiltration score based on the updated Sydney System for endoscopically taken biopsies. Cyclooxygenase (COX)-2 expression was evaluated immunohistochemically. RESULTS: There was no difference in neutrophil infiltration or COX-2 expression scores between the patients in groups P and N. There was a significant correlation between neutrophil infiltration score and COX-2 expression score (p<0.001). CONCLUSIONS: Endoscopic diagnosis of remnant gastritis was not correlated with histological findings. Histological remnant gastritis had significant correlation with COX-2 expression score, which was induced by inflammation. Therefore, proper diagnosis of remnant gastritis should be based on histological examination.