Changes Of Magnifying Endoscopic Views, Gastric Mucosal Histopathology And Serum PGI, Gastrin, EGF Concentrations After Eradication Of Helicobacter Pylori In Patients With Chronic Atrophic Gastritis

Background and Aims Helicobacter pylori (Hp) play an important role in the promotion of chronic atrophic gastritis (CAG). Long-term Hp infection will result in glandular atrophy. Severe gastric atrophy induced by Hp is suggested to be an important risk factor in the development of gastric carcinoma. Therefore, it is presumed that the control of histological gastritis is linked to the control of gastric cancer developments. Although many studies have discussed the effect of Hp eradication therapy on histological gastritis, it is still unclear whether atrophic change is reversible or not. With improved resolution power and operability, magnifying endoscope has begun to be used in clinical practice. Our previous studies have displayed magnifying endoscopy can be used to diagnosis Hp infection and glandular atrophy. In this study, to further explored the diagnostic value of magnifying endoscopy in CAG, to clarify whether magnifying endoscope is a useful tool for the estimation Hp infection and effect of the eradication treatment, and whether the Hp eradication can improve gastric atrophy, we observed the changes of magnifying endoscopic views, gastric mucosal histopathology and serum PGI, Gastrin, EGF concentrations after Hp eradication in patients with chronic atrophic gastritis. Materials and Methods First, with a prospective investigation method, microstructures of gastric mucosa in 120 patients with different chronic gastritis were studied using Olympus GIF-Q240Z magnifying endoscope. Endoscopic diagnosis was made at real time. Biopsies were then taken from the magnified sites to check the accuracy of the diagonsis. Second, we selected 60 patients both with CAG and Hp infection as treatment group and 30 patients without Hp infection and no obvious gastric lesions as control group. Treatment group received Hp eradication therapy. Magnifying endoscopy was performed before and three months after the therapy. One biopsy specimen was obtained from the antrum for rapid urease test and four biopsy specimens were obtained (two from the antrum and two from the corpus) for histopathology, immunohistochemistry and warthin-starry staining. Fasting serum was collected from all patents at entry into the study before magnifying endoscopy. The samples were stored at -20℃ until use. The serum concentrations of PGⅠ,Gastrin and EGF were determined by radioimmunoassay.Results 1.The diagnostic value of magnifying endoscopy in chronic atrophic gastritis Under magnifying endoscopy, chronic gastritis were classfied into three types:Type I: representative of superficial gastritis, with characteristics of regularly distributed round-spot or short-rod gastric pits;Type II: main being mild CAG,with appearance of unclear,irregular pits and dot- or line-like areas with disappeared pits in dispersed localized regions;Type III: mainly being moderate and severe CAG,with appearances of piece or strap scar-like changes without gastric pits in larger regions ,or branched, villus-like pits due to dilated, prolonged and irregularly distributed pits or intestinal metaplasia. The results revealed that sensitivity, specificity and accuracy of magnifying endoscopy and routine endoscopy in the diagnosis of CAG were 89.3% and 42.9%(P<0.05); 89.1% and 82.8%(P>0.05); 89.2% and 64.2%(P<0.05) respectively. Magnifying endoscopy is significantly superior to routine endoscopy in the diagnosis of CAG. 2. Changes of magnifying endoscopic views, gastric mucosal histopathology and serum PGI, Gastrin, EGF concentrations after Hp eradication in patients with chronic atrophic gastritis Hp was eradicated in 24 patients among 31 patients received re-examination after the eradication therapy. The eradication rate was 77.4%. (1).Magnifying endoscopic views The following five features of magnified views after successful eradication were observed:In corpus:①Disappeared collecting venules became visible, or irregular pattern of collecting venules became regular pattern; ②Swelled pits relieved, obscure structure of pits became pinhole-like; ③White pits and sulc...