Endoscopic Diagnosis Of Chronic Atrophic Gastritis And Its Relation With Pathology And Hp

Chronic atrophic gastritis (CAG) is inherent gastric glands wilt as the main performance of chronic inflammation.WHO take it as a state of precancerous gastric cancer in 1978.Its accompanying on the basis of incomplete intestinal metaplasia or severe dysplasia are considered as important precancerous lesions. With the in-depth study of CAG, scholars at home and abroad put forward that the development and changes of CAG is the key in the evolution gastric cancer.Therefore, the early and correct diagnosis of CAG is of great significance for the treatment of this disease and improving prognosis and is also an important measure for the prevention and early detection of gastric cancer. With the wider use of electronic gastroscope and the level of doctors on endoscopic medical diagnosis raising, the rate that endoscopic diagnosis of CAG in line with pathological diagnosis has been greatly increased, but each report is different,the rate of differences is 37.5%~80%. So to study and explore the correlation between common CAG Endoscopic mucosal changes and the pathological diagnosis is of great significance to raise the endoscopic doctors's awareness on CAG and also helpful for diagnosis. We collected 94 cases of CAG diagnosed by Endoscope from December 2006 to December 2007 and did research on histopathological examination and Hp infection .ObjectiveTo asses endoscopic diagnosis of CAG and its association with histologic changes and Hp infection.MethodsFrom December 2006 to December 2007 due to symptoms of upper gastrointestinal endoscopy to check 2,845 cases, including 94 cases of CAG (3.30%) diagnosed by endoscope including male 53 cases, 41 cases of women, aged 27 to 75 years old, with an average age of 56.3±10.5. All patients were excluded peptic ulcer, gastric and duodenal tumors and other gastrointestinal disorders.Gastroscopy expert, in accordance with the endoscopic characteristics of CAG,it was divided into three types:Type A: antral mucosal thinning, vascular permeability see; Type B: mucosa is red-and-white,mainly white- based; Type C: rough mucosal and hyperplasia particles, as paving stones; Another two are respectively made with a: uplift erosion; b: a flat gray uplift; as observation target.Histopathological examination: Gastric mucosa of CAG identified in the endoscopic, according to the new standard in Sydney ,getting a small mucosa at antrum (2-3cm from Helicobacter pylori) bend , two at small bend, one at the greater curvature of the stomach (middle of big bend Central about 8cm from the cardia)and small bend (about 4cm from the stomach angle) of stomach angle, then packed senting to pathological examinations. According to the degree of inherent gland atrophy ,CAG is divided into three: mild, inherent gland reduced by about 1/3; moderate, inherent gland reduced by 1/3 to 2/3; severe, the inherent gland reduced by 2/3 above. According to aera of the intestinal metaplasia glands,CAG is divided into three degree: mild, 1/3 of inherent gastric mucosal cells replaced by intestinal metaplasia; moderate, 1/3 of inherent gastric mucosal cells replaced by intestinal metaplasia. According to the number of cell proliferation and the formation of the special-shaped gland,dysplasia is divided into three degree: light, medium and heavy. Hp tests: a piece of small bend in the antral biopsy tested by rapid urease test (RUT). Put fresh gastric mucosa into the paper, observation under room temperature. Hp-positive: the paper turns from yellow to red in one minute; Hp weak positive: the test strip from yellow to red in 1-3 minutes; negative:no color turned after three minutes.ResultsOf 94 patients with CAG diagnosed by endoscope, 79 cases with CAG diagnosed by pathological (84.04%), CSG15 cases (15.96%). the performance of CAG endoscopic mucosal are as follows: type A ,mucosa thinning, 28 patients with vascular permeability see, CAG for the pathological diagnosis of 23 cases (82.14%), B-type mucosal red-and-white, 43 cases white mainly, the pathological diagnosis of 37 cases of CAG (86.06%), C-type mucosal rough, granular change in 55 cases, the CAG for the pathological diagnosis of 50 cases (90.91%), the rate that B-type with a uplift inline with erosion b gray flat was 100%.The specificity that various endoscopic manifestations of CAG in accordance with pathological diagnosis was 60% ,sensitivity was 13.41% -63.29%; The specificity of Type B with a for diagnosis of intestinal metaplasia and dysplasia was 85.96 %, 81.67%; the specificity of B type with b for the diagnosis of intestinal metaplasia and dysplasia was 85.96%, 83.33%.19 cases (26.39%) with mild atrophy of the intestinal, 18 cases (25%) with dysplasia , 63(87.5%) cases of Hp infection; 25 cases with moderate atrophy with intestinal metaplasia (40.32%),19 cases of atypical hyperplasia ( 30.65%), 57 cases with Hp infection (91.94%); 15 cases (88.24%) of severe atrophy with intestinal metaplasia, 14 cases with dysplasia (82.35%), 17 cases with Hp infection(100%);difference between the three groups was significant (P<0.05).And the extent of atrophy intestinal metaplasia, dysplasia and Hp infection was positively correlated.The rate of Hp infection is high among various CAG's manifestations under endoscope of infection, above 67 percent , particularly, the performance of the two coexist, the infection rate is higher, reaching more than 95 percent. The rate of Hp-positive patients with mucosal atrophy positive were 90.46%, 56.23% intestinal metaplasia, dysplasia 65.13%.Relation between Hp positive and three kinds of the gastric mucosa of pathological changes, the comparison between 3 were significantly different (P <0.05 ), Comparison between the positive rate of mucosal atrophy of Hp-positive patients and intestinal dysplasia was of significant difference (P <0.05), and no statistical significance(P> 0.05 ) between intestinal metaplasia and dysplasia.Gastroscopy CAG diagnosis is the best means of endoscopy under the various manifestations of the CAG, intestinal metaplasia, dysplasia of the pathological diagnosis of high value, and histopathological test can improve the diagnosis rate of CAG, the correct diagnosis on CAG should be based on observation and endoscopic mucosal biopsy closely together. In the community as a whole attaching great importance to the prevention of cancer, it is very important whether accurately judge precancerous lesions of gastric cancer. there is a big difference between gastroscopy judgement and the biopsy in some cases, which should analyze the causes one by one;Main factors about impact of the rate of diagnosis of the consistent with endoscopy and pathology are: the resolution and clarity gastroscopy; gastroscopy operator vision restrictions ;the CAG of the three main characteristic of gastroscope grasp is not accurate enough, often missed and misdiagnosed; gastroscopy at the master gas injection well; biopsy based depth, as well as an insufficient number of positions inaccurate. Furthermore, it should be clear that histological changes from a point-like lesions gradually evolved into patchy spots, and sometimes a biopsy specimens with the disease do not homogeneous, a considerable part of CSG and CAG coexist, the two diametrically difficult to distinguish. Therefore, the careful observation under gastroscopy mucosal lesions, efforts to find a meaningful characteristic endoscopic performance; Timely and accurately inspecting the possible abnormal histological mucosal lesions; Accurate, more lesions, large enough tissue biopsy , Strictly regulate the pathological examination of all aspects of diagnosis and unified standards, Gastroscopy physicians can greatly enhance Endoscopic diagnosis level of CAG. Therefore, to improve the atrophic gastritis endoscopy diagnostic rate,we believe that: On the one hand, in addition to attention atrophic gastritis endoscopic unique performance, more attention should be the nodular changes under Endoscopic; Coping with multi-point based, Regulating all aspects of the pathological examination,which can reduce the chronic atrophic gastritis rate of misdiagnosis to a certain extent. Also through the gastroscope understanding of the performance of the United States, as well as blue staining technology applications can enhance the diagnostic rate. This study also showed that the HP infection is one of the important causes between CAG and chronic superficial gastritis,the chronic infection of Hp can prompt the CAG and the formation of the intestine, supporting Helicobacter pylori infection→activities gastritis→gland atrophy→intestinal metaplasia→dysplasia→gastric cancer model, and the research shows that the eradication of Hp will mucosal atrophy, intestinal metaplasia improve or reverse, it should actively detect and eradicate Hp.