Magnifying Endoscope Combining With Serologic Detection Diagnose Chronic Atrophic Gastritis

Background/ObjectivesChronic atrophic gastritis(CAG) was the one of precancerous lesion of gastric cancer,its regular follow-up and early diagnosis had important.When its development,the gastric pits had changed.At present we diagnosed CAG by routine endoscope and biopsy,but the slight process was difficult to find by routine endscope, and the non-objectivity of diagnosis and the blind,local of biopsy.In this article,we viewed gastric pits of CAG by magnifying endoscope,and approached diagnosing value of magnifying endoscope.Due to the mulifocality distribution of CAG and the defect of magnifying endoscopy and the invariable local of biopsy,we can not well judge gastric atrophy.So we studied the relationship serum pepsinogen,gastrin-17 with CAG,and calculated the best cut-off point.Magnifying endoscope combining with serology profited to screen and diagnose CAG.MethodsGastric mucosal patterns in 100 patients were studied using Olympus GIF-Q240Z magnifying endoscope.Histopathological examination was taken with biopsy samples from the stomach.We observated gastric mucosal patterns and compared the diagnosis of magnifying endoscopy and routine endoscopy.And the concentration of serum pepsinogenⅠ(PGI),the ratio of PGI/PGⅡ(PGR) and gastrin- 17(G-17) in those patients with CAG was compared with those in the control group,and comparison theirs among the different type of CAG,which detected by immunoradiometic assay and radioimmunoassay.And according to the ROC curves,we definite the best cut-off to diagnose CAG.Results1.Routine endoscopy diagnosed CAG lowly and had some error with pathologic biopsy.The sensitivity,specificity and accuracy of it were 38.5%,68.7%and 53% respectively,and the detection rate of atrophic corpus gastritis and atrophic antral gastritis were 40%and 17.1%.2.The pit patterns of normal gastric mucosa were round spot and short rod by magnifying endoscopy.Gastric mucosal patterns of the CAG were barred,en plaque and villus,but en plaque and villus were specific.3.To observe the changes of pit patterns of gastric mucosa by magnifying endoscope raised the final diagnosis rate of CAG by pathologic biopsy.The sensitivity,specificity and accuracy of magnifying endoscopy in the diagnosis of CAG were 82.6%,79.1%and 81%respectively.And the detection rate of atrophic corpus gastritis and atrophic antral gastritis were 50.9%and 30.1%.Comparing with routine endoscopy,the sensitivity and accuracy of diagnosis of CAG by magnifying endoscopy had increased,and had significant differences(P＜0.001).The detection rate of atrophic corpus gastritis and atrophic antral gastritis had increased,and had significant differences(P＜0.01).4.In our study,the mark of the corpus atrophy and antral atrophy respectively were low PG,PGR and G-17,and determined the best cut-off point.Compared with the control group,the concentration of PGI,PGR and G-17 in those patients with CAG had significant differences(P＜0.001);among the different type of CAG,the concentration of PGI,PGR and G-17 had significant differences(P＜0.001),and the concentration of PGI,PGR of atrophic corpus gastritis group and mulifocal atrophic gastritis group had decreased comparing to atrophic antral gastritis group,otherwise the concentration of G-17 in atrophic corpus gastritis group had increased,and these groups had significant differences(P＜0.001).According to the ROC curves,the best cut-off point of PGI,PGR and G-17 were 82.1μg/L(sensitivity 85%,specificity73%), 7.5(sensitivity 89%,specificity71%) and 8.3(sensitivity 85%,specificity73%),and according to the best cut-off point,we found fifty patients during fifty-two patients which were diagnosed specifically by pathlogic examine,and thirty-nine patients in control groups,so its sensitivity,specificity and accuracy were 89.2%,81.2%and 89% respectively.5.Detection of PGI,PGR and G-17 could retrieve the local of pathologic biopsy. And on the basis of the cut-off point,we found three patients were atrophic corpus gastritis and six patients were atrophic antral gastritis,which were diagnosed chronic superficial gastritis by magnifying endoscopy;ten patients were all mulifocal atrophic gastritis,which only were diagnosed atrophic corpus gastritis or atrophic antral gastritis by magnifying endoscopy,and these results were confirmed by histopathological examination.Conclusion1.Diagnosing atrophy by routine endscope had major disagree with histopathologic examine,and its diagnostic rate was low.2.The observation of gastric pit by magnifying endoscope could provide the clue to diagnose CAG,and its distinctive changes were barred,en plaque and villus. And it could raised the final diagnosis rate of CAG by pathologic biopsy.3.Detection of PGI,PGR and G-17 was a way of non-invasive serology examination,their changed rule could conduce to cue the condition of atrophic corpus gastritis or atrophic antral gastritis,and retrieved the local of pathologic biopsy.