Histological evaluation and H. pylori status of dyspeptic patients without gastrooesophageal reflux

Abstract

OBJECTIVE: To identify different types of gastric pathology in patients with dyspeptic symptoms without gastro oesophageal reflux, to assess the prevalence of H, pylori in their biopsies and to correlate the histological changes with the presence of these organisms. METHOD: 788 dyspeptic patients were included in the study during the period April 2000 - August 2002. Their gastric biopsies were reviewed and diagnoses were classified as normal, chronic gastritis, reactive gastritis, portal gastropathy, peptic ulcer, neoplastic and others. 22 non diagnostic biopsies were excluded. The biopsies in which H. pylori was identified were graded histologically as mild, moderate and severe for organism density, chronic inflammation, activity, intestinal metaplasia and glandular atrophy in accordance with the updated Sydney classification. RESULTS: Gastric pathology identified in the dyspeptic patients studied included normal (187), chronic gastritis (373), reactive gastritis (50), portal gastropathy (9), peptic ulcers including both gastric and duodenal ulcers (128), neoplastic (15) and others (4). H pylori was identified in 210 patients. 189 (90%) of these were associated with chronic gastritis. Chronic inflammation in gastric biopsies was graded as mild in 75, moderate in 104, severe in 31 and activity was graded as absent in 45, mild in 115, moderate in 3 8 and severe in 12. Associated intestinal metaplasia was present in 32/210 > ymild (26), moderate (6)?y and glandular atrophy was present in 42/210 (mild (36), moderate (8)). H .pylori density was mild in 165, moderate in 39 and severe in 6. The H. pylori density showed a significant correlation with inflammation and activity. CONCLUSION: Chronic gastritis was the single most common condition diagnosed in dyspeptic patients without gastro oesophageal reflux. Overall, H. pylori was identified in 27.4% of dyspeptic patients. In most biopsies chronic inflammation was moderate and activity was mild or absent, and this was associated with a low H. pylori density. The incidence of metaplasia and glandular atrophy was low.