Biopsy Sites Suitable for the Diagnosis of Helicobacter pylori Infection and the Assessment of the Extent of Atrophic Gastritis

Satoh, Kiichi; Kimura, Ken; Taniguchi, Yushi; Kihira, Ken; Takimoto, T; Saifuku, Koji; Kawata, Hiroshi; Tokumaru, Kenkichi; Kojima, Toshichika; Seki, Masaru; Ido, Kenichi; Fujioka, Toshio

doi:10.1111/j.1572-0241.1998.166_b.x

Cited by 114 publications

(18 citation statements)

References 19 publications

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“…Kaminishi et al reported “ash-colored nodular change” as an indicator for IM; the accuracy of these investigators’ findings was high, with a specificity of 98-99%, but the sensitivity was low (6-12%). Kaminishi et al noted that conventional endoscopy is less useful for confirming the diagnosis of IM [5]. Recent studies have emerged concerning the endoscopic finding of IM using magnifying endoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…IM and gastric atrophy are considered together to be risk factors for the development of intestinal-type gastric cancer and are regarded as premalignant lesions [2, 3]. Gastric atrophy can be recognized by endoscopy and correlates with histologic evaluation [4, 5]. However, the diagnosis of IM by using standard white light endoscopy has been considered to be difficult due to IM lacking distinction in color and its presence as multiple flat lesions [6, 7].…”

Section: Introductionmentioning

confidence: 99%

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Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy

Nagata

Shimbo²,

Akiyama

et al. 2011

Gastroenterol Res

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BackgroundIntestinal metaplasia (IM) is regarded as a premalignant lesion. However, endoscopic diagnosis of IM has been considered difficult. Using endoscopy, we found a unique pattern of erythema, “Mottled Patchy Erythema (MPE),” which includes severe IM. Helicobacter pylori (Hp) infection itself can cause erythema, which reflects histologic changes in the gastric mucosa. Therefore we enrolled Hp eradication patients to validate the relation between MPE and pathologic findings.MethodsWe enrolled patients with chronic gastritis who underwent successful Hp eradication at least 6 months before the study. We defined MPE as multiple flat or depressed erythematous lesions. When encountering MPE on endoscopy, we performed biopsy on both the MPE site and non-MPE site. The non-MPE site was defined as an adjacent mucosa located within 3 cm of the MPE site. All biopsy specimens were evaluated immunohistochemically for IM subtype using MUC2, MUC5AC, MUC6, CD10, and CDX2 stains. The degree of IM was defined according to the Updated Sydney System. The diagnostic accuracy of the MPE findings for pathologic IM was calculated. The relation between MPE and IM subtype was also assessed.ResultsA total of 102 patients were selected for the study. Of these, 55 (54%) patients had MPE. Biopsy specimens were taken from the MPE sites and non-MPE sites from these 55 patients. The IM percentages and median scores of IM were both significantly higher at the MPE sites (P < 0.001) than at the non-MPE sites. The sensitivity and specificity for MPE in the detection of histologic IM were 72.7% and 84.1%, respectively. No significant associations were observed in the expression of MUC2, MUC5AC, MUC6, CD10, and CDX2 between the MPE sites and non-MPE sites. There were no significant differences in the ratios (complete/incomplete) of IM subtypes between the two groups.ConclusionsMPE is a useful endoscopic finding to detect histologic IM without the use of chromoendoscopy and magnifying endoscopy. However, the IM subtype is difficult to identify. In the era of Hp eradication, MPE has the potential to become a predictive finding for the risk of gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy

Nagata

Shimbo²,

Akiyama

et al. 2011

Gastroenterol Res

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“…Studies on the most practical biopsy site for diagnosing H. pylori infection have conflicting results. Antrum biopsy is recommended by Genta et al [11] while others recommend at least one corpus biopsy [12,13]. Hazell et al and Woo et al found it necessary to take both antral and corpus biopsies [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…Additional corpus biopsy is suggested in these situations [12] but the exact additional benefit is not well known.…”

Section: Introductionmentioning

confidence: 99%

Additional corpus biopsy enhances the detection of Helicobacter pylori infection in a background of gastritis with atrophy

Lan

Chen

et al. 2012

BMC Gastroenterol

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BackgroundThe best sites for biopsy-based tests to evaluate H. pylori infection in gastritis with atrophy are not well known. This study aimed to evaluate the site and sensitivity of biopsy-based tests in terms of degree of gastritis with atrophy.MethodsOne hundred and sixty-four (164) uninvestigated dyspepsia patients were enrolled. Biopsy-based tests (i.e., culture, histology Giemsa stain and rapid urease test) and non-invasive tests (anti-H. pylori IgG) were performed. The gold standard of H. pylori infection was defined according to previous criteria. The sensitivity, specificity, positive predictive rate and negative predictive rate of biopsy-based tests at the gastric antrum and body were calculated in terms of degree of gastritis with atrophy.ResultsThe prevalence rate of H. pylori infection in the 164 patients was 63.4%. Gastritis with atrophy was significantly higher at the antrum than at the body (76% vs. 31%; p<0.001). The sensitivity of biopsy-based test decreased when the degree of gastritis with atrophy increased regardless of biopsy site (for normal, mild, moderate, and severe gastritis with atrophy, the sensitivity of histology Giemsa stain was 100%, 100%, 88%, and 66%, respectively, and 100%, 97%, 91%, and 66%, respectively, for rapid urease test). In moderate to severe antrum or body gastritis with atrophy, additional corpus biopsy resulted in increased sensitivity to 16.67% compare to single antrum biopsy.ConclusionsIn moderate to severe gastritis with atrophy, biopsy-based test should include the corpus for avoiding false negative results.

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“…This can be explained on the basis that H. pylori colonization and gastritis have a patchy distribution [30]and they are not uniformly distributed all over. It has also been shown recently that sites of biopsy that would be most reliable for the diagnosis of infection differ from those sites that are considered suitable for examining the status of H. pylori colonization [31].…”

Section: Discussionmentioning

confidence: 99%

Resolution of Gastritis Induced by <i>Helicobacter pylori</i> 4–5 Weeks after Successful Eradication of Infection Using a Triple Therapy Regimen of Pantoprazole, Amoxycillin and Clarithromycin for One Week

Aal¹,

Dajani²,

Nounou³

et al. 1999

Digestion

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This open-label study was designed to determine the extent of histological resolution of gastritis induced by Helicobacter pylori infection 4–5 weeks after successful eradication of the infection. Eradication was achieved using a triple therapy regimen consisting of a twice daily dose of pantoprazole 40 mg, clarithromycin 500 mg, and amoxicillin 1,000 mg taken for 1 week only. No other medications were given thereafter. Four biopsies were processed for histological examination of each patient, two from the antral and two from the corporeal mucosa, first at the start of the study and then again 4 weeks after cessation of the medication trial. Scoring for H. pylori colonization and the severity of gastritis was determined for each patient according to the Sydney system. 53 of 57 patients in this study had their H. pylori infection successfully eradicated by the regimen mentioned and could be histologically evaluated. According to the severity of gastritis in the antral mucosa, patients were studied in 3 groups: mild, moderate and severe gastritis. 17 of 19 cases with mild gastritis showed complete resolution of the inflammation, with residual inflammatory changes persisting in 2 cases only. 22 of the 26 cases with moderate gastritis showed almost complete recovery except for minor residual inflammatory changes as judged by irregularity of intracytoplasmic mucine storage. Persistent residual inflammatory changes in the lamina propria were detected in 4 cases. Of the 8 cases with severe gastritis 5 showed subsidence of the inflammatory changes, but the mucosa in these cases revealed some scarring, distortion of the glandular epithelium and atrophy. In 3 cases residual inflammation persisted. Conclusion: One-week therapy with a twice daily dose of pantoprazole 40 mg, clarithromycin 500 mg and amoxicillin 1,000 mg, used to eradicate H. pylori causing active inflammation of the gastric mucosa, has led to subsidence of the acute inflammatory changes in all the cases with residual inflammation persisting in 17%. Severe gastritis may cause irreparable damage to the gastric mucosa. The density of H. pylori colonization does not appear to be related to the severity of gastritis, nor to the successful eradication achieved.

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Biopsy Sites Suitable for the Diagnosis of Helicobacter pylori Infection and the Assessment of the Extent of Atrophic Gastritis

Cited by 114 publications

References 19 publications

Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy

Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy

Additional corpus biopsy enhances the detection of Helicobacter pylori infection in a background of gastritis with atrophy

Resolution of Gastritis Induced by <i>Helicobacter pylori</i> 4–5 Weeks after Successful Eradication of Infection Using a Triple Therapy Regimen of Pantoprazole, Amoxycillin and Clarithromycin for One Week

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