Viewpoints on digestive diseases

Gastroscopy is incomplete without biopsy: Clinical relevance of distinguishing gastropathy from gastritis

La enfermedad inflamatoria gástrica se puede clasificar de manera general en dos subgrupos: gastritis y gastropatía. La gastritis es un concepto anatomopatológico, debiendo existir inflamación de la mucosa. Aunque existen definiciones clínicas y endoscópicas que complementan su clasificación, no suele haber correlación entre la sintomatología, la histología y las pruebas endoscópicas. Por su parte, la gastropatía es el daño de la mucosa gástrica sin inflamación microscópica o siendo esta mínima. Las causas más comunes de gastritis son la infecciosa por Helicobacter pylori, la atrófica y la gastropatía por ácido acetilsalicílico y otros antiinflamatorios no esteroideos. La biopsia de la mucosa gástrica es necesaria para el diagnóstico de certeza, aunque existen pruebas no invasivas indirectas para el diagnóstico de la infección por H. pylori como la prueba del aliento. No existe un tratamiento estándar ni mucho menos único de la gastritis, ya que depende fundamentalmente de su etiología.

Inflammatory gastric disease may be generally classified in two subgroups: gastritis and gastropathy. The word «gastritis» refers to anatomopathological concept in which mucosal inflammation is required. Although its classification is supplemented by endoscopic and clinical definitions, commonly, usually no correlations among symptoms, histology and endoscopic tests are found. On the other hand, gastropathy is the injury of the gastric mucosa, in which inflammation is absent or minimal. The most common gastritis causes are: gastritis by Helicobater pylori, atrophic gastritis and chemical gastropathy (caused by acetylsalicylic acid and other non-steroidal anti-inflammatory drugs). To achieved diagnostic certainty, mucosa biopsy is mandatory. However, in H. pillory infection, indirect, non-invasive tests (for example breath test) are available. There is no single standard treatment of gastritis, since it depends fundamentally on its etiology.

Lymphocytic disorders of the upper and lower gastrointestinal tract seem to cluster in patients. We aimed to assess the frequency of comorbid occurrence of lymphocytic disorders in patients with microscopic colitis (MC).

We collected data from the Miraca Life Sciences Database, a large national electronic repository of histopathologic records of patients throughout the United States. In a population of 228,506 patients who underwent bidirectional endoscopy from January 2008 through July 2016, we studied the comorbid occurrence of celiac disease, duodenal intraepithelial lymphocytosis, lymphocytic gastritis, and lymphocytic esophagitis among 3456 patients with MC. Associations were described in terms of their odds ratios (OR) and 95% CIs.

Any type of lymphocytic disorder occurred in 13.7% of patients with MC and 5.9% of patients without MC. The ORs of lymphocytic disorders in patients with MC were: 2.56 (95% CI, 2.32–2.82) for any type of lymphocytic disorder, 3.07 (95% CI, 1.25–7.52) for lymphocytic esophagitis, 15.05 (95% CI, 12.31–18.41) for lymphocytic gastritis, 1.73 (95% CI, 1.53–21.96) for duodenal intraepithelial lymphocytosis, and 6.06 (95% CI, 5.06–7.25) for celiac disease. Comorbidities were more common in patients with lymphocytic than collagenous colitis, with an OR of 1.74 (95% CI, 1.42–2.13). Patients with MC with comorbidities were significantly younger and had a lower proportion of men than patients with MC patients without comorbidities. Diarrhea was the predominant symptoms in all patients MC, irrespective of comorbidities.

In a retrospective study, we identified lymphocytic disorders of the upper gastrointestinal tract that are significantly more common in patients with than without MC. These associations suggest the existence of an underlying etiology that is common to all lymphocytic disorders and that affects the upper and lower gastrointestinal tract.

Aunque el término gastritis define la inflamación microscópica de la mucosa gástrica, también incluye otras definiciones clínicas, endoscópicas y radiológicas variadas. En los pacientes con gastritis suele haber muy poca correlación entre los síntomas, los hallazgos endoscópicos y los hallazgos histológicos.

La causa más frecuente de gastritis crónica es la infección por H. pylori seguida por las gastritis atróficas. Las gastropatías reactivas son la tercera causa de agresión de la mucosa gástrica y, dentro de ellas, destacan las producidas por la toma de ácido acetilsalicílico y otros AINE. Además de H. pylori, existen otros gérmenes que pueden contaminar el estómago y producir gastritis infecciosas.

La realización de biopsias gástricas a diversos niveles es fundamental para el diagnóstico de certeza de los diversos tipos de gastritis. La mayor parte de los cánceres gástricos tiene su origen en algunos tipos concretos de gastritis.

Los tratamientos son variables según su etiopatogenia.

Although the term gastritis defined microscopic inflammation of the gastric mucosa, also it includes other various clinical, endoscopic and radiologic definitions. In patients with gastritis usually very little correlation between symptoms, endoscopic findings and histological findings.

The most common cause of chronic gastritis is Helicobacter pylori infection followed by atrophic gastritis. Reactive gastropathies are the third leading cause of aggression of gastric mucosa and within them include those produced by taking aspirin and other NSAIDs. In addition H. pylori other germs that can contaminate the stomach and cause gastritis are infectious.

Performing gastric biopsies at different levels is crucial for accurate diagnosis of the various types of gastritis. The majority of gastric cancers originated in specific types of gastritis.

Treatments vary according to its pathogenesis.