Abstract
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.
Highlights
The best sites for biopsy-based tests to evaluate H. pylori infection in gastritis with atrophy are not well known
Around onethird of infected patients are estimated to have gastritis with atrophy [2] and the regression of these preneoplasm lesions may occur after successful eradication [3,4,5]
H. pylori eradication in patients with gastritis with atrophy is recommended by current guidelines [1,6,7]
Summary
The best sites for biopsy-based tests to evaluate H. pylori infection in gastritis with atrophy are not well known. The updated Sydney Classification had set the gold standard for gastric biopsy more than 10 years ago [10]. According to this Classification, five biopsy sites should be collected: one specimen each should be obtained from the lesser and the greater curvature of the antrum, both within 2–3 cm form the pylorus; from the lesser curvature of the corpus about 4 cm proximal to the angulus; from the middle portion of the greater curvature of the corpus, approximately 8 cm from the cardia; and one from incisura angularis. There is no optimal site when performing a biopsy-based test in a general condition, much less in those with gastritis with atrophy [16]
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