Supra-angular biopsy is more reliable for atrophy recognization: Analysis of 1598 cases for gastric mucosal histological examination

Abstract

Chronic gastritis might be a disease of the highest morbidity in the world. Since Warren and Marshall successfully isolated and cultured Helicobacter pylori (H. pylori) from a gastric antrum biopsy[1], intensive researches produced a historic change in the etiology and treatment of gastroduodenal diseases[2-14]. Stimulated by this momentous discovery, a group of gastroenterologists maily from Europe and pathologists presented a novel classification of gastritis (so-called the Sydney system) at the 9th World Congress of Gastroenterology in Sydney, Australia, in 1990[15]. In the Sydney system, attempts were made to incorporate etiologic, topographic, and morphologic criteria into a clinically relevant scheme. It usually involves the histopathological analysis of the biopsy specimens obtained from the arbitrary sites in the antrum or corpus. In September 1994, a group of gastric pathologists from various parts of the world gathered in Houston, Texas, USA, to reproved the Sydney system 4 years after its introduction[16]. One of the most controversial issues at the Houston Workshop was the concept of atrophy. Since the relationship of H. pylori with gastric adenocarcinoma rests on the natural history of atrophical gastritis induced by the bacterial infection[17-23], it is very important to identify the histological lesions. According to the Sydney system, H. pylori, chronic and active inflammations were usually recognized and scored with an agreement of degree of accuracy, but the judgments of the atrophy were often poor[24-31]. Although many factors are involved in the failure of responsible detection of the atrophy, the biopsy sites in gastric mucosa may be one of most important factors for this lack of concordance. In this study, we collected biopsy specimens from the antrum, corpus and angularis simultaneously to compare the differences among the biopsy sites for the evaluation of mucosal atrophic inflammation.