Diagnosis Of Chronic Atrophic Gastritis Research Articles

S1897 Comparing Artificial Intelligence-Assisted and Clinician-Performed Endoscopy in the Diagnosis of Chronic Atrophic Gastritis: A Diagnostic Accuracy Meta-Analysis

S1897 Comparing Artificial Intelligence-Assisted and Clinician-Performed Endoscopy in the Diagnosis of Chronic Atrophic Gastritis: A Diagnostic Accuracy Meta-Analysis

Histopathological Evaluation of Gastric Mucosal Atrophy for Predicting Gastric Cancer Risk: Problems and Solutions.

Patients suffering from chronic gastritis and developing gastric mucosa atrophy are at increased risk of the development of gastric cancer. The diagnosis of chronic atrophic gastritis (CAG) is a complex procedure involving a detailed history taking, a thorough physical examination and the use of laboratory and instrumental diagnostic methods among which the endoscopy of the upper digestive tract is the cornerstone because it allows the assessment of the topography of gastritis and identification of erosions and areas of intestinal metaplasia with the use of NBI endoscopy. However, the diagnosis of CAG requires morphological examination of the gastric mucosa. So, in addition to assessing macroscopic changes in the gastric mucosa, it is necessary to take biopsy specimens in accordance with the protocols for their morphological and immunohistochemical examination. In the absence of specific diagnostic stigmas of CAG, close cooperation between a clinician, endoscopist and pathologist is necessary. The article presents systematized data on the histopathological assessment of the gastric mucosa atrophy to predict the risk of gastric cancer.

Deep learning-assisted diagnosis of chronic atrophic gastritis in endoscopy.

Chronic atrophic gastritis (CAG) is a precancerous condition. It is not easy to detect CAG in endoscopy. Improving the detection rate of CAG under endoscopy is essential to reduce or interrupt the occurrence of gastric cancer. This study aimed to construct a deep learning (DL) model for CAG recognition based on endoscopic images to improve the CAG detection rate during endoscopy. We collected 10,961 endoscopic images and 118 video clips from 4,050 patients. For model training and testing, we divided them into two groups based on the pathological results: CAG and chronic non-atrophic gastritis (CNAG). We compared the performance of four state-of-the-art (SOTA) DL networks for CAG recognition and selected one of them for further improvement. The improved network was called GAM-EfficientNet. Finally, we compared GAM-EfficientNet with three endoscopists and analyzed the decision basis of the network in the form of heatmaps. After fine-tuning and transfer learning, the sensitivity, specificity, and accuracy of GAM-EfficientNet reached 93%, 94%, and 93.5% in the external test set and 96.23%, 89.23%, and 92.37% in the video test set, respectively, which were higher than those of the three endoscopists. The CAG recognition model based on deep learning has high sensitivity and accuracy, and its performance is higher than that of endoscopists.

Chronic atrophic gastritis as a precancer: the evolution of ideas from the Sydney consensus to Maastricht VI

Aim. The purpose of the work is the evolution of systems and classifications of gastritis: Sydney Consensus (1990), Houston Modification (1994), OLGA/OLGIM (2008), Kyoto (2014), MAPS II (2019), Maastricht IV (2022). Materials and methods. During the work, 25 sources of information were used. Results. Chronic atrophic gastritis (ChAG) is a clinical and morphological diagnosis, and the presented clinical forms (types) of gastritis have characteristic morphological criteria. According to the Sydney system, changes in the antrum and body of the stomach are described separately. This has led to a lack of clear risk stratification criteria for CG and also complicates the objective analysis of regression of inflammation and atrophy. OLGA/OLGIM systems were proposed to determine the stage of atrophy and IM. The authors of the Kyoto consensus add and clarify the etiological section of ChAG. In MAPS II, ChAG and IM are considered precancerous conditions, as they increase the risk of developing gastric cancer and are the background for the occurrence of dysplasia and adenocarcinoma. For patients with dysplasia and the absence of visible changes in the mucous membrane, high-resolution endoscopy with staining is recommended. They should be examined after 6 months for a high degree of dysplasia and after 12 months for a low degree of dysplasia. Patients with IM and one localization have a high risk of developing gastric cancer. However, the high risk does not give the right to follow up in the majority of cases when high-quality endoscopy with biopsy does not show severe atrophy. Patients with IM of one location, with a family history of cancer, or with incomplete IM and persistence of H. pylori chromo endoscopy with biopsy must be done once every 3 years. Patients with extended fields of atrophic aggression (pronounced atrophic changes) or IM in the antrum and body, OLGA/OLGIM III/IV should be screened with chromoendoscopy with biopsy every 3 years. Patients with significant atrophy and familial cancer benefit from chromoendoscopy and biopsy every 1–2 years after initial diagnosis. Patients with autoimmune gastritis are recommended to be screened every 3–5 years. According to Maastricht VI, H. pylori is the main etiological factor of gastric adenocarcinoma, including proximal gastric cancer. Conclusions. After careful study and analysis, we came to the conclusion about the gradual development of the principles of evidence-based medicine in the issue of improving the clinical and morphological diagnosis of chronic atrophic gastritis as a precancerous of the stomach.

Repair stimulator alpha-glutamyl-tryptophan in the complex therapy of chronic atrophic gastritis: results of histological examination

To study the effect of the repair stimulator alpha-glutamyl-tryptophan on the morphological characteristics of the gastric mucosa and the expression of CXCL-12 and CDX-2 in chronic atrophic gastritis associated with Helicobacter pylori. Biopsy samples of 116 patients with a verified diagnosis of chronic atrophic gastritis associated with Helicobacter pylori were analyzed in a multicenter double-blind randomized placebo-controlled study. During the morphological study, the parameters characterizing the process of atrophy were evaluated: the number of glands per 1 mm2 of the gastric mucosa, the depth of the gastric mucosa glands, the number of parietal cells per 100 epithelial cells of the gastric mucosa, and the presence of signs of intestinal metaplasia. Primary antibodies Anti-CXCL-12 (MA5-23759) and Anti-CDX-2 (EP25) were used to set up immunohistochemical reactions to verify the expression of CXCL-12 and CDX-2. In patients taking the studied drug, a statistically significant increase in the number of glands per 1 mm2 of the gastric mucosa was revealed when compared with the initial screening indicators by 26.1% (p=0.028) and with the placebo group (p=0.026), a tendency to decrease the signs of intestinal metaplasia was determined. There was a statistically significant increase in the expression in the relative area of CXCL-12 expression in patients taking placebo when compared with the parameters of the initial data (p=0.045) and the absence of statistically significant changes in the main group. A statistically significant increase in the relative area of the CDX-2 expression was revealed in the group taking alpha-glutamyl-tryptophan in comparison with the baseline data (p=0.015), no statistically significant dynamics of this indicator was found in the placebo group. A statistically significant positive effect of the study drug on regenerative mechanisms leading to stabilization and/or improvement of the histological picture in the atrophic area of the gastric mucosa was found in comparison with the control of the initial state and with placebo. The results of an immunohistochemical study to increase CDX-2 expression while taking the study drug can also be regarded as an indicator of improvement in reparative processes.

U-Net deep learning model for endoscopic diagnosis of chronic atrophic gastritis and operative link for gastritis assessment staging: a prospective nested case–control study

Background: The operative link for the gastritis assessment (OLGA) system can objectively reflect the stratification of gastric cancer risk in patients with chronic atrophic gastritis (CAG). Objectives: We developed a real-time video monitoring model for the endoscopic diagnosis of CAG and OLGA staging based on U-Net deep learning (DL). To further validate and improve its performance, we designed a study to evaluate the diagnostic evaluation indices. Design: A prospective nested case–control study Methods: Our cohort consisted of 1306 patients from 31 July 2021 to 31 January 2022. According to the pathological results, patients in the cohort were divided into the CAG group and the chronic non-atrophic gastritis group to evaluate the diagnostic evaluation indices. Each atrophy lesion was automatically labeled and the atrophy severity was assessed by the model. Propensity score matching was used to minimize selection bias. Results: The diagnostic evaluation indices and the consistency between OLGA staging and pathological diagnosis of the model were superior to those of endoscopists [sensitivity (89.31% versus 67.56%), specificity (90.46% versus 70.23%), positive predictive value (90.35% versus 69.41%), negative predictive value (89.43% versus 68.40%), accuracy rate (89.89% versus 68.89%), Youden index (79.77% versus 37.79%), odd product (79.23 versus 4.91), positive likelihood ratio (9.36 versus 2.27), negative likelihood ratio (0.12 versus 0.46)], areas under the curves (AUC) (95% CI) (0.919 (0.893–0.945) versus 0.749 (0.707–0.792), p < 0.001) and kappa (0.816 versus 0.291)]. Conclusion: Our study demonstrated that the DL model can assist endoscopists in real-time diagnosis of CAG during gastroscopy and synchronous identification of high-risk OLGA stage (OLGA stages III and IV) patients. Trial registration: ChiCTR2100044458.

Influence of Helicobacter pylori infection and its eradication treatment on small intestinal bacterial overgrowth

Objectives: To analyze the effects of Helicobacter pylori (H. pylori) infection and eradication therapy on small intestinal bacterial overgrowth (SIBO). Methods: From September to December 2021, patients with abdominal symptoms who received 13C urea breath test at the Department of Gastroenterology in Peking University First Hospital were enrolled.13C urea breath test was used to detect H. pylori infection and patients were divided into H. pylori positive and negative groups accordingly. Lactulose hydrogen methane breath test was performed to determine SIBO. H. pylori positive patients were treated with quadruple therapy including amoxicillin, metronidazole, rabeprazole and bismuth potassium citrate. 13C urea breath test and lactulose hydrogen methane breath test were reexamined 6 weeks after the treatment. Results: A total of 102 patients (49 males and 53 females) were enrolled, with a mean age of (42.1±9.9) years. Among them, 49 patients were H. pylori negative and 53 were H. pylori positive. Moreover, 47 patients were SIBO positive and 55 were SIBO negative. There was no significant difference in age, sex, body mass index, abdominal symptoms and the diagnosis of chronic atrophic gastritis between H. pylori positive and negative patients at the enrollment (all P>0.05). The detection rate of SIBO in H. pylori infected patients was higher than that in uninfected patients, and the difference was statistically significant (60.4% vs 30.6%, P=0.003). Patients with SIBO had significantly more frequent abdominal distension (36.2% vs 10.9%, P=0.002) and constipation (27.7% vs 1.8%, P<0.001) than patients without SIBO. The rate of SIBO after H. pylori eradication treatment was significantly lower than that before treatment (20.8% vs 60.4%, P<0.001). The remission rate of SIBO after eradication therapy was 66.7% (20/30). Besides, patients had obvious improvement of constipation (6.0% vs 18.9%, P=0.008), and the incidence of other abdominal symptoms decreased to various degrees including diarrhea, abdominal pain, abdominal distention and poor appetite. Conclusion: H. pylori infection increases the risk of SIBO, and the quadruple regimen containing amoxicillin and metronidazole has a therapeutic effect for patients with H.pylori infection and concomitant SIBO.

Deep learning as a novel method for endoscopic diagnosis of chronic atrophic gastritis: a prospective nested case–control study

Background and aimsChronic atrophic gastritis (CAG) is a precancerous disease that often leads to the development of gastric cancer (GC) and is positively correlated with GC morbidity. However, the sensitivity of the endoscopic diagnosis of CAG is only 42%. Therefore, we developed a real-time video monitoring model for endoscopic diagnosis of CAG based on U-Net deep learning (DL) and conducted a prospective nested case–control study to evaluate the diagnostic evaluation indices of the model and its consistency with pathological diagnosis.MethodsOur cohort consisted of 1539 patients undergoing gastroscopy from December 1, 2020, to July 1, 2021. Based on pathological diagnosis, patients in the cohort were divided into the CAG group or the chronic nonatrophic gastritis (CNAG) group, and we assessed the diagnostic evaluation indices of this model and its consistency with pathological diagnosis after propensity score matching (PSM) to minimize selection bias in the study.ResultsAfter matching, the diagnostic evaluation indices and consistency evaluation of the model were better than those of endoscopists [sensitivity (84.02% vs. 62.72%), specificity (97.04% vs. 81.95%), positive predictive value (96.60% vs. 77.66%), negative predictive value (85.86% vs. 68.73%), accuracy rate (90.53% vs. 72.34%), Youden index (81.06% vs. 44.67%), odd product (172.5 vs. 7.64), positive likelihood ratio (28.39 vs. 3.47), negative likelihood ratio (0.16 vs. 0.45), AUC (95% CI) [0.909 (0.884–0.934) vs. 0.740 (0.702–0.778)] and Kappa (0.852 vs. 0.558)].ConclusionsOur prospective nested case–control study proved that the diagnostic evaluation indices and consistency evaluation of the real-time video monitoring model for endoscopic diagnosis of CAG based on U-Net DL were superior to those of endoscopists.Trial registrationChiCTR2100044458, 18/03/2020.

A deep learning network based on multi-scale and attention for the diagnosis of chronic atrophic gastritis.

Chronic atrophic gastritis plays an important role in the process of gastric cancer. Deep learning is gradually introduced in the medical field, and how to better apply a convolutional neural network (CNN) to the diagnosis of chronic atrophic gastritis remains a research hotspot. This study was designed to improve the performance of CNN on diagnosing chronic atrophic gastritis by constructing and evaluating a network structure based on the characteristics of gastroscopic images. Three endoscopists reviewed the endoscopic images of the gastric antrum from the Gastroscopy Image Database of Zhongnan Hospital and labelled available images according to pathological results. Two novel modules proposed recently were introduced to construct the Multi-scale with Attention net (MWA-net) considering the characters of similar medical images. After training the network using images of training sets, the diagnostic ability of the MWA-net was evaluated by comparing it with those of other deep learning models and endoscopists with varying degrees of expertise. As a result, 5,159 images of the gastric antrum from 2,240 patients were used to train and test the MWA-net. Compared with the direct application of famous networks, the MWA-net achieved the best performance (accuracy, 92.13%) with an increase of 1.80% compared to that of ResNet. The suspicious lesions indicated by the network are consistent with the conclusion of experts. The sensitivity and specificity of the convolutional network for gastric atrophy diagnosis are 90.19% and 94.51%, respectively, which are higher than those of experts. Highly similar images of chronic atrophic gastritis can be identified by the proposed MWA-net, which has a better performance than other well-known networks. This work can further reduce the workload of gastroscopists, simplify the diagnostic process and provide medical assistance to more residents.

SERUM PEPSINOGEN I AND PEPSINOGEN II AS NON-INVASIVE BIOMARKERS FOR THE DIAGNOSIS OF CHRONIC ATROPHIC GASTRITIS

Atrophic gastritis, intestinal metaplasia and dysplasia of the gastric mucosa are major risk factors for the development of an intestinal type of gastric cancer. The selection of patients with such lesions could help with early detection and improve better the prognosis. Esophagogastroscopy is the "gold standard" in detecting gastric cancer and precancerous lesions of the stomach. However, this examination is invasive, expensive, and cannot serve as a screening method. Measurement of serum levels of pessinogen I and pessinogen II is used in high-risk populations in Europe and Asia as a non-invasive marker for the diagnosis of chronic atrophic gastritis. A serum pepsinogen I level ≤ 70ng/ml and pepsinogen I/pepsinogen II ratio ≤ 3 are accepted in many countries as values that most accurately identify patients with advanced atrophic gastritis. On the other hand, the differences in the analytical methods used to determine the level of pepsinogens make the interpretation of results and diagnostic validation difficult.

A Deep Learning Network Based on Multi-Scale and Attention for the Diagnosis of Chronic Atrophic Gastritis

A Deep Learning Network Based on Multi-Scale and Attention for the Diagnosis of Chronic Atrophic Gastritis

Complex diagnostics of early gastric cancer associated with Helicobacter pylori infection in the adult population of Siberia

Background: Most researchers point to a decrease in immunity indicators in patients with gastric cancer. At the same time, there are ambiguous interactions between tumor growth and the functioning of the immune system. Identifying gastric cancer patients at an early and curable stage of the disease is essential if the mortality rates for this disease are to decrease. The only way to prevent the development of gastric cancer is the potential reversibility of precancerous changes in the gastric mucosa. The early diagnosis of chronic atrophic gastritis is a preventive measure and it should be carried out in both the presence and absence of the symptoms of dyspepsia. Methods: A total of 299 blood samples were collected, inclusive of 98 gastric cancer patients, 104 healthy controls, and 97 patients with chronic atrophic gastritis. An evaluation of spontaneous and induced chemiluminescence (CL) was carried out for 90 minutes using a 36-channel biochemiluminometer "BLM — 3607" (Russia), and an Olympus fluorescence microscope was used for cell counting. Interpretation &amp; conclusions: Our study showed the significance of the parameters, specifically the maximum intensity of spontaneous (Ispont) and induced chemiluminescence (Iindus) of the neutrophils and monocytes, the indices of granulocytic and monocytic phagocytosis, malondialdehyde (MDA), and the ratio of the activity of the enzyme superoxide dismutase to glutathione/CAT ratio superoxide dismutase to glutathione peroxidase (SOD/GPO) in the diagnosis of early gastric cancer. Using the threshold values ​​of the proposed criteria in the screening of the adult population, it is possible to form a group that is at a high risk of developing early gastric cancer and to achieve a decrease in the mortality and disability rates in the population of Siberia. This is as well as allowing for the choosing of a more personalized therapy for the patients at a high risk of developing early gastric cancer.

Хронический атрофический гастрит: тактика курации пациента

Patient management in chronic atrophic gastritis (CAG) in real clinical practice is a difficult task for a clinician. It is mainly due to the lack of reliable clinical stigmas that allow suspecting the presence of gastric mucosal atrophy. The diagnosis of chronic atrophic gastritis is valid only after a morphological assessment of gastrobiopaths taken during an endoscopy. According to a contemporary view, regardless of the inflammatory process etiology, CAG can progress to stomach cancer. At the same time, the point of no-return (at which the risk of inflammatory changes progression in the gastric mucosa and carcinogenesis preserves) is the CAG formation with the presence of intestinal metaplasia, even after the etiological factor is eliminated. Patients of this group, depending on the severity of inflammatory changes and atrophy, require constant dynamic follow-up and timely implementation of necessary measures for cancer prevention. To inhibit the progression of gastric mucosal precancerous changes, it is necessary to include the regimen using gastroprotective drugs for patients with CAG. Patients with autoimmune gastritis (in addition to the gastroprotective drugs) need to conduct regimens of cyanocobalamin therapy to prevent hematological and neurological disease manifestations. KEYWORDS: chronic atrophic gastritis, intestinal metaplasia, gastric cancer, Helicobacter pylori, autoimmune gastritis, gastroprotection, carcinoprevention, eradication therapy, rebamipide. FOR CITATION: Livzan M.A., Gaus O.V., Mozgovoi S.I. Chronic atrophic gastritis: patient management. Russian Medical Inquiry. 2021;5(6):427–432 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-427-432.

Chronic atrophic gastritis: an update on diagnosis.

Background and aimAtrophic gastritis is a precancerous gastric lesion, therefore its early detection is a priority in preventing gastric cancer. The aim of the present paper is to develop a narrative synthesis of the present knowledge on diagnostic methods of chronic atrophic gastritis.MethodsA literature search was carried out on main databases: PubMed, Hinari, SpringerLink and Scopus (Elsevier) for the period 2000–2020. The searched keywords were: chronic atrophic gastritis, intestinal metaplasia and dysplasia + diagnosis. Inclusion criteria were focused on the articles about the invasive and non-invasive diagnosis of chronic atrophic gastritis and of precancerous gastric lesions, intestinal metaplasia and dysplasia; exclusion criteria were articles published before 2000 and those that did not include the proposed theme.ResultsThe search returned 575 papers addressing the topic of precancerous lesions. From these, 60 articles were qualified representative for the materials published on the topic of this synthesis article, being those that met the inclusion criteria. The data emphasize the need to use upper digestive endoscopy with biopsies for the diagnosis of chronic atrophic gastritis. However serological diagnosis is available as alternative mainly recommended in follow up.ConclusionsThere are two main methodological approaches for the evaluation of chronic atrophic gastritis as a precancerous gastric lesions: invasive examination, which requires histological analysis of biopsy samples taken during upper digestive endoscopy, being the “gold standard” for diagnosis, and non-invasive serological examination using markers of gastric function.

Analysis of correlation between gastroscopic manifestations and pathological diagnosis of chronic atrophic gastritis

Objective To investigate the correlation of endoscopic and pathological diagnosis of chronic atrophic gastritis(CAG). Methods 108 patients diagnosed as CAG by gastroscopy were selected.Whether the results were consistent with the diagnosis between gastroscope and pathology were observed, and the diagnosis relationship between gastroscopic and histopathological features, and the relationship between CAG and Hp were observed, and the coincidence rates of the diagnostic results by using these two methods were calculated. Results 19 cases of chronic superficial gastritis(CSG) and 89 cases of CAG were diagnosed by pathologic biopsy, and 42 cases of CAG with intestinal metaplasia, 13 cases with dysplasia.The coincidence rate of CAG between gastroscopic and pathological diagnosis was 82.41%.9 cases showed the gastric mucosa in rough and showed granular or nodular changes, meanwhile, 7 cases of them with CAG were confirmed by histopathology, following 3 cases of them with intestinal metaplasia(33.33%) and 1 case of them with heterosexual hyperplasia(11.11%).18 cases showed the change of the color of the gastric mucosa with red and white, and mainly in white, following vascular exposure tested by gastroscope.13 cases of them(72.22%) with CAG were confirmed by histopathology, 4 cases of them with intestinal metaplasia(22.22%) and 1 case of them with heterosexual hyperplasia(5.56%).14 cases showed gastric mucosal folds flat, thinning or even disappear tested by gastroscope.10 cases of them(71.43%) with CAG were confirmed by histopathology, following 4 cases of them with intestinal metaplasia(28.57%) and 2 cases of them with heterosexual hyperplasia(14.29%). When the three manifestations of gastroscope were presented, the CAG coincidence rate was more than 70.00%, and the highest was the rough gastric mucosa with the rate of 77.78%.When the any two of the manifestations of gastroscope were simultaneously presented, the CAG coincidence rate was more than 80.00%, and the highest was the rough gastric mucosa and the color of red and white combination with the rate of 88.00%.When the three of the manifestations of gastroscope were simultaneously presented, the CAG coincidence rate was more than 80.00%.Hp was positive in 55 cases(50.93%).89 cases were diagnosed by pathology, 48 cases of them(53.93%) were Hp positive.In the 42 cases with intestinal metaplasia, 24 cases of them(57.14%) were Hp positive.In 13 cases with dysplasia, 9 cases of them(69.23%) were Hp positive. Conclusion It should be combined with gastroscopy and pathological examination in clinic, and should pay more attention to the typical site biopsy and strengthen the identify of endoscopic morphology, and also standardize the endoscopic operation.It can ultimately improve the diagnostic coincidence rate of the two methods. Key words: Gastritis, atrophic; Gastroscopy; Pathology; Diagnosis

The application value in diagnosis of chronic atrophic gastritis using the magnifying endoscopy and narrow-band imaging

Objective To explore the application value in diagnosis of chronic atrophic gastritis using the magnifying endoscopy and narrow-band imaging. Methods A total of 98 cases of chronic atrophic gastritis patients was selected, and carried out the ordinary white light endoscopy, magnifying endoscopy and narrow-band imaging(ME-NBI) and pathological examination in file, followed by comparison of the results. Results The sensitivity and specificity of chronic atrophic gastritis by magnifying endoscopy and narrow-band imaging mode were 74.07% and 82.35%, respectively; which were significantly higher than that obtained by conventional endoscopy, which were 48.15% and 64.71% (P<0.05). In magnifying endoscopy and narrow-band imaging endoscopy group, 60 patients were positive, which intestinal metaplasia accounted for 35%, while in conventional endoscopy group, 39 patients were positive which was only 17.95% (P<0.05). Conclusions Magnifying endoscopy and narrow-band imaging can improve the diagnostic accuracy of chronic atrophic gastritis. Key words: Endoscopy/MT; Gastritis, atrophic/DI

Determination of whether screening tests for chronic atrophic gastritis really has a positive predictive value.

Intestinal‑type gastric adenocarcinomas are preceded by precancerous lesions, which begin with chronic atrophic gastritis. Over the last few years, multiple serological screening techniques have been performed and commercialized for the diagnosis of chronic atrophic gastritis. In the present study, 123 patients were recruited at the International Cancer Institute 'G. Pascale' Foundation (Naples, Italy) to test commercial kits for the serological determination of chronic atrophic gastritis, supported by histological analysis, according to the International Group of Gastroenterologists 'Operative Link for Gastritis Assessment Staging System'. The results revealed a significant discrepancy between serological screening and histological evaluation in 10.6% of patients, which highlighted the dubious positive predictive value of commercial serological screening kits.

Interobserver consistency in histopathological assessment of chronic gastritis

Objective To study the improvement of interobserver consistency in pathological diag- nosis of chronic gastritis by using a visual-analog scale after the training on diagnostic criteria of chronic gas- tritis. Methods Eight pathologists conducted two rounds of evaluation of 70 slides with confirmed diagnosis of chronic atrophic gastritis. After the first round, every pathologist was trained with the diagnosis criteria from ＂Chinese consensus on chronic gastritis （2012, Shanghai）＂, and the visual analog scale was used in the second round. Eight pathologists were grouped by working experience and hospital, respectively, and the interobserver consistency was evaluated using Kappa analysis. Results The overall Kappa values of 5 kinds of chronic gastritis features improved in the second round when compared with those from the first one. In the second round of diagnosis, the difference in Kappa value between the senior and the junior group was -0. 018 0-0. 034 1, while the interobserver consistency was at the same level. The difference in Kappa value between the same hospital and the different hospital groups was 0. 012 2-0. 049 7, but the interobserver consistency was at the same level for the various chronic gastritis features, expect for H. pylori infection, which was better for the same hospital group. Conclusion Interohserver consistency generally improves after the training of the proposed diagnostic criteria of “Chinese consensus on chronic gastritis （2012, Shang- hai）” accompanied with a visual-analog scale. Key words: Gastritis, atrophic ; Pathology, Clinical; Interobserver variation

Tu1284 “Optical Biopsy” in Diagnosis of Chronic Atrophic Gastritis and Intestinal Metaplasia: a Comparison of Probe-Based Confocal LASER Endomicroscopy With Narrow-Band Imaging Endoscopy and Histology

total of 41 patients were enrolled: 19 patients (46%) had known CD, 13 patients (32%) were being evaluated for suspected CD, and 9 patients (22%) had an endoscopy for evaluation of GERD or abdominal. The total number of biopsy pieces available for analysis was 85 (mean 2.1 per patient) in the 1-pass group and 74 (mean 2.0 per patient) in the 2-pass group. A total of 49% of specimens were well-oriented: 17 patients (41%) had well-oriented specimens with the 1-pass method and 23 patients (56%) had well-oriented specimens with the 2-pass method. A repeated measures logistic regression analysis was strongly suggestive of improved orientation with the 2-pass method for all patients (OR 1.80; 95% CI 0.84 3.86). In subset analyses of patients with and without CD, the trend towards improved orientation with the 2-pass method persisted. In 8 of 19 (42%) patients with known CD, the Marsh score differed between the 1and 2pass methods; this included 3 patients (16%) in whom the Marsh score differed by two or more stages. Conclusions: Our study suggests a trend towards improved orientation of duodenal biopsy specimens with the 2-pass method compared to the 1-pass method. Practitioners should consider using the 2-pass method among patients undergoing endoscopy for known or suspected CD.

Sa1977 A Preliminary Longitudinal Assessment of Mutational Load in Patients With Barrett's Esophagus

INTRODUCTION: Chronic Atrophic Gastritis (CAG) is the most important independent risk condition for gastric cancer, histology being considered the gold standard for both diagnosis and follow up. The Operative Link for Gastritis Assessment (OLGA) is an innovative histological system proposed for staging atrophic gastritis in a prognostic view. GastroPanel (Biohit, Helsinki, Finland) is a serological kit for a non-invasive diagnosis of chronic atrophic gastritis (CAG), including serum pepsinogen I (PGI), pepsinogen II (PGII), gastrin-17 (G17) and IgG anti-Helicobacter pylori antibodies (IgG-Hp). Clinical practice is lacking of a non invasive instrument useful to predict and to follow the stage of atrophic gastritis. AIMS& METHODS: To evaluate correlation between GastroPanel and OLGA stage, in a cohort of dyspeptic patients referred from a primary care setting to our G.I. Unit Histological evaluation of gastric biopsies was performed in 125 pts (83 females, mean age 53 yrs). Atrophy was assessed according to the OLGA staging system. OLGA stages III and IV are considered at high risk for gastric cancer development. From each subject, a blood sample was taken for GastroPanel analysis. RESULTS: GastroPanel analysis showed that 79 pts (63,2%) have no gastritis, 22 pts (17,6%) a Hp-related chronic gastritis and 24 (19,2%) atrophic gastritis picture. Comparing GastroPanel results to the histological findings, 48 pts of the first group were confirmed normal at histology, 27 pts have an OLGA stage 0-II, 4 pts have an OLGA stage III, none stage IV. Among the patients with Hp-related gastritis, 1 pt results normal at the histological evaluation, 20 pts have an OLGA stage 0-II, 1 pt has an OLGA stage III; 6 out of the 24 pts with evidence of CAG at GastroPanel have an OLGA stage 0-II, 18 pts have an OLGA stage III-IV. The negative predictive value (NPV) of GastroPanel for CAG is 95,0%, being the positive predictive value (PPV) 75,0%. CONCLUSION: GastroPanel shows an high NPV to predict absence of atrophic gastritis. The relationship beetween GastroPanel and OLGA system seems to confirm the clinical performances of the test