Gastric atrophy: use of OLGA staging system in practice

Aim: This study used the OLGA system to characterize the histology pattern of gastritis in dyspeptic outpatients with a mean age of 45 years from regions with different gastric cancer risks

Background: Several classification systems have been purposed for understanding the status of the gastric mucosa. Currently, the Sydney system is the most widely employed. Nevertheless, the applicability of the Sydney system in therapeutic and prognostic areas is a matter of debate. Given this shortcoming an international group of gastroenterologists and pathologists developed a new system named Operative Link on Gastritis Assessment [OLGA]

Patients and methods: In this cross-sectional comparative study the OLGA system was used to characterize the histology pattern of gastritis in 685 dyspeptic patients referring to the department of gastroenterology of a training hospital

Results: No significant correlation was found between active inflammation and total OLGA score [P > 0.05]. Also, no statistically significant correlation was found between activity and intestinal metaplasia, dysplasia, atrophy, and cancer [P > 0.05]. Even though, there is a positive correlation between mild chronic inflammation and total OLGA score, no correlation has been identified between chronicity and dysplasia or cancer [P > 0.05]. Nearly, In all cases with no dysplasia OLGA score was zero but all patients with gastric cancer OLGA score was more than two

Conclusion: Generally, the activity is not a useful factor in predicting prognosis and its loss of relation with total OLGA score does not make OLGA score any less predictable

[Celiac disease in dyspeptic patients]

The screening of patients with dyspepsia, may allow an early identification of affected individuals. The aim of this study was to determine the prevalence of celiac disease in dyspeptic patients submitted to routine diagnostic upper gastrointestinal endoscopy. From November 2007 to October 2008, 407 patients who underwent endoscopy for any reason [193 male, 214 women; mean age36.1 years] were studied in this work. Histological characteristics in duodenal biopsy specimens for celiac disease were evaluated according to the modified Marsh Classification1999. In addition, all patients were tested for total immunoglobulin A and antitransglutaminase [tTG] antibodies. The patients with IgA deficiency were tested with IgG tTG. Duodenal histology showed the malabsorption pattern [Marsh I-IIIc] in 26 [6.4%] cases and 33 cases had serological positive test for tTGA. In term of the serological analysis, 10 out of 33 tTGA positive patients had malabsorption pattern [Marsh I,-IIIc], and all of them had a positive tTGA [2.45%]. Four of the 407 recruited patients were IgA deficient and none of them were positive for IgG tTG. In this study, about 6.4% of patients had malabsorption pattern and 8.1% presented with positive serology for CD. However, both histology and serology were positive in 10/407 [2.45%]. The high prevalence of celiac among dyspeptic symptomatic individuals indicates that they are a higher risk group for developing celiac disease

Clinical and histological presentation of helicobacter pylori and gluten related gastroenteropathy

Celiac disease has been reported to be associated with gastric abnormalities. The aim of this study was to assess the relationship between the prevalence of celiac disease and Helicobacter pylori infection in an Iranian population of 250 patients. Biopsies were taken from the gastric antrum and duodenum. Morphology and histology were evaluated using the updated Sydney system and modified Marsh criteria, respectively. To simplify the interpretation of gastric lesions we classified gastritis in macroscopic and microscopic stages. Serology for anti-tissue transglutaminase antibody was performed to determine the presence of celiac disease. Among 250 patients, 232 [93%] had histological evidence of Helicobacter pylori infection. Histological abnormalities [Marsh I to IIIc] were present in 24 [10%]. Of 24 patients, 20 [83%] with histological abnormalities were infected with Helicobacter pylori. Of 250 patients, 25 [10%] had a positive anti-tissue transglutaminase antibody. Of 25 anti-tissue transglutaminase antibody positive patients, 9 [3.6%] had microscopic and macroscopic enteritis [Marsh I to IIIc]. Clinical presentation of celiac disease was not distinguishable from cases infected with Helicobacter pylori. Histology, even in patients with positive serology, was non-specific and unhelpful. We found a high prevalence of Helicobacter pylori infection and chronic gastritis, but neither was associated with celiac disease, in agreement with studies in Western populations

Gastritis cystica polyposa in an unoperated stomach, treated by endoscopic polypectomy

Gastritis cystic polyposa is a rare and peculiar polypoid lesion arising at a gas-troenterostomy site, and almost always on the gastric side. It is characterized by elongation of the gastric foveolae along with hyperplasia and cystic dilatation of the gastric glands extending into the submucosal layer. Esophagogastroduodenoscopy in a 47-year-old woman without any history of gastric operation revealed a pedunculated polyp approximately 2 cm in diameter, in a background of erythematous gastric folds along the anterior wall of the fundus. Polypectomy was performed, with endoscopic impression of hyperplastic or fundic gland polyp, without any complications. Histopathological findings were consistent within gastritis cystic polyposa[GCP]. A mild Helicobacter pylori colonization in gastric pits was seen. GCP could occur in an unoperated stomach and treated by endoscopic polypectomy. However, removal and histopathologic confirmation of these lesions are necessary