Preliminary analysis of association between stomach cracks under gastroscopy and h.pylori infection and its pathological significance / 中国综合临床

ABSTRACT

Objective To investigate the clinical significance of gastric cracks by investigating the relationship between stomach cracks under gastroscopy and H.pylori infection as well as its pathological manifestation,in order to improve the detection rate of H.pylori.Methods Gastroscopy patients were enrolled as our subjects excluding those with tumors,major diseases and under 18 years old.Mucosal biopsies were obtained from the lesser curvature of antrum and the greater curvature of body in each patient,then by HE staining,pathological and HP examination.The information including the pathological diagnosis,HP antibody,rapid urease test,endoscopic diagnosis and endoscopic gastric body cracking phenomenon were collected from all patient.H.pylori positivity was defined as a patient who showed two or more positive results in the Rapid Urea's Test,pathohistological examination and H.pylori antibody detection.Results (1) 437 patients with gastroscopy were included between December 2009 and December 2011,among whom 210 were male and 227 were female.There were 32 cases with gastric ulcer,59 cases with duodenal ulcer,51 cases with duodenitis,62 cases with reflux esophagitis,and 276 cases with chronic gastritis.(2) H.pylori distribution in stoma of all patients160 of 437 patients(36.61％) are H.pylori positive,of which 68.75％ (110/160) was found H.pylori positive in both of gastric antrum and body,25.63％ (41/160) was H.pylori positive only in antrum,and 3.13％ (5/160) was H.pylori positive only in the body of stomach.(3)Relationship between the presence of cracks in gastric body and H.pylori infectionthe H.pylori positivity was 62.58％ (97/155) and 22.34％ (63/282) respectively in the group with or without the presence of cracks in body.Cracks in gastric body examined by gastroscopy was related to H.pylori infection(x2 =69.788,P =0.000).(4) Relationship between the presence of cracks in gastric body and patho-histologythe presence of cracks in gastric body was related with severity of gastric inflammation by Wilcoxon rank sum test (P ＜ 0.0001),while there was no relationship between gastric body cracks and atrophy,intestinal metaplasia and atypical hyperplasia(P ＞ 0.05).(5) Relationship between the presence of cracks in gastric body and diseasesthe presence of cracks in body was related with duodenitis,bile reflux under gastroscopy while there was no difference among in gastric body and gastric ulcer,esophagitis and chronic gastritis in terms of cracking appearance (P ＞ 0.05).Conclusion Our finding showed that cracking appearance in the gastric body is related with severity of inflammation in gastric mucosa bile reflux and duodenitis,suggesting that it can be one of the gastroscopic manifestations of more severe gastritis.