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Tiankanon K, Pittayanon R, Faknak N, Sirimongkolkasem J, Rattanachaisit P, Lerttanatum N, Sanpavat A, Klaikaew N, Rerknimitr R. Diagnostic validity and learning curve of non-NBI expert endoscopists in gastric intestinal metaplasia diagnosis. Surg Endosc 2023; 37:6771-6778. [PMID: 37226035 DOI: 10.1007/s00464-023-10123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Endoscopists' experience influences narrow-band imaging (NBI)-guided gastric intestinal metaplasia (GIM) diagnostic performance. We aimed to evaluate the general gastroenterologists (GE) performance in NBI-guided GIM diagnosis compared to NBI experts (XP) and assess GEs' learning curve. METHODS A cross-sectional study was conducted between 10/2019 and 2/2022. Histology-proven GIM who underwent esophagogastroduodenoscopy (EGD) were randomly assessed by 2XPs or 3GEs. Endoscopists' performance on NBI-guided diagnoses were compared to the pathological diagnosis (gold standard) in five areas of the stomach according to the Sydney protocol. The primary outcome were GIM diagnosis validity scores of GEs compared to XPs. The secondary outcome was the minimum number of lesions required for GEs to achieve an accuracy of GIM diagnosis ≥ 80%. RESULTS One thousand one hundred and fifty-five lesions from 189 patients (51.3% male, mean age 66 ± 10 years) were examined. GEs performed EGD in 128 patients with 690 lesions. the GIM diagnosis sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GEs compared to the XPs, were 91% vs.93%, 73% vs.83%, 79% vs.83%, 89% vs.93%, and 83% vs.88%, respectively. GEs demonstrated lower specificity (mean difference - 9.4%; 95%CI - 16.3, 1.4; p = 0.008) and accuracy (mean difference - 5.1%; 95%CI - 3.3, 6.3; p = 0.006) compared to XPs. After 100 lesions (50% GIM), GEs achieved an accuracy of ≥ 80% and all diagnostic validity scores were comparable to the XPs (p < 0.05 all). CONCLUSIONS Compared to XPs, GEs had lower specificity and accuracy for GIM diagnosis. The learning curve for a GE to achieve comparable performance to XPs would necessitate at least 50 GIM lesions. Created with BioRender.com.
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Affiliation(s)
- Kasenee Tiankanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand
| | - Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand.
| | - Natee Faknak
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand
| | - Jarongkorn Sirimongkolkasem
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand
| | - Pakkapon Rattanachaisit
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand
| | - Nathawadee Lerttanatum
- Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Anapat Sanpavat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Naruemon Klaikaew
- Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Rama 4 Road, Patumwan, Bangkok, 10330, Thailand
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Cao R, Tang L, Fang M, Zhong L, Wang S, Gong L, Li J, Dong D, Tian J. Artificial intelligence in gastric cancer: applications and challenges. Gastroenterol Rep (Oxf) 2022; 10:goac064. [PMID: 36457374 PMCID: PMC9707405 DOI: 10.1093/gastro/goac064] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 08/10/2023] Open
Abstract
Gastric cancer (GC) is one of the most common malignant tumors with high mortality. Accurate diagnosis and treatment decisions for GC rely heavily on human experts' careful judgments on medical images. However, the improvement of the accuracy is hindered by imaging conditions, limited experience, objective criteria, and inter-observer discrepancies. Recently, the developments of machine learning, especially deep-learning algorithms, have been facilitating computers to extract more information from data automatically. Researchers are exploring the far-reaching applications of artificial intelligence (AI) in various clinical practices, including GC. Herein, we aim to provide a broad framework to summarize current research on AI in GC. In the screening of GC, AI can identify precancerous diseases and assist in early cancer detection with endoscopic examination and pathological confirmation. In the diagnosis of GC, AI can support tumor-node-metastasis (TNM) staging and subtype classification. For treatment decisions, AI can help with surgical margin determination and prognosis prediction. Meanwhile, current approaches are challenged by data scarcity and poor interpretability. To tackle these problems, more regulated data, unified processing procedures, and advanced algorithms are urgently needed to build more accurate and robust AI models for GC.
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Affiliation(s)
| | | | - Mengjie Fang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, P. R. China
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, P. R. China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, P. R. China
| | - Lianzhen Zhong
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, P. R. China
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, P. R. China
| | - Siwen Wang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, P. R. China
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, P. R. China
| | - Lixin Gong
- College of Medicine and Biological Information Engineering School, Northeastern University, Shenyang, Liaoning, P. R. China
| | - Jiazheng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Radiology Department, Peking University Cancer Hospital & Institute, Beijing, P. R. China
| | - Di Dong
- Corresponding authors. Di Dong, CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing 100190, P. R. China. Tel: +86-13811833760; ; Jie Tian, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, P. R. China. Tel: +86-10-82618465;
| | - Jie Tian
- Corresponding authors. Di Dong, CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing 100190, P. R. China. Tel: +86-13811833760; ; Jie Tian, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, P. R. China. Tel: +86-10-82618465;
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Vu NTH, Quach DT, Dang NLB, Le QD, Nguyen DTN, Le HM, Le NQ, Hiyama T. Performance of chromoendoscopy and narrow-band imaging in the diagnosis of gastric intestinal metaplasia. Scand J Gastroenterol 2022; 57:1005-1010. [PMID: 35275785 DOI: 10.1080/00365521.2022.2048066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Chromoendoscopy and narrow-band imaging (NBI) have been reported to aid in the diagnosis of gastric intestinal metaplasia (GIM). This study aimed to assess the diagnostic validity of chromoendoscopy combined with NBI in the diagnosis of GIM in Vietnamese. METHODS A cross-sectional study was carried out on patients with dyspeptic symptoms who underwent esophagogastroduodenoscopy (EGD) at the University Medical Center at Ho Chi Minh City. We compared the detection rates of GIM in the group of patients examined with white-light endoscopy (WLE) alone and those examined with WLE in combination with chromoendoscopy and NBI. RESULTS A total of 374 patients have been recruited. The additional GIM detection rate after chromoendoscopy combined with NBI was 8.6% (95% confidence interval [CI]: 4.3 - 12.8), p < .005. The rate of GIM within the group of patients biopsied under the guidance of chromoendoscopy combined with NBI was statistically significantly higher than in the group with WLE alone with a distinct rate of 14.4% (95% CI: 6.3 - 2.6), p = .001. CONCLUSIONS Chromoendoscopy combined with NBI helped to detect the GIM lesions missed by WLE and was a more reliable endoscopic method for the diagnosis of GIM.
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Affiliation(s)
- Nhu Thi Hanh Vu
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
- Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
- Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Ngoc Le Bich Dang
- Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Quang Dinh Le
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
- Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Doan Thi Nha Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
- Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Huy Minh Le
- Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
- Department of Surgical Pathology, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Nhan Quang Le
- Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Toru Hiyama
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
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Yan T, Wong PK, Choi IC, Vong CM, Yu HH. Intelligent diagnosis of gastric intestinal metaplasia based on convolutional neural network and limited number of endoscopic images. Comput Biol Med 2020; 126:104026. [PMID: 33059237 DOI: 10.1016/j.compbiomed.2020.104026] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Gastric intestinal metaplasia (GIM) is a precancerous lesion of gastric cancer. Currently, diagnosis of GIM is based on the experience of a physician, which is liable to interobserver variability. Thus, an intelligent diagnostic (ID) system, based on narrow-band and magnifying narrow-band images, was constructed to provide objective assistance in the diagnosis of GIM. METHOD We retrospectively collected 1880 endoscopic images (1048 GIM and 832 non-GIM) via biopsy from 336 patients confirmed histologically as GIM or non-GIM, from the Kiang Wu Hospital, Macau. We developed an ID system with these images using a modified convolutional neural network algorithm. A separate test dataset containing 477 pathologically confirmed images (242 GIM and 235 non-GIM) from 80 patients was used to test the performance of the ID system. Experienced endoscopists also examined the same test dataset, for comparison with the ID system. One of the challenges faced in this study was that it was difficult to obtain a large number of training images. Thus, data augmentation and transfer learning were applied together. RESULTS The area under the receiver operating characteristic curve was 0.928 for the pre-patient analysis of the ID system, while the sensitivities, specificities, and accuracies of the ID system against those of the human experts were (91.9% vs. 86.5%, p-value = 1.000) (86.0% vs. 81.4%, p-value = 0.754), and (88.8% vs. 83.8%, p-value = 0.424), respectively. Even though the three indices of the ID system were slightly higher than those of the human experts, there were no significant differences. CONCLUSIONS In this pilot study, a novel ID system was developed to diagnose GIM. This system exhibits promising diagnostic performance. It is believed that the proposed system has the potential for clinical application in the future.
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Affiliation(s)
- Tao Yan
- School of Mechanical Engineering, Hubei University of Arts and Science, Xiangyang, 441053, China; Department of Electromechanical Engineering, University of Macau, Taipa, 999078, Macau, China
| | - Pak Kin Wong
- Department of Electromechanical Engineering, University of Macau, Taipa, 999078, Macau, China.
| | | | - Chi Man Vong
- Department of Computer and Information Science, University of Macau, Taipa, 999078, Macau, China
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Cho JH, Jeon SR, Jin SY. Clinical applicability of gastroscopy with narrow-band imaging for the diagnosis of Helicobacter pylori gastritis, precancerous gastric lesion, and neoplasia. World J Clin Cases 2020; 8:2902-2916. [PMID: 32775373 PMCID: PMC7385595 DOI: 10.12998/wjcc.v8.i14.2902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/01/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
Premalignant gastric lesions such as atrophic gastritis and intestinal metaplasia frequently occur in subjects with long-term Helicobacter pylori (H. pylori) infection. The regular arrangement of collecting venules (RAC) is seen in the normal gastric corpus, whereas mucosal swelling and redness without RAC are observed in H. pylori-infected mucosa. Despite successful H. pylori eradication, the presence of atrophic gastritis and/or gastric intestinal metaplasia (GIM) is a risk factor for gastric cancer. With the development of advanced imaging technologies, recent studies have reported the usefulness of narrow-band imaging (NBI) for endoscopic diagnosis of atrophic gastritis and GIM. Using NBI endoscopy with magnification (M-NBI), atrophic gastritis is presented as irregular coiled microvessels and loss of gastric pits. Typical M-NBI endoscopic findings of GIM are a light blue crest and a white opaque substance. Based on the microvascular patterns, fine network, core vascular, and unclear patterns are useful for predicting gastric dysplasia in polypoid lesions. For diagnosis of early gastric cancer (EGC), a systematic classification using M-NBI endoscopy has been proposed on the basis of the presence of a demarcation line and an irregular microvascular/microsurface pattern. Furthermore, M-NBI endoscopy has been found to be more accurate for determining the horizontal margin of EGC compared to conventional endoscopy. In this review, we present up-to-date results on the clinical usefulness of gastroscopy with NBI for the diagnosis of H. pylori gastritis, precancerous gastric lesion, and neoplasia.
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Affiliation(s)
- Jun-Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul 04401, South Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul 04401, South Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Seoul 04401, South Korea
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Xie J, Chen S, Wang N, Wang L, Bo E, Liu L. Automatic differentiation of nonkeratinized stratified squamous epithelia and columnar epithelia through feature structure extraction using OCT. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.101919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Sun YN, Zhang MM, Li LX, Ji R, Wang X, Li P, Li YY, Zheng MQ, Liu GQ, Zuo XL, Li Z, Li YQ. Cresyl violet as a new contrast agent in probe-based confocal laser endomicroscopy for in vivo diagnosis of gastric intestinal metaplasia. J Gastroenterol Hepatol 2020; 35:453-460. [PMID: 31518444 DOI: 10.1111/jgh.14864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIM Cresyl violet (CV) is a topical dye that allows simultaneous chromoendoscopy and in vivo confocal laser endomicroscopy in identification of neoplastic changes of the lower gastrointestinal tract without intravenous injection of fluorescein, but as yet no investigation has reported its application in the diagnosis of gastric intestinal metaplasia (GIM). This study aims to assess the feasibility as well as diagnosis accuracy of topical CV for in vivo diagnosis of GIM by using probe-based confocal laser endomicroscopy (pCLE). METHODS In this prospective, open-label, feasibility study, 129 confocal videos from 22 patients with known GIM were analyzed and compared with corresponding histological images to establish the CV staining characteristics. In addition, 47 patients with known or suspected GIM were prospectively enrolled to evaluate the accuracy of this topical CV endomicroscopic imaging. RESULTS Probe-based confocal laser endomicroscopy with topical CV enabled clear visualization of the goblet cells, absorptive cells, and intestinal villi of GIM. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of pCLE diagnosis of GIM on a per-location analysis was 93.01%, 91.95%, 93.51%, 86.96%, and 96.11%, respectively. The intraclass correlation coefficient for inter-observer agreement and mean kappa value for intra-observer agreement for the diagnosis of GIM was 0.82 and 0.87, respectively. CONCLUSIONS Topical CV enables real-time chromoendoscopy in conjunction with pCLE examination of the stomach and warrants accurate diagnosis of GIM. It may be an acceptable and potentially alternative dye for confocal imaging in the future.
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Affiliation(s)
- Yi-Ning Sun
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Ming-Ming Zhang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Li-Xiang Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Rui Ji
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiao Wang
- Department of Pathology, Qilu Hospital, Shandong University, Jinan, China
| | - Peng Li
- Department of Pathology, Qilu Hospital, Shandong University, Jinan, China
| | - Yue-Yue Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Meng-Qi Zheng
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Guan-Qun Liu
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
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Trieu JA, Bilal M, Saraireh H, Wang AY. Update on the Diagnosis and Management of Gastric Intestinal Metaplasia in the USA. Dig Dis Sci 2019; 64:1079-1088. [PMID: 30771043 DOI: 10.1007/s10620-019-05526-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Gastric intestinal metaplasia (GIM) is a premalignant condition that can lead to intestinal-type gastric adenocarcinoma. It is characterized by a change in the gastric mucosa to a small-intestinal phenotype. Infection with Helicobacter pylori is the most common factor associated with GIM. Although GIM is typically a histologic diagnosis, various techniques have been developed to enable the endoscopic identification of GIM. There are presently no widely accepted guidelines on screening and surveillance strategies in patients with GIM in the USA. The aim of this review is to provide an update regarding the problem, diagnosis, and management of GIM in the USA.
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Affiliation(s)
- Judy A Trieu
- Department of Internal Medicine, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Mohammad Bilal
- Division of Gastroenterology and Hepatology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Hamzeh Saraireh
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, 1200 East Broad Street, P.O. Box 98034, Richmond, VA, 23298, USA
| | - Andrew Y Wang
- Division of Gastroenterology and Hepatology, University of Virginia, P.O. Box 800708, Charlottesville, VA, 22908, USA
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Sha J, Wang P, Zhu B, Zhu M, Li X, Gao F. Acetic Acid Enhanced Narrow Band Imaging for the Diagnosis of Gastric Intestinal Metaplasia. PLoS One 2017; 12:e0170957. [PMID: 28135297 PMCID: PMC5279783 DOI: 10.1371/journal.pone.0170957] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/13/2017] [Indexed: 02/06/2023] Open
Abstract
Gastric intestinal metaplasia (GIM) is a precancerous lesion of the stomach. The detection of GIM using conventional white-light endoscopy (WLE) is difficult. In this study, we determined whether acetic acid-enhanced narrow band imaging (AA-NBI) improves the detection of GIM. A consecutive cohort of 132 individuals aged 40 years or older was subjected to upper gastrointestinal endoscopy using WLE, NBI and AA-NBI. The ability of the three methods to diagnose GIM in patients was compared. Histological assessment (per-patient and per-biopsy) was used for the accuracy assessment. Sixty-six (50.0%) out of the 132 individuals examined were found to have GIM, of which 44 (66.7%) were diagnosed correctly by NBI (sensitivity 66.7% and specificity 68.2%) and 58 (87.9%) were correctly identified by AA–NBI (sensitivity 87.9% and specificity 68.2%), as compared to only 22 (33.3%) by WLE (sensitivity 33.3% and specificity 28.8%). Therefore, the sensitivity of AA–NBI in the diagnosis of GIM was significantly higher than NBI (p<0.05) and WLE (p < 0.001). Our study indicates that AA-NBI can improve the accuracy of endoscopy-targeted biopsies for GIM.
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Affiliation(s)
- Jie Sha
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, Jiangsu, China
| | - Pin Wang
- Department of Gastroenterology, Drum Tower Clinical Medical School of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bingliang Zhu
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, Jiangsu, China
| | - Minghui Zhu
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, Jiangsu, China
| | - Xueliang Li
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Feng Gao
- Department of Gastroenterology, Jingjiang People's Hospital, Jingjiang, Jiangsu, China
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He XK, Liu D, Sun LM. Diagnostic performance of confocal laser endomicroscopy for optical diagnosis of gastric intestinal metaplasia: a meta-analysis. BMC Gastroenterol 2016; 16:109. [PMID: 27596838 PMCID: PMC5011919 DOI: 10.1186/s12876-016-0515-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 08/10/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gastric intestinal metaplasia (IM) is generally considered as a precancerous condition, a related risk factor for intestinal-type gastric cancer. However, an accurate endoscopic diagnosis of IM is a clinical challenge. Confocal Laser Endomicroscopy (CLE) is a newly technique that can provide real-time magnified images and visualize tissues at cellular or subcellular levels. The aim of this study is to clarify the diagnostic value of CLE in detection of IM in patients at high risk of gastric cancer. METHODS Systematic literature searches up to April 2015 in PubMed, Embase, Web of Science, Cochrane Library databases were conducted by two reviewers independently. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was applied to assess study quality and to reduce potential bias. A meta-analysis using Meta-Disc (version 1.4) and STATA software (version 13) was performed. RESULTS A total of four studies enrolled 218 patients and 579 lesions were included in this meta-analysis. On per-lesion basis, the pooled sensitivity and specificity of CLE were 0.97(95 % confidence interval (CI) = 0.94-0.98) and 0.94 (95 % CI = 0.91-0.97) respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 15.20 (95 % CI = 9.46-24.41) and 0.04 (95 % CI = 0.02-0.07) respectively. The pooled diagnostic odds ratio (DOR) was 479.59 (95 % CI = 205.64-1118.51) and summary receiver operating curve (SROC) area under the curve was 0.9884. There was no statistical significance of publication bias. CONCLUSION CLE is a promising endoscopic tool in the detection of IM with the relatively high diagnostic value in patients at high risk of gastric cancer.
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Affiliation(s)
- Xing-Kang He
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, 310016, China.,Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, 310016, China
| | - Dan Liu
- Department of Statistics, Texas A & M University, College Station, TX, 77843, USA
| | - Lei-Min Sun
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, 310016, China. .,Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, 310016, China.
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Evaluating the diagnoses of gastric antral lesions using magnifying endoscopy with narrow-band imaging in a Chinese population. Dig Dis Sci 2014; 59:1513-9. [PMID: 24488235 DOI: 10.1007/s10620-014-3027-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/02/2014] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the accuracy of diagnosing gastric antral lesions in routine clinical practice using magnifying endoscopy with narrow-band imaging (M-NBI) as a real-time diagnosing technique. METHODS Consecutive patients undergoing upper endoscopy were selected for the study. In each patient, the mucosa of the gastric antrum was observed by M-NBI, and the gastric microstructure was categorized into five types (A-E). Based on these patterns, histological types were predicted in a real-time manner. The accuracy of these predictions was evaluated based on histological findings. Inter-observer agreement was also assessed. RESULTS A total of 207 sites in 90 patients were examined by M-NBI. Compared with type A gastric microstructure, types B and C gastric microstructure showed a significantly higher degree of inflammation (P < 0.001). The sensitivity, specificity and accuracy of types B + C microstructure as a predictor of gastric inflammation were 85.4, 81.7 and 83.1 %, respectively. Similarly, the sensitivity, specificity and accuracy of type D microstructure as a predictor of gastric intestinal metaplasia were 71.8, 95.2 and 90.8 %, respectively, and those of type E microstructure as a predictor of early gastric cancer were 80.0, 98.9 and 97.6 %, respectively. The sensitivity and specificity of type B alone, type C alone and types B + C combined for the detection of Helicobacter pylori infection were 52.2 and 87.0 %, 22.8 and 92.2 %, 75.0 and 79.1 %, respectively. The kappa value for the inter-observer agreement was 0.715 (95 % confidence interval 0.655-0.895). CONCLUSIONS In conclusion, M-NBI can significantly improve the accuracy of the prediction of histopathology of gastric antral lesions in vivo, implying the possibility of using M-NBI as an effective diagnosis technique.
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So J, Rajnakova A, Chan YH, Tay A, Shah N, Salto-Tellez M, Teh M, Uedo N, Noriya U. Endoscopic tri-modal imaging improves detection of gastric intestinal metaplasia among a high-risk patient population in Singapore. Dig Dis Sci 2013; 58:3566-75. [PMID: 23996468 DOI: 10.1007/s10620-013-2843-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 08/09/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Detection of pre-neoplastic gastric mucosal changes and early gastric cancer (EGC) by white-light endoscopy (WLE) is often difficult. In this study we investigated whether combined autofluorescence imaging (AFI) and narrow band imaging (NBI) can improve detection of pre-neoplastic lesions and early gastric cancer in high-risk patients. PATIENTS AND METHODS Chinese patients who were 50-years-old or above with dyspepsia were examined by both high-resolution WLE and combined AFI followed by NBI (AFI-NBI), consecutively in a prospective randomized cross-over setting, by two experienced endoscopists. The primary outcome was diagnostic ability of the two methods for patients with pre-neoplastic lesions such as intestinal metaplasia (IM) and mucosal atrophy. RESULTS Sixty-five patients were recruited. One patient with large advanced gastric cancer was found and excluded from the analysis. Among the remaining 64 patients, 38 (59%) had IM; of these, 26 (68%) were correctly identified by AFI-NBI (sensitivity 68%, specificity 23%) and only 13 (34%) by WLE (sensitivity 34%, specificity 65%). AFI-NBI detected more patients with IM than did WLE (p=0.011). Thirty-one patients (48%) had mucosal atrophy. Ten patients (32%) were identified by AFI-NBI (sensitivity 32%, specificity 79%) and four patients (13%) by WLE (sensitivity 13%, specificity 88%) (p=0.100). No dysplasia or EGC was found. CONCLUSION AFI-NBI identified significantly more patients with IM than did WLE. Our result warrants further studies to define the role of combined AFI-NBI endoscopy for detection of precancerous conditions.
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Affiliation(s)
- Jimmy So
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,
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Savarino E, Corbo M, Dulbecco P, Gemignani L, Giambruno E, Mastracci L, Grillo F, Savarino V. Narrow-band imaging with magnifying endoscopy is accurate for detecting gastric intestinal metaplasia. World J Gastroenterol 2013; 19:2668-2675. [PMID: 23674874 PMCID: PMC3645385 DOI: 10.3748/wjg.v19.i17.2668] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 02/14/2013] [Accepted: 03/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the predictive value of narrow-band imaging with magnifying endoscopy (NBI-ME) for identifying gastric intestinal metaplasia (GIM) in unselected patients. METHODS We prospectively evaluated consecutive patients undergoing upper endoscopy for various indications, such as epigastric discomfort/pain, anaemia, gastro-oesophageal reflux disease, suspicion of peptic ulcer disease, or chronic liver diseases. Patients underwent NBI-ME, which was performed by three blinded, experienced endoscopists. In addition, five biopsies (2 antrum, 1 angulus, and 2 corpus) were taken and examined by two pathologists unaware of the endoscopic findings to determine the presence or absence of GIM. The correlation between light blue crest (LBC) appearance and histology was measured. Moreover, we quantified the degree of LBC appearance as less than 20% (+), 20%-80% (++) and more than 80% (+++) of an image field, and the semiquantitative evaluation of LBC appearance was correlated with IM percentage from the histological findings. RESULTS We enrolled 100 (58 F/42 M) patients who were mainly referred for gastro-esophageal reflux disease/dyspepsia (46%), cancer screening/anaemia (34%), chronic liver disease (9%), and suspected celiac disease (6%); the remaining patients were referred for other indications. The prevalence of Helicobacter pylori (H. pylori) infection detected from the biopsies was 31%, while 67% of the patients used proton pump inhibitors. LBCs were found in the antrum of 33 patients (33%); 20 of the cases were classified as LBC+, 9 as LBC++, and 4 as LBC+++. LBCs were found in the gastric body of 6 patients (6%), with 5 of them also having LBCs in the antrum. The correlation between the appearance of LBCs and histological GIM was good, with a sensitivity of 80% (95%CI: 67-92), a specificity of 96% (95%CI: 93-99), a positive predictive value of 84% (95%CI: 73-96), a negative predictive value of 95% (95%CI: 92-98), and an accuracy of 93% (95%CI: 90-97). The NBI-ME examination overlooked GIM in 8 cases, but the GIM was less than 5% in 7 of the cases. Moreover, in the 6 false positive cases, the histological examination showed the presence of reactive gastropathy (4 cases) or H. pylori active chronic gastritis (2 cases). The semiquantitative correlation between the rate of LBC appearance and the percentage of GIM was 79% (P < 0.01). CONCLUSION NBI-ME achieved good sensitivity and specificity in recognising GIM in an unselected population. In routine clinical practice, this technique can reliably target gastric biopsies.
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Hyun YS, Han DS, Bae JH, Park HS, Eun CS. Interobserver variability and accuracy of high-definition endoscopic diagnosis for gastric intestinal metaplasia among experienced and inexperienced endoscopists. J Korean Med Sci 2013; 28:744-9. [PMID: 23678267 PMCID: PMC3653088 DOI: 10.3346/jkms.2013.28.5.744] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 02/27/2013] [Indexed: 02/06/2023] Open
Abstract
Accurate diagnosis of gastric intestinal metaplasia is important; however, conventional endoscopy is known to be an unreliable modality for diagnosing gastric intestinal metaplasia (IM). The aims of the study were to evaluate the interobserver variation in diagnosing IM by high-definition (HD) endoscopy and the diagnostic accuracy of this modality for IM among experienced and inexperienced endoscopists. Selected 50 cases, taken with HD endoscopy, were sent for a diagnostic inquiry of gastric IM through visual inspection to five experienced and five inexperienced endoscopists. The interobserver agreement between endoscopists was evaluated to verify the diagnostic reliability of HD endoscopy in diagnosing IM, and the diagnostic accuracy, sensitivity, and specificity were evaluated for validity of HD endoscopy in diagnosing IM. Interobserver agreement among the experienced endoscopists was "poor" (κ = 0.38) and it was also "poor" (κ = 0.33) among the inexperienced endoscopists. The diagnostic accuracy of the experienced endoscopists was superior to that of the inexperienced endoscopists (P = 0.003). Since diagnosis through visual inspection is unreliable in the diagnosis of IM, all suspicious areas for gastric IM should be considered to be biopsied. Furthermore, endoscopic experience and education are needed to raise the diagnostic accuracy of gastric IM.
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Affiliation(s)
- Yil Sik Hyun
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Dong Soo Han
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Joong Ho Bae
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Hye Sun Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Chang Soo Eun
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
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Marelli L, Jaboli FM, Jackson L, Palmer H, Erian G, Hamilton M, Epstein O. A pilot study comparing ESO-2 capsule endoscopy with conventional upper endoscopy for the assessment of uncomplicated heartburn and dyspepsia. Frontline Gastroenterol 2013; 4:96-101. [PMID: 28839708 PMCID: PMC5369810 DOI: 10.1136/flgastro-2012-100251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 11/13/2012] [Accepted: 11/15/2012] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND ESO-2 video capsule endoscopy provides images of the oesophageal mucosa and continues to transmit gastric, and often small bowel images, for up to 30 min. This study compares ESO capsule endoscopy capsule oesophago-gastro-duodenoscopy (Cap-OGD) with conventional endoscopy (OGD). METHODS 50 outpatients with uncomplicated dyspepsia underwent Cap-OGD followed by OGD which was recorded on DVD. Cap-OGD and OGD were each reported independently by two gastroenterologists. A benchmark report was also produced by two gastroenterologists viewing both Cap-OGD and OGD on side-by-side monitors. Major findings included large hiatus hernia, Barrett's oesophagus, oesophagitis, erosive gastritis, tumour and ulceration. Minor findings included histologically-proven superficial gastritis, pouting gastric folds and fundic gland polyps. A questionnaire assessed the patient experience. RESULTS 49 patients completed the study. In 61%, Cap-OGD transmitted in the duodenum. In the benchmark study, all the major OGD findings were observed on Cap-OGD. Cap-OGD revealed fewer minor findings. When reported independently, Cap-OGD and OGD reports indicated differences in interpretation most marked between the capsule readers with or without previous ESO-2 experience. Patients expressed a clear preference for Cap-OGD. CONCLUSIONS When compared side-by-side, all the major findings on OGD are seen on Cap-OGD while there is under-reporting of minor findings. Previous experience of ESO-2 capsule reporting improves reading accuracy and indicates the need for training. This pilot study provides a backdrop to explore the possible role of Cap-OGD, especially where patients are reluctant to undergo conventional OGD or where there is risk of prion contamination of the endoscope.
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Affiliation(s)
- Laura Marelli
- Centre for Gastroenterology, Royal Free Hospital, London, UK
| | | | - Linda Jackson
- Centre for Gastroenterology, Royal Free Hospital, London, UK
| | - Hansa Palmer
- Centre for Gastroenterology, Royal Free Hospital, London, UK
| | - Gamal Erian
- Centre for Gastroenterology, Royal Free Hospital, London, UK
| | - Mark Hamilton
- Centre for Gastroenterology, Royal Free Hospital, London, UK
| | - Owen Epstein
- Centre for Gastroenterology, Royal Free Hospital, London, UK
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An JK, Song GA, Kim GH, Park DY, Shin NR, Lee BE, Woo HY, Ryu DY, Kim DU, Heo J. Marginal turbid band and light blue crest, signs observed in magnifying narrow-band imaging endoscopy, are indicative of gastric intestinal metaplasia. BMC Gastroenterol 2012; 12:169. [PMID: 23185997 PMCID: PMC3543218 DOI: 10.1186/1471-230x-12-169] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 11/15/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Gastric intestinal metaplasia (IM) usually appears in flat mucosa and shows few morphologic changes, making diagnosis using conventional endoscopy unreliable. Magnifying narrow-band imaging (NBI) endoscopy enables evaluation of detailed morphological features that correspond with the underlying histology. The aim of this study was to investigate and clarify the diagnostic efficacy of magnifying NBI endoscopic findings for the prediction and diagnosis of IM. METHODS Forty-seven patients were prospectively enrolled, and magnifying NBI examinations were performed in the lesser curvature of the midbody and the greater curvature of the upper body. The marginal turbid band (MTB) was defined as an enclosing white turbid band on the epithelial surface/gyri; light blue crest (LBC), as a fine, blue-white line on the crest of the epithelial surface/gyri. Immediately after observation under magnifying endoscopy, biopsy specimens were obtained from the evaluated areas. RESULTS The degree of IM significantly increased with increasing MTB/LBC positivity (MTB(-)/LBC(-), 0.00 ± 0.00; MTB(+)/LBC(-), 0.44 ± 0.51; MTB(+)/LBC(+), 0.94 ± 0.24; p < 0.001). Moderate-to-severe IM was more common in MTB(+)/LBC(+) areas than in MTB(+)/LBC(-) areas (p < 0.001). For the diagnosis of IM, MTB had a sensitivity, specificity, and accuracy of 100%, 66.0%, and 81.7%, respectively, and the corresponding values for LBC were 72.1%, 96.0%, and 84.9%. CONCLUSION MTB and LBC observed in the gastric mucosa with magnifying NBI endoscopy are highly accurate indicators of the presence of IM. MTB likely represents a sign of early gastric IM, while LBC appears with progression to severe IM.
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Affiliation(s)
- Jin Kwang An
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-739, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-739, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-739, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Na Ri Shin
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-739, Korea
| | - Hyun Young Woo
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-739, Korea
| | - Dong Yup Ryu
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-739, Korea
| | - Dong Uk Kim
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-739, Korea
| | - Jeong Heo
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-739, Korea
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Pittayanon R, Rerknimitr R. Role of digital chromoendoscopy and confocal laser endomicroscopy for gastric intestinal metaplasia and cancer surveillance. World J Gastrointest Endosc 2012; 4:472-478. [PMID: 23189218 PMCID: PMC3506957 DOI: 10.4253/wjge.v4.i10.472] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In Japan and countries such as South Korea and Taiwan, China, the standard technique for detecting early gastric cancer (EGC) is chromoendoscopy. This technique involves a magnified endoscope and the use of an indigo-carmine spray to distinguish between EGC and non-EGC areas. However, this technique is not widely adopted in many parts of the world. One important reason for limited use is that this technique needs an experienced endoscopist to interpret the images during the procedure. In addition, the sensitivity for detecting gastric intestinal metaplasia (GIM), a precancerous lesion of EGC, is graded as suboptimal. Moreover, the requirement of a cumbersome spraying method is inconvenient and needs preparation time. Easier digital chromoendoscopy techniques, such as Narrow-band Imaging and Flexible spectral Imaging Color Enhancement, have been reported to facilitate targeted GIM and EGC biopsy. They provide higher sensitivities over conventional white light endoscopy. Recently, the novel technology of confocal laser endomicroscopy has been introduced as a high-magnification (1000 ×) real-time evaluation for many early gastrointestinal (GI) cancers and precancerous GI lesions, including colonic polyp, Barrett’s esophagus, and GIM. The advantage of this technique is that it can be used as an in vivo confirmation of the presence of GIM and EGC during endoscopic surveillance. This review aims to explain the current information on the usefulness of digital chromoendoscopy and confocal laser endomicroscopy for evaluating GIM and EGC during endoscopic surveillance and the possible future role of these techniques for GI cancer screening programs.
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Affiliation(s)
- Rapat Pittayanon
- Rapat Pittayanon, Rungsun Rerknimitr, Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
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Ahrens D, Behrens G, Himmel W, Kochen MM, Chenot JF. Appropriateness of proton pump inhibitor recommendations at hospital discharge and continuation in primary care. Int J Clin Pract 2012; 66:767-773. [PMID: 22805269 DOI: 10.1111/j.1742-1241.2012.02973.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Inappropriate prescriptions of proton pump inhibitors (PPI) in hospital and primary care have been widely reported. Recommendations from hospital have been implicated as one reason for inappropriate prescriptions of PPI in primary care. Objective: To quantify the amount of appropriate PPI recommendations in hospital discharge letters and the influence of these recommendations on general practitioners' (GPs') PPI-prescriptions. Materials and Methods: This is an observational study in 31 primary care practices. We identified patients discharged from hospital with PPI recommendation between 2006 and 2007 and assessed practice records and PPI prescription six months prior and after hospital admission. Hospital recommendation for continuous PPI-treatment and continuation by GPs was classified as appropriate, inappropriate or uncertain. Logistic regression analysis was used to calculate factors associated with indicated and non-indicated PPI continuation. Results: In 263 (58%) out of 506 patients discharged from 35 hospitals with a PPI recommendation no indication could be found. Non-indicated PPIs were continued by GPs in 58% for at least 1 month. Indicated PPIs were discontinued in 33%. Two thirds of non-indicated PPIs were initiated in hospital. The strongest factor associated with non-indicated continuation was a PPI-prescription prior to hospital admission [OR: 3.0; 95% confidence interval (CI): 1.7-5.4]. This was also the strongest factor for continuation of an indicated PPI medication (OR: 3.2; 95% CI: 1.4-7.5). Conclusions: We found a strong influence of hospital recommendations and previous prescriptions on PPI prescriptions after discharge. Hospitals should critically review their practice of recommending PPI and document indications. GPs should carefully assess hospital recommendations and their medication prior to admission to avoid over- and under-prescribing.
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Affiliation(s)
- D Ahrens
- Department of Family Practice, Göttingen University Medical Center, Göttingen, Germany Department of Family Practice, University Medicine Greifswald, Institute for Community Medicine, Greifswald, Germany
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Correlation between the endoscopic and histologic diagnosis of gastritis. Ann Diagn Pathol 2011; 16:13-5. [PMID: 22079171 DOI: 10.1016/j.anndiagpath.2011.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 08/03/2011] [Indexed: 12/19/2022]
Abstract
Our aims were to determine the rate of concordance between endoscopic and pathologic diagnoses of gastritis and to determine if there was any common factor in discordant cases. A retrospective analysis of data from 400 patients was performed. The endoscopic diagnoses were compared with the pathologic diagnoses, and histologic slides from discordant cases were reviewed. Of the 400 patients, there was discordance between endoscopy and histology in 136 (34%; κ statistic, 0.31). These discordant cases comprised 56 with normal endoscopy but abnormal histology and 80 with abnormal endoscopy but normal histology. In 13 patients, there was normal histology, although erosions had been diagnosed endoscopically. No consistent histologic features were found in the discordant cases. These findings show that standard endoscopy is a poor predictor of pathologic changes. Biopsies are required for accurate diagnosis of gastritis.
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Rerknimitr R, Imraporn B, Klaikeaw N, Ridtitid W, Jutaghokiat S, Ponauthai Y, Kongkam P, Kullavanijaya P. Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia. World J Gastroenterol 2011; 17:1336-42. [PMID: 21455334 PMCID: PMC3068270 DOI: 10.3748/wjg.v17.i10.1336] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/16/2010] [Accepted: 12/23/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of non-sequential narrow band imaging (NBI) for a better recognition of gastric intestinal metaplasia (GIM).
METHODS: Previously diagnosed GIM patients underwent targeted biopsy from areas with and without GIM, as indicated by NBI, twice at an interval of 1 year. The authors compared the endoscopic criteria such as light blue crest (LBC), villous pattern (VP), and large long crest (LLC) with standard histology. The results from two surveillance endoscopies were compared with histology results for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio of positive test (LR+). The number of early gastric cancer cases detected was also reported.
RESULTS: NBI targeted biopsy was performed in 38 and 26 patients during the first and second surveillance endoscopies, respectively. There were 2 early gastric cancers detected in the first endoscopy. No cancer was detected from the second study. Surgical and endoscopic resections were successfully performed in each patient. Sensitivity, specificity, PPV, NPV, and LR+ of all 3 endoscopic criteria during the first/second surveillances were 78.8%/91.3%, 82.5%/89.1%, 72.8%/77.8%, 86.8%/96.1, and 4.51/8.4, respectively. LBC provided the highest LR+ over VP and LLC.
CONCLUSION: Non-sequential NBI is useful for GIM targeted biopsy. LBC provides the most sensitive reading. However, the optimal duration between two surveillances requires further study.
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Ahrens D, Chenot JF, Behrens G, Grimmsmann T, Kochen MM. Appropriateness of treatment recommendations for PPI in hospital discharge letters. Eur J Clin Pharmacol 2010; 66:1265-71. [PMID: 20694459 PMCID: PMC2982961 DOI: 10.1007/s00228-010-0871-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 07/10/2010] [Indexed: 12/18/2022]
Abstract
PURPOSE The reasons for the dramatic increase in proton pump inhibitors (PPI) prescriptions remain unclear and cannot be explained solely by increased morbidity, new indications or a decrease in alternative medication. Inappropriate use and discharge recommendations in hospitals are considered to be possible explanations. As the quality of PPI recommendations in hospital discharge letters in Germany has not been investigated to date, we have studied the appropriateness of these referrals. METHODS Hospital discharge letters with recommendations for PPI medication from 35 primary care practices in the county of Mecklenburg-Western Pomerania (MV; North-east Germany) were collected and analysed, and the appropriateness of the PPI indication was rated. RESULTS No information justifying the recommendation for continuous PPI medication could be identified in 54.5% of the discharge letters; in 12.7%, the indication was uncertain, and in 32.7%, we found an evidence-based indication for PPI medication. The most common indication for adequate PPI use was nonsteroidal anti-inflammatory drug-prophylaxis in high-risk patients. CONCLUSIONS Inadequate recommendations for PPIs in discharge letters are frequent. This may lead to a continuation of this therapy in primary care, thereby unnecessarily increasing polypharmacy and the risk of adverse events as well as burdening the public health budget. Hospitals should therefore critically review recommendations for PPI medication and the dosage thereof in their discharge letters and clearly document the reason for PPI use and the need for continuous prescription in primary care.
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Affiliation(s)
- Dirk Ahrens
- Department of General Practice, University of Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
| | - Jean-François Chenot
- Department of General Practice, University of Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
| | - Gesa Behrens
- Department of General Practice, University of Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
| | - Thomas Grimmsmann
- Medical Review Board of the Statutory Health Insurance Funds Mecklenburg-Vorpommern, Schwerin, Germany
| | - Michael M. Kochen
- Department of General Practice, University of Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
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Capelle LG, Haringsma J, de Vries AC, Steyerberg EW, Biermann K, van Dekken H, Kuipers EJ. Narrow band imaging for the detection of gastric intestinal metaplasia and dysplasia during surveillance endoscopy. Dig Dis Sci 2010; 55:3442-8. [PMID: 20393882 PMCID: PMC2975908 DOI: 10.1007/s10620-010-1189-2] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Accepted: 03/05/2010] [Indexed: 02/07/2023]
Abstract
Background Surveillance of premalignant gastric lesions relies mainly on random biopsy sampling. Narrow band imaging (NBI) may enhance the accuracy of endoscopic surveillance of intestinal metaplasia (IM) and dysplasia.We aimed to compare the yield of NBI to white light endoscopy (WLE) in the surveillance of patients with (IMa)and dysplasia.Methods Patients with previously identified gastric IM or dysplasia underwent a surveillance endoscopy. Both WLE and NBI were performed in all patients during a single procedure. The sensitivity of WLE and NBI for the detection of premalignant lesions was calculated by correlating endoscopic findings to histological diagnosis.Results Forty-three patients (28 males and 15 females,mean age 59 years) were included. IM was diagnosed in 27 patients; 20 were detected by NBI and WLE, four solely by NBI and three by random biopsies only. Dysplasia was detected in seven patients by WLE and NBI and in two patients by random biopsies only. Sixty-eight endoscopically detected lesions contained IM: 47 were detected by WLE and NBI, 21 by NBI only. Nine endoscopically detected lesions demonstrated dysplasia: eight were detected by WLE and NBI, one was detected by NBI only.The sensitivity, specificity, positive and negative predictive values for detection of premalignant lesions were 71, 58,65 and 65% for NBI and 51, 67, 62 and 55% for WLE,respectively.Conclusions NBI increases the diagnostic yield for detection of advanced premalignant gastric lesions compared to routine WLE.
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Affiliation(s)
- Lisette G Capelle
- Department of Gastroenterology and Hepatology, ErasmusUniversity Medical Center, Room L 462, 3015 CE Rotterdam,The Netherlands.
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Chen TS, Li AFY, Chang FY. Gastric reddish streaks in the intact stomach: endoscopic feature of reactive gastropathy. Pathol Int 2010; 60:298-304. [PMID: 20403032 DOI: 10.1111/j.1440-1827.2010.02523.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The pathogenesis of reddish streaks in the intact stomach is unclear. Sixty-three functional dyspeptic patients with gastric reddish streaks were recruited for the study. Fifty-five patients (group I) had only reddish streaks while nine patients (group II) had additional lesions such as reddish patches or spots randomly scattered throughout the stomach. Updated Sydney system and parameters of reactive gastropathy were used to score the biopsy specimens from reddish streaks separately. Helicobacter pylori infection rate was found to be markedly lower in group I than group II patients (13% vs 89%, P < 0.001). H. pylori-infected patients had higher scores for acute and chronic inflammation (P < 0.001) and foveolar hyperplasia (P < 0.005) than non-infected patients, while other parameters for gastritis and gastropathy were similar between infected and non-infected patients. In H. pylori-non-infected patients all biopsy specimens had at least one histological feature of reactive gastropathy. Bile reflux was observed in 54% of patients (34/63). Only 7.9% used non-steroidal anti-inflammatory drugs and 4.9% drank alcohol. The present data indicate that the fundamental histological features of gastric reddish streaks are reactive gastropathy with low H. pylori infection, and are probably enterogastric reflux related in etiology. Coincidental H. pylori infection increased acute and chronic inflammatory cell infiltration, and enhanced the grade of foveolar hyperplasia.
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Affiliation(s)
- Tseng-Shing Chen
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Capelle LG, de Vries AC, Haringsma J, Steyerberg EW, Looman CWN, Nagtzaam NMA, van Dekken H, ter Borg F, de Vries RA, Kuipers EJ. Serum levels of leptin as marker for patients at high risk of gastric cancer. Helicobacter 2009; 14:596-604. [PMID: 19889078 DOI: 10.1111/j.1523-5378.2009.00728.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Serological screening for gastric cancer (GC) may reduce mortality. However, optimal serum markers for advanced gastric precursor lesions are lacking. AIM To evaluate in a case-control study whether serum leptin levels correlate with intestinal metaplasia (IM) and can serve as a tool to identify patients at high risk for GC. MATERIALS AND METHODS Cases were patients with a previous diagnosis of IM or dysplasia, controls were patients without such a diagnosis. All patients underwent endoscopy. Fasting serum was collected for the measurement of leptin, pepsinogens I/II, gastrin, and Helicobacter pylori. Receiver operating characteristic (ROC) curves and their area under the curve (AUC) were provided to compare serum leptin levels with other serological markers. RESULTS One hundred nineteen cases and 98 controls were included. In cases, the median leptin levels were 116.6 pg/mL versus 81.9 pg/mL in controls (p = .01). After adjustment for age, sex and BMI, leptin levels remained higher in cases than in controls (p < .005). In multivariate analysis, male sex (p = .002), age (<0.001), low pepsinogen levels (p = .004) and high leptin levels (p = .04) were independent markers for the presence of IM. In addition, a ROC curve including age, sex and pepsinogen I levels had an AUC of 0.79 (95% CI (0.73-0.85)). Adding serum leptin levels increased the AUC to 0.81 (95% CI (0.75-0.86)). CONCLUSIONS High leptin levels are associated with an increased risk of IM. Moreover, serum leptin levels are a significant independent marker for the presence of IM. However, in combination with the serological test for pepsinogen I the additional value of serum leptin levels is rather limited.
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Affiliation(s)
- Lisette G Capelle
- Department of Gastroenterology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Dinis-Ribeiro MJ, Correia RC, Santos C, Fernandes S, Palhares E, Silva RA, Amaro P, Areia M, Costa-Pereira A, Moreira-Dias L. Web-based system for training and dissemination of a magnification chromoendoscopy classification. World J Gastroenterol 2008; 14:7086-92. [PMID: 19084915 PMCID: PMC2776838 DOI: 10.3748/wjg.14.7086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the use of web-based technologies to assess the learning curve and reassess reproducibility of a simplified version of a classification for gastric magnification chromoendoscopy (MC).
METHODS: As part of a multicenter trial, a hybrid approach was taken using a CD-ROM, with 20 films of MC lasting 5 s each and an “autorun” file triggering a local HTML frameset referenced to a remote questionnaire through an Internet connection. Three endoscopists were asked to prospectively and independently classify 10 of these films randomly selected with at least 3 d apart. The answers were centrally stored and returned to participants together with adequate feedback with the right answer.
RESULTS: For classification in 3 groups, both intra- [Cohen’s kappa (κ) = 0.79-1.00 to 0.89-1.00] and inter-observer agreement increased from 1st (moderate) to 6th observation (κ = 0.94). Also, agreement with reference increased in the last observations (0.90, 1.00 and 1.00, for observers A, B and C, respectively). Validity of 100% was obtained by all observers at their 4th observation. When a 4th (sub)group was considered, inter-observer agreement was almost perfect (κ = 0.92) at 6th observation. The relation with reference clearly improved into κ (0.93-1.00) and sensitivity (75%-100%) at their 6th observations.
CONCLUSION: This MC classification seems to be easily explainable and learnable as shown by excellent intra- and inter-observer agreement, and improved agreement with reference. A web system such as the one used in this study may be useful for endoscopic or other image based diagnostic procedures with respect to definition, education and dissemination.
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Areia M, Amaro P, Dinis-Ribeiro M, Cipriano MA, Marinho C, Costa-Pereira A, Lopes C, Moreira-Dias L, Romãozinho JM, Gouveia H, Freitas D, Leitão MC. External validation of a classification for methylene blue magnification chromoendoscopy in premalignant gastric lesions. Gastrointest Endosc 2008; 67:1011-8. [PMID: 18178207 DOI: 10.1016/j.gie.2007.08.044] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 08/20/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Conventional endoscopy has low sensitivity, specificity, and interobserver agreement for the diagnosis of gastric atrophy, intestinal metaplasia, and dysplasia. Magnification chromoendoscopy (ME) may optimize the evaluation of premalignant gastric lesions. OBJECTIVE AND DESIGN As part of a multicenter trial, we aimed at validating a previously proposed classification for gastric methylene blue ME at a different center. SETTING, PATIENTS, AND INTERVENTIONS: A sample of patients (n = 42) with previously diagnosed chronic atrophic gastritis with or without intestinal metaplasia underwent ME (Pentax EG-3430Z) with 1% methylene blue by 2 endoscopists. MAIN OUTCOME MEASUREMENTS A simplified version of a previously published ME classification (group I, group II [further divided into subgroups IIE and IIF], and group III) was used for macroscopic lesions (n = 203) with Sydney-Houston and Vienna classifications being used for histologic analysis (n = 479 biopsy specimens). RESULTS AND LIMITATIONS Excellent reproducibility (wK = 0.92 [95% CI, 0.88-0.96]) was observed for classification in groups and substantial reproducibility (wK = 0.78 [95% CI, 0.72-0.84]) was found for classification in subgroups. Global validity was 82% (range 78%-86%), showing no false negatives (sensitivity of 100% [1/1 biopsy]) and a very low rate of false positives (specificity 99% [297/299 biopsies]) for dysplasia detection. CONCLUSIONS This classification for methylene blue ME was highly reproducible and valid for the diagnosis of premalignant gastric lesions when used in a center different from that involved in its conception. Despite requiring an unconventional endoscope and a longer procedure, these results could reinforce ME as a valuable technique in the surveillance of patients at risk for gastric cancer.
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Affiliation(s)
- Miguel Areia
- Gastroenterology Department, Coimbra University Hospital, Coimbra, Portugal
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de Vries AC, Kuipers EJ. Epidemiology of premalignant gastric lesions: implications for the development of screening and surveillance strategies. Helicobacter 2007; 12 Suppl 2:22-31. [PMID: 17991173 DOI: 10.1111/j.1523-5378.2007.00562.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastric cancer is one of the most common cancers worldwide; however, gastric cancer incidence varies greatly between different geographic areas. As gastric cancer is usually diagnosed at an advanced stage, the disease causes considerable morbidity and mortality. To detect gastric carcinomas at an early and curable stage, screening and surveillance seem necessary. Premalignant gastric lesions are well known risk factors for the development of intestinal type gastric adenocarcinomas. In a multistep cascade, chronic Helicobacter pylori-induced gastritis progresses through premalignant stages of atrophic gastritis, intestinal metaplasia and dysplasia, to eventually gastric cancer. Therefore, this cascade may provide a basis for early detection and treatment of gastric cancer. Epidemiology of gastric cancer and premalignant gastric lesions should guide the development of screening and surveillance strategies, as distinct approaches are required in countries with low and high gastric cancer incidences.
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Affiliation(s)
- Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Abstract
Early diagnosis represents the most important measure to decrease gastric cancer mortality. Endoscopists should be trained to perform standardized extremely rigorous observation with a low threshold of suspicion for neoplasia. Together with recent interest in new imaging techniques such as magnification, chromoendoscopy should be considered to represent a simple, safe and inexpensive technique that may be useful in identifying premalignant conditions and minute cancerous lesions, estimating their superficial extent and determining the histological type and submucosal invasion.
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Affiliation(s)
- Mário Dinis-Ribeiro
- Department of Gastroenterology, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal.
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N/A, 杨 玉, 刘 海, 李 国, 孙 平. N/A. Shijie Huaren Xiaohua Zazhi 2005; 13:1484-1485. [DOI: 10.11569/wcjd.v13.i12.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Dinis-Ribeiro M, da Costa-Pereira A, Lopes C, Lara-Santos L, Guilherme M, Moreira-Dias L, Lomba-Viana H, Ribeiro A, Santos C, Soares J, Mesquita N, Silva R, Lomba-Viana R. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastrointest Endosc 2003; 57:498-504. [PMID: 12665759 DOI: 10.1067/mge.2003.145] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to define the reproducibility and accuracy of magnification chromoendoscopy for the diagnosis of lesions associated with gastric cancer (intestinal metaplasia and dysplasia). METHODS A total of 136 patients with previously diagnosed lesions and 5 gastrectomy specimens were studied. Endoscopic examination was performed with a magnification endoscope after methylene blue (1%) spraying. According to differences in color and mucosal pattern, groups and subgroups of endoscopic images were defined, and biopsies taken (n = 462). Five endoscopists were asked to classify individually 2 endoscopic images per subgroup on 2 separate occasions. RESULTS Three groups of endoscopic images were defined: nonmetaplastic, nondysplastic mucosa (I); metaplastic mucosa (II); and dysplastic mucosa (III). Ten subgroups were defined according to pit pattern: round small (IA), round and tubular small (IB), coarse round (IC), and course round pits with a straight pit (ID); blue irregular marks (IIA), blue round and tubular pits (IIB), blue villi (IIC), and blue small pits (IID); and loss of clear pattern, with depression (IIIA) or with slight elevation (IIIB). The kappa statistic for intraobserver agreement on the classification of endoscopic images in groups was 0.86; for interobserver agreement, it was 0.74. For classification into subgroups, kappa values ranged from 0.48 to 0.78. For 85% of the areas classified endoscopically as Group I (n = 146), no mucosal lesions or gastritis was described at histologic examination; for 83% of those in Group II (n = 198), intestinal metaplasia was found. Subgroups IIA and IIB were more often associated with complete intestinal metaplasia (62%), and IIC and IID with incomplete metaplasia (67%); in Group III (n = 118), dysplasia was diagnosed histopathologically in 33%. For the diagnosis of dysplasia, specificity was 81% (95% CI [77%, 85%]) and negative predictive value 99% (95% CI [99%, 100%]). CONCLUSIONS Gastric endoscopic patterns with chromoendoscopy and magnification seem reproducible and valid for the diagnosis of lesions associated with gastric cancer. This procedure may improve the follow-up of individuals at high-risk of gastric cancer, at least for the exclusion of severe lesions.
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Affiliation(s)
- Mário Dinis-Ribeiro
- Instituto Português de Oncologia Francisco Gentil, Centro do Porto, Faculdade de Medicina do Porto, Hospital de S. João, Portugal
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Kawabe T, Maeda S, Ogura K, Yamaji Y, Okamoto M, Yoshida H, Shiratori Y, Omata M. Antral Red Streaking is a Negative Endoscopic Sign for Helicobacter Pylori Infection. Dig Endosc 2002. [DOI: 10.1046/j.1443-1661.2002.00184.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Park JS, Kim MH, Lee SK, Seo DW, Lee SS, Chang HS, Han J, Kim JS, Min YI. The clinical significance of papillitis of the major duodenal papilla. Gastrointest Endosc 2002; 55:877-82. [PMID: 12024144 DOI: 10.1067/mge.2002.124559] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND This study investigated the clinical significance of papillitis of the major duodenal papilla and analyzed the correlation between endoscopic and histologic papillitis in patients with biliary or pancreatic disorders. METHODS Eighty-seven patients and 12 healthy control subjects were enrolled. The endoscopic appearance of papillitis was classified by two blinded endoscopists, and biopsy specimens were taken of the papilla. Various factors were prospectively analyzed to identify any relationship with the endoscopic severity of the papillitis. RESULTS By univariate analysis, a clinically acute inflammatory condition and elevation of serum transaminase levels were significantly associated with moderate and severe endoscopic papillitis (p < 0.05). However, by multivariate analysis, only a clinically acute inflammatory condition was significantly associated with moderate and severe endoscopic papillitis (p < 0.001). The endoscopic severity of papillitis was poorly correlated with monocyte infiltration, but there was a good correlation with neutrophil infiltration. Moderate and severe papillitis were not observed in healthy volunteers. CONCLUSIONS Moderate and severe endoscopic papillitis were significantly more common in patients with biliary or pancreatic disorders plus a clinically acute inflammatory condition, whereas moderate and severe papillitis were not observed in healthy volunteers. Moderate and severe endoscopic papillitis are characteristic of biliary or pancreatic disorders.
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Affiliation(s)
- Ju Sang Park
- Department of Internal Medicine and Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Dahshan A, Rabah R. Correlation of endoscopy and histology in the gastroesophageal mucosa in children: are routine biopsies justified? J Clin Gastroenterol 2000; 31:213-6. [PMID: 11033999 DOI: 10.1097/00004836-200010000-00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Guidelines for obtaining biopsies during endoscopy in children are needed. The endoscopic evaluation may be considered deficient on many occasions if not accompanied by a histopathologic evaluation. A retrospective review of our endoscopic records and biopsies was undertaken to determine the correlation of the visualized endoscopic appearance and the histopathologic findings in the upper gastrointestinal (GI) tract in children. Over a 1-year period, 204 patients, all of whom had esophageal biopsies and 59 of whom had gastric biopsies as well, were evaluated by an upper GI endoscopy. Endoscopic findings included erythema, granularity, abnormal vascular pattern, friability, erosions, plaques, ulceration, and strictures. Histologic evaluation of biopsies was undertaken by one pathologist according to the presence of and type of cellular infiltrate and cellular morphologic abnormalities in the mucosa and submucosa where available. In this study, the correlation of endoscopic appearance with histology was rather limited in both the esophagus and the gastric mucosa. Low specificity and sensitivity of endoscopy in both locations (41% and 81% for the esophagus; and 43% and 86% for the gastric mucosa, respectively) illustrated the discrepancy. The overall accuracy of endoscopic evaluation in matching the histologic diagnosis was not more than two out of three (63.8%). No single endoscopic finding had a reliable correlation with histologic diagnosis but some had higher predictive value than others. Of the multiple indications for endoscopy in children, recurrent abdominal pain had the least diagnostic yield. Endoscopic appearance correlates poorly with histologic diagnosis in the gastroesophageal mucosa in children. Regardless of the appearance of the mucosa, routine biopsy during upper GI endoscopy in children should be encouraged.
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Affiliation(s)
- A Dahshan
- Division of Pediatric Gastroenterology, Oklahoma University School of Medicine, Tulsa 74129, USA
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35
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Ohkusa T, Fujiki K, Takashimizu I, Kumagai J, Tanizawa T, Eishi Y. Endoscopic and histological comparison of nonulcer dyspepsia with and without Helicobacter pylori infection evaluated by the modified Sydney system. Am J Gastroenterol 2000; 95:2195-9. [PMID: 11007217 DOI: 10.1111/j.1572-0241.2000.02302.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Our aim was to identify endoscopic features associated with Helicobacter pylori (H. pylori) infection in patients with nonulcer dyspepsia. METHODS A total of 50 infected patients with nonulcer dyspepsia who underwent endoscopy with antral and corporal biopsies and 50 patients matched for age and sex but with nonulcer dyspepsia without H. pylori were reviewed retrospectively by three endoscopists blinded to the H. pylori status and the patient's history. The endoscopic findings of gastritis, classified by a modification of the Sydney system as present or absent, were evaluated, and the histological severity was graded by the updated Sydney system. RESULTS For endoscopic features, the odds ratio was 53.1 (95% confidence interval, 6.8-414.9) for edema, 18.8 (5.8-60.5) for erythema with reddish streaks excluded, 0.0275 (0.0002-0.477) for reddish streaks, 17.4 (0.97-313.7) for friability, 14.2 (5.1-40.0) for exudate, 17.2 (2.2-137.6) for flat erosions, 2.54 (0.81-7.94) for raised erosions, 40.1 (2.3-694.5) for rugal hypertrophy, 19.1 (2.4-151.6) for rugal atrophy, 96.2 (23.4-395.9) for a vascular pattern, 0.125 (0.010-1.06) for bleeding spots, and 21.0 (2.6-166.5) for nodularity. The histological severity of inflammation, neutrophil activity, and atrophy in the antrum and corpus and of metaplasia in the antrum was greater in the infected patients than in the noninfected patients. CONCLUSIONS Endoscopic features associated with H. pylori were a vascular pattern, edema, rugal hypertrophy, nodularity, rugal atrophy, erythema with reddish streaks excluded, flat erosions, and exudate. These endoscopic features were associated with the histological findings of inflammation, neutrophil activity, atrophy, and metaplasia.
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Affiliation(s)
- T Ohkusa
- First Department of Internal Medicine, School of Medicine, Tokyo Medical and Dental University, Japan
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Abstract
The stigmata of recent haemorrhage are endoscopically identified features that have a predictive value for the risk of further bleeding and thus help to determine which patients should receive endoscopic therapy. In conjunction with endoscopic features, clinical features related to the magnitude of bleeding and to patient co-morbidity have important independent effects on the risk of further haemorrhage. Stigmata have been best studied in the context of bleeding ulcers, the most common cause of upper gastrointestinal bleeding. Stigmata in ulcers are usually classified as active bleeding (spurting or oozing), a non-bleeding visible vessel, an adherent clot, a flat pigmented spot, or a clean base, in order of decreasing risk of further haemorrhage. Ulcer size and location may also affect the re-bleeding potential. Recent data suggest that both non-pigmented visible vessels and adherent clots have a higher risk of re-bleeding than was previously thought. The wide variation in prevalence and re-bleeding rates reported for various stigmata in the literature probably reflects variations in the definitions of stigmata and of re-bleeding, the vigour with which the ulcer bases are washed, the co-morbidity and ages of the patients, and the severity of bleeding encountered. Inter-observer agreement in the classification of stigmata is relatively poor and limits the utility of endoscopic features alone in making decisions regarding the management of patients with bleeding peptic ulcers. Imaging devices such as Doppler probes are being evaluated to refine the identification of underlying vessels and their re-bleeding potential, but the utility of these is currently uncertain. The findings of low-risk endoscopic stigmata in a haemodynamically and otherwise stable patient can in many cases allow out-patient management.
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Affiliation(s)
- M L Freeman
- Division of Gastroenterology, University of Minnesota, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, Minnesota 55415, USA
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Gold BD. Pediatric Helicobacter pylori infection: clinical manifestations, diagnosis, and therapy. Curr Top Microbiol Immunol 1999; 241:71-102. [PMID: 10087658 DOI: 10.1007/978-3-642-60013-5_6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- B D Gold
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA 30322, USA
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Veldhuyzen van Zanten S, Hunt RH, Cockeram A, Schep G, Malatjalian D, Sidorov J, Matisko A, Jewell D. Adding once-daily omeprazole 20 mg to metronidazole/amoxicillin treatment for Helicobacter pylori gastritis: a randomized, double-blind trial showing the importance of metronidazole resistance. Am J Gastroenterol 1998; 93:5-10. [PMID: 9448164 DOI: 10.1111/j.1572-0241.1998.005_c.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We compared the Helicobacter pylori eradication rate after a 14-day treatment with amoxicillin 500 mg t.i.d. and metronidazole 500 mg t.i.d. with or without omeprazole 20 mg once daily. METHODS This was a randomized, controlled trial in which omeprazole was given in double-blind fashion. Patients with H. pylori-associated gastritis were enrolled in four centers in Canada from July 1991 to January 1994. Eradication of H. pylori was assessed by histological evaluation and culture of endoscopic biopsies obtained from the antrum and corpus of the stomach. RESULTS The H. pylori eradication rate was 73% (33 of 45) in the omeprazole-amoxicillin-metronidazole group, compared with 66% (31 of 47) in the amoxicillin-metronidazole group. This 7% difference was not statistically significant (p = 0.43, 95% confidence interval for difference -11% to 26%). Metronidazole primary resistance in the prestudy cultures was found more frequently in the omeprazole-amoxicillin-metronidazole group than in the amoxicillin-metronidazole group. Resistance to metronidazole was an important predictor of treatment failure. The H. pylori eradication rate was 61% (19 of 31) for patients infected with metronidazole-resistant H. pylori strains, compared with 91% (30 of 33) eradication for those infected with metronidazole-sensitive strains (p < 0.01). Vaginal candidiasis was reported in four patients. CONCLUSIONS The H. pylori eradication rate was higher (73%) for omeprazole-amoxicillin-metronidazole than for the dual antibiotic therapy given without omeprazole (66%); however, this difference was not statistically significant. Metronidazole resistance significantly reduces H. pylori eradication rates.
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Abstract
In view of its potential risk for the development of gastrointestinal disease or even gastric cancer at a later age, the study of Helicobacter pylori infection in childhood is gaining increasing importance and H. pylori infection is being considered a major issue of public health. H. pylori infection can be detected by a variety of methods. Because of its easy use, affordability, and overall availability, serology is the preferred diagnostic test, especially for large epidemiological studies. Based on our results, one might consider treating a child with recurrent abdominal pain and positive serology for H. pylori without further work-up, and only perform additional investigations when an anti-H. pylori therapy fails to resolve the complaints. According to this proposition, endoscopy of the upper gastrointestinal tract remains indicated in children if the noninvasive tests for Helicobacter pylori are negative in the absence of a diagnosis, or if symptomatology persists despite treatment.
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Affiliation(s)
- U Blecker
- Division of Pediatric Gastroenterology, Louisiana State University Medical Center, New Orleans 70112, USA
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40
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Laine L, Cohen H, Sloane R, Marin-Sorensen M, Weinstein WM. Interobserver agreement and predictive value of endoscopic findings for H. pylori and gastritis in normal volunteers. Gastrointest Endosc 1995; 42:420-3. [PMID: 8566631 DOI: 10.1016/s0016-5107(95)70043-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic findings such as erythema are frequently labeled as gastritis. We sought to determine interobserver agreement for specific endoscopic features and assess the diagnostic value of features with good agreement for Helicobacter pylori and histologic gastritis. METHODS Fifty-two healthy subjects without ulcers, erosions, or hemorrhages had a full endoscopy recorded on video tape. Biopsy specimens were examined for H. pylori and gastritis. Two endoscopists independently reviewed the tapes for predefined features (erythema, area gastricae, clefts, and nodularity) in the gastric body and antrum. Diagnostic value of endoscopic features with acceptable agreement (kappa > 0.40) was then determined for H. pylori and gastritis. RESULTS Kappa was greater than 0.40 only for prominent body area gastricae (0.49), body nodularity (0.65), and antral nodularity (0.68). For antral nodularity, sensitivity was 32%, specificity was 96%, and positive predictive value was 90% for H. pylori. when both antral nodularity and body area gastricae were both present, sensitivity was only 18% but specificity and positive predictive value were 100%. CIRCULATION: Interobserver agreement is poor for some features such as erythema labeled as gastritis. Antral nodularity is a fairly reproducible finding and is very specific, though not sensitive, for H. pylori gastritis.
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Affiliation(s)
- L Laine
- Department of Medicine, U.S.C. School of Medicine, Los Angeles 90033, USA
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Laine L, Freeman M, Cohen H. Lack of uniformity in evaluation of endoscopic prognostic features of bleeding ulcers. Gastrointest Endosc 1994; 40:411-7. [PMID: 7926529 DOI: 10.1016/s0016-5107(94)70202-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Management strategies in patients with bleeding ulcers are based on ulcer appearance. We assessed the level of agreement among endoscopists regarding the labeling of endoscopic features of bleeding ulcers and also evaluated the effect of a short teaching session on the level of agreement. Two hundred two endoscopists at the 1992 American College of Gastroenterology Postgraduate Course answered multiple-choice questions using interactive keypads. They were shown 6 slides of typical ulcer stigmata of recent hemorrhage, attended a brief teaching session, and then saw 6 different slides of comparable stigmata plus 2 additional slides. Color of stigmata was assessed in 9 slides. Information on years of endoscopic experience and numbers and types of procedures performed was also obtained. The proportion of correct answers before the teaching session increased significantly with years of experience, reaching a plateau in endoscopists who were 6 years or more beyond training. The proportion of correct answers for physicians performing no more than 5 upper gastrointestinal endoscopies per month was significantly lower than for those performing more than 5 per month: 33/56 (59%) compared with 647/891 (73%), a difference of 14% (95% CI, 0.4% to 27%; p = 0.03), but performance of a greater number of endoscopies was not associated with a further increase in the rate of correct answers. The total number of correct answers increased from 845/1181 (72%) before the teaching session to 1268/1554 (82%) afterwards, a difference of 10% (95% CI, 7% to 13%; p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Laine
- U.S.C. School of Medicine, Los Angeles 90033
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42
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Abstract
BACKGROUND Idiopathic iron-deficiency anemia in adults is assumed to be the result of occult chronic blood loss from the gastrointestinal tract. The aim of this study was to determine an effective clinical strategy for managing this common clinical problem. BACKGROUND We prospectively studied 100 consecutive patients with iron-deficiency anemia, using colonoscopy and esophagogastroduodenoscopy and, in patients with negative endoscopic studies, enteroclysis (radio-graphic examination of the small intestine). RESULTS Gastrointestinal endoscopy revealed at least one lesion potentially responsible for blood loss in 62 of the 100 patients. Endoscopic examination of the upper gastrointestinal tract showed a bleeding source in 36 patients, and colonoscopy showed a lesion in 25; 1 patient had lesions in both the upper and lower gastrointestinal tracts. The most common abnormality in the upper gastrointestinal tract was peptic ulceration (duodenal ulcer in 11 patients, gastric ulcer in 5, and anastomotic ulcer in 3). Cancers, detected in 11 patients, were the most common colonic lesions. Enteroclysis was performed in 26 of the 38 patients with negative endoscopic studies, and the results were normal in all instances. Symptoms at a specific site in the gastrointestinal tract were predictive of disease in the corresponding portion of the bowel. In addition, the combination of positive tests for fecal occult blood and symptoms in the lower gastrointestinal tract had a positive predictive value of 86 percent for detecting a lesion in the lower gastrointestinal tract. CONCLUSIONS Gastrointestinal lesions (in both the upper gastrointestinal tract and the colon) are frequently found in patients with iron-deficiency anemia. Since site-specific symptoms are predictive of abnormalities in the corresponding portion of the bowel, the initial evaluation should be directed by the location of the symptoms. Concomitant lesions of the upper and lower gastrointestinal tract are rare; thus, detection of a likely source of blood loss during the initial examination may obviate the need for further procedures.
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Affiliation(s)
- D C Rockey
- Gastroenterology Division, San Francisco General Hospital, University of California
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43
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Veldhuyzen van Zanten SJ, Tytgat KM, Pollak PT, Goldie J, Goodacre RL, Riddell RH, Hunt RH. Can severity of symptoms be used as an outcome measure in trials of non-ulcer dyspepsia and Helicobacter pylori associated gastritis? J Clin Epidemiol 1993; 46:273-9. [PMID: 8455052 DOI: 10.1016/0895-4356(93)90075-c] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Most trials of non-ulcer dyspepsia (NUD) and Helicobacter pylori associated gastritis (HPAG) have not used validated methods of measuring symptoms. Three attributes are necessary for use of symptom severity scoring systems as outcome measures in clinical trials: reproducibility, responsiveness to change and validity compared to corroborating measures. The objective of this study was to establish that selected gastrointestinal symptoms recorded as a series of 5-point Likert Scales meet the 3 criteria for use as outcome measures in clinical trials. Patients with NUD (Helicobacter pylori-negative) and HPAG were studied. A preliminary assessment of 24 patients was used to select the 8 most frequently occurring and most severe symptoms. These symptoms were then scored in a further 55 patients to assess their utility as outcome measures. Observations were made at 3 time points, enrollment (T1), after 1 week with no intervention (T2) and after 4 weeks of therapy for either disease (T3). The study took place in a university hospital outpatient gastroenterology service. Symptom scores were reproducible before treatment (symptom scores at T1 and T2 were correlated), responsive (symptom scores changed after treatment between T2 and T3) and valid (symptom score changes corresponded to changes in general health status). Scoring of gastrointestinal symptom severity using 5-point Likert Scales satisfies the 3 criteria for use as outcome measures in clinical trials of NUD and HPAG.
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Affiliation(s)
- S J Veldhuyzen van Zanten
- Department of Anatomic Pathology, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
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44
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45
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Holcombe C, Kaluba J, Lucas SB. Non-ulcer dyspepsia in Nigeria: a case-control study. Trans R Soc Trop Med Hyg 1991; 85:553-5. [PMID: 1755074 DOI: 10.1016/0035-9203(91)90258-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Non-ulcer dyspepsia is common in Africa, yet there are few data on its possible cause. In this study 40 patients with strictly defined non-ulcer dyspepsia were matched with 40 asymptomatic volunteers. Both groups were questioned concerning their intake of alcohol, cola nut, non-steroidal anti-inflammatory drugs, and smoking. They then underwent upper gastrointestinal endoscopy with mucosal biopsy of the gastric mucosa: these biopsies were examined for gastritis and Helicobacter pylori. Ingestion of cola nut was the only statistically significant difference between the two groups. A high prevalence of gastritis and H. pylori infection was found in both groups, suggesting that these factors are not important in the aetiology of non-ulcer dyspepsia in northern Nigeria.
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Affiliation(s)
- C Holcombe
- Department of Surgery, University of Maiduguri, Nigeria
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46
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Hackett RP, Ducharme NG, Fubini SL, Erb HN. The reliability of endoscopic examination in assessment of arytenoid cartilage movement in horses. Part I: Subjective and objective laryngeal evaluation. Vet Surg 1991; 20:174-9. [PMID: 1853549 DOI: 10.1111/j.1532-950x.1991.tb00331.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Videorecordings of the laryngeal activity of 108 unsedated horses were obtained at rest by passing a flexible videoendoscope into the nasopharynx through the right ventral meatus. All videotaped images were reviewed once, and 72 were reviewed twice, by three veterinarians. Laryngeal cartilage movement was assessed subjectively with a five-tier grading system. The mean intraobserver agreement was 83.3% (range, 75.0%-90.2%) with a kappa statistic of .65 to .98. The mean interobserver agreement was 79.0% (range, 70.4%-80.6%) with a kappa statistic of .51 to .90. A computer program was developed to measure the left:right ratio of the rima glottidis. The mean left:right ratio for horses assigned a median laryngeal grade of I was 0.84 (range, 0.55-1.03); for grade II, 0.82 (0.50-1.12); for grade III, 0.59 (0.39-0.91); and for grade IV, 0.24 (0.07-0.35).
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Affiliation(s)
- R P Hackett
- Department of Clinical Sciences, New York State College of Veterinary Medicine, Cornell University, Ithaca 14853
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47
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Affiliation(s)
- G N Tytgat
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
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48
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Pokorny G, Karácsony G, Lonovics J, Hudák J, Németh J, Varró V. Types of atrophic gastritis in patients with primary Sjögren's syndrome. Ann Rheum Dis 1991; 50:97-100. [PMID: 1998399 PMCID: PMC1004346 DOI: 10.1136/ard.50.2.97] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Histological examination of the gastric mucosa was performed in 44 patients with primary Sjögren's syndrome with extraglandular symptoms (mean age 51.9, range 22-76). Biopsy specimens were taken from each of three separate regions: the antrum, the corpus, and the transitional zone between the antrum and the corpus. The incidence of chronic atrophic gastritis was considerably higher in patients with Sjögren's syndrome than in the controls. In the young patients with Sjögren's syndrome atrophic lesions were more common both in the antrum and in the corpus than in the control group. In middle aged patients, however, only the antrum, and in the elderly only the corpus, was much more commonly affected than in the controls. All three types of chronic atrophic gastritis occurred in patients with Sjögren's syndrome. Decreased gastric acid secretion was associated mainly with atrophic gastritis of types A and AB, whereas hypergastrinaemia occurred almost exclusively in gastritis of type A.
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Affiliation(s)
- G Pokorny
- First Department of Internal Medicine, Albert Szent-Györgyi Medical School, Szeged, Hungary
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49
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50
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Jönsson KA, Gotthard R, Bodemar G, Brodin U. The clinical relevance of endoscopic and histologic inflammation of gastroduodenal mucosa in dyspepsia of unknown origin. Scand J Gastroenterol 1989; 24:385-95. [PMID: 2675301 DOI: 10.3109/00365528909093064] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Two hundred and ten patients were defined as having dyspepsia of unknown origin. At endoscopy 11% had body gastritis, 46% antral gastritis, and 19% bulbitis (two thirds combined with antral gastritis). Histologically, 22% had chronic corpus gastritis (79% superficial, 21% atrophic), which was combined with chronic antral gastritis in 84%, 33% had chronic antral gastritis (82% superficial, 18% atrophic); and 14% had duodenitis, which was combined with antral gastritis in 65%. Polymorphonuclear leukocytes were found in specimens from the body mucosa in 6%, from the antral mucosa in 13%, and from the duodenal cap in 4%. The endoscopic findings correlated significantly with the histologic findings in the duodenal bulb (kappa = 0.33) but not in the stomach. The frequency of endoscopic antral gastritis and the frequency of histologic chronic body and antral gastritis increased with age. Endoscopic bulbitis and histologic duodenitis and gastric metaplasia were commoner in men than in women. Peak acid output was higher in patients with than in those without endoscopic bulbitis and higher in smokers than in non-smokers when the significant sex differences in peak acid output were taken into account. Gastric metaplasia of the bulb was predominantly correlated to higher peak acid output and to some extent also to sex and smoking. Episodic pain was correlated to histologic duodenitis. Other dyspeptic symptoms and the intragastric bile acid concentration were not associated with any endoscopic or histologic findings. Of the 210 patients, 172 were reexamined after a double-blind 6-week treatment period with cimetidine, antacid, or placebo. The symptomatic outcome of these treatments was not associated with any significant change in endoscopic or histologic findings.
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Affiliation(s)
- K A Jönsson
- Dept of Internal Medicine, University Hospital Linköping, Sweden
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