Prevalence of H.Pylori infection and histomorphologic spectrum in endoscopic biopsies

Abstract

Background and Objectives: Most of the cases of chronic gastritis are due to infection by H.pylori. H.pylori is also associated with peptic ulcer disease, gastric cancer and also with primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma. This study explores the prevalence of H.pylori infection in endoscopically suspected cases of gastritis and correlates the endoscopic findings with the histomorphological findings. Method: We conducted this study in a teaching hospital attached to a medical college in Bangalore from January 2010 to June 2011 at the Departments of Surgical Gastroenterology and Pathology. All the patients who had endoscopic features of gastritis were biopsied and these biopsies were studied for the presence of H. pylori infection. We routinely used Hematoxylin and Eosin staining along with the Giemsa for the identification of H.pylori in the biopsy specimens. Results: Antral biopsy was performed in 400 dyspeptic patients. Of these biopsies, H.pylori was present in 150 cases (37.5%), with maximum prevalence in the 4^th decade of life and higher preponderance in men compared to that in women (66% vs.34%). Endoscopically, findings noted were linear erythema (n = 60, 40%), subepithelial hemorrhagic spots (n = 50, 33%) and multiple erosions (n = 40, 27%). The present study revealed substantial prevalence of H.pylori (37.5%) . Histopathologically, all the specimens displayed features of chronic gastritis with a varying degree of active inflammation (80%), regenerative atypia (72%), glandular atrophy (60%) and intestinal metaplasia (8%). Conclusion: H.Pylori infection was diagnosed in more than a third of endoscopically suspected cases of gastritis emphasizing the need for early detection and treatment. Awareness of histomorphological features that are typical to H.pylori gastritis would help clinical pathologists in identifying conditions such as atrophic gastritis and intestinal metaplasia which can later progress onto carcinoma.