A TEN – YEAR REVIEW OF ENDOSCOPIC GASTRODUODENAL BIOPSIES IN ILE – IFE USING THE UPDATED SYDNEY SYSTEM OF CLASSIFICATION (1994 – 2003)

Abstract

Gastroduodenitis and its associated complications such as peptic ulcer disease
and gastric malignancies had been a subject of intense research within medical
communities in the last few decades. The discovery of H. pylori and its
association with gastritis offered rays of hope in terms of treatment and
prognosis, and also stimulated intense research in this subject. The improvement
in the classification scheme and grading of gastritis had helped to standardize
reports, monitor disease progression and response to therapy. Routine
histopathological work has shown that gastroduodenal diseases are quite
common in Nigeria going by the number of endoscopic biopsies that are received
in our laboratories annually. We therefore undertook a retrospective study of
such biopsies over a ten-year period.
Using the updated Sydney System of classification and grading, a total of 1094
out of 1307 endoscopic gastroduodenal biopsies recorded in the surgical
daybook from the year 1994 –2003 were studied and re-classified by reviewing
the request cards and the slides. There was evidence of significant chronic
gastritis in 98.9% of the biopsies and in 78.0% of these, H. pylori was the
identifiable aetiological agent. Also H. pylori was found in 29.6% of chronic
duodenitis cases studied. Marked atrophic changes and intestinal metaplasia
that may likely predispose to gastric malignances were generally low, 4.8% and
9.2% respectively despite high prevalence of H. pylori infection. We also found
that topographically, antral lesions were the commonest (75.4%) and pre
neoplastic changes of intestinal metaplasia and atrophy were also commonly
seen in the antrum. Few chronic peptic ulcer cases were seen, 9(0.9%) in the
stomach and 3(7.1%) in the duodenum.
Thus H. pylori was the single most important aetiological factor responsible for
the biopsy changes associated with chronic gastroduodenitis. Though the
prevalence of preneoplastic changes seen was low, the finding of 17cases
(1.65% of total cases of chronic gastritis) of intestinal metaplasia in patients who
were below 30 years of age has obvious implications for the epidemiology of
gastric cancer for the populations of developing countries, among whom a high
prevalence of H. pylori has been reported. Studies correlating the epidemiology
of these changes with those of gastric carcinoma among these populations are
called for.

A TEN – YEAR REVIEW OF ENDOSCOPIC GASTRODUODENAL BIOPSIES IN ILE – IFE USING THE UPDATED SYDNEY SYSTEM OF CLASSIFICATION (1994 – 2003)