A FIVE YEAR REVIEW OF GASTRIC BIOPSIES FROM PATIENTS WITH DYSPEPTIC SYMPTOMS IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN, NIGERIA

Abstract

Background: Dyspepsia is a common way in which patient with a wide array of upper GI
diseases present to many a gastroenterologist. The use of endoscopy and biopsy pathology is
a most crucial way in which the underlying disorder is quickly elucidated in each case.
Aim: We therefore set out to analyse the histopathological features that were found in the
endoscopic gastric biopsies of dyspeptic patients in our practice at Ilorin, over a five-year
period since endoscopy became routinely available.
Methods: Archival case records, slides and FFPE tissue blocks of patients who present
mainly with features of dyspepsia were examined using H & E, Giemsa, PAS and Alcian
blue stains as necessary. The histological features of chronic gastritis were graded using the
modified Sydney system of classification.
Results: A total of 372 gastric biopsies were analysed. Chronic gastritis was seen in 316
(84.9%) cases while 26 (7%) showed gastric carcinoma. The male to female ratio for
chronic gastritis was 1.1:1 and 1.3:1 for gastric carcinoma. The patients age range from 5
years to 93 years with a median of 48.86 (±16.59 SD).
The commonest endoscopic finding was inflammation in 288 (87.5%) cases, and ulceration
in 88 (26.8%) cases. Normal endoscopic finding was seen in 41(12.5%) cases
Graded morphological variables in Sydney classification of chronic gastritis include chronic
inflammation in 316 (100%) cases, inflammatory activity in 207 (65.5%) cases, glandular
atrophy in 137 (43.3%) cases, intestinal metaplasia in 64 (20.2%) cases and H. pylori was
seen in 171 (52 %) cases. The sensitivity of endoscopy in detecting inflammation is 91%
while the specificity is 100%. Non graded histologic variables detected, include surface
epithelial damage, 30.1% cases, lymphoid follicles, 31.3% cases and dysplastic changes in
5.5% cases.
Conclusion: While this study has demonstrated the great value of upper gastrointestinal
endoscopy and biopsy in the diagnosis and evaluation of patients with dyspepsia, there is an
obvious need for a further clinicopathological study of the largest diagnostic group –
chronic gastritis – since only about half of them are H. pylori –associated despite what the
recent literature on this phenomenon has suggested to the contrary.

A FIVE YEAR REVIEW OF GASTRIC BIOPSIES FROM PATIENTS WITH DYSPEPTIC SYMPTOMS IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN, NIGERIA