Histopathological Study of Endoscopic Biopsies

Introduction: Diseases of upper gastrointestinal tract are responsible for a great deal of morbidity and mortality. The histopathological study of endoscopic biopsies permits exact diagnosis for further management.The aim of this study is to fi nd out the histopathological pattern of endoscopic biopsy. Methods: A descriptive study was conducted in consecutive endoscopic gastric biopsies in a Hospital over a period of one year. The patient of all ages and both sexes who underwent gastric biopsy during the study period was included. Results: Endoscopic biopsies were studied on patients of age ranging from 20 years female to 84 years male. The histopathology revealed non-neoplastic lesions 54 (67.5%) and neoplastic lesions 26 (32.5%). Most common non-neoplastic lesion noted was mild chronic gastritis 22(27.5%) followed by chronic active gastritis 15 (18.75%) while H. pylori was present in 13 (16.25%) and absent in 2 (2.5%). Conclusions: Mild chronic gastritis was the commonest lesion noted in non-neoplastic lesions and adenocarcinoma was the commonest neoplastic lesion in the endoscopic gastric biopsies. ______________________________________________________________________________________


INTRODUCTION
Diseases of upper gastrointestinal tract are responsible for a great deal of morbidity and mortality.The term gastritis should be reserved for histologically documented infl ammation of the gastric mucosa.Gastritis is simply defi ned as infl ammation of the gastric mucosa.Infl ammation may be predominantly acute, with neutrophilic infl ammation, or chronic, with lymphocytes and/or plasma cells predominating and associated intestinal metaplasia and atrophy. 1 Gastritis has been classifi ed in several ways, which differ from one country to another, sometimes from one department to another and even within a single institution, depending upon the investigator concerned.In order to avoid confusion, Sydney system has been proposed for the microscopic reporting of gastritis. 2e upper gastrointestinal fl exible fi bropticendoscope was fi rst used in 1968 and proved to be a major breakthrough in the diagnosis of oesophago-gastro duodenal lesions. 3The histopathological study of endoscopic biopsies permits exact diagnosis for further management.It also provides an opportunity to see Helicobacter pylori status and plans for specifi c medical or surgical therapy.It can detect the early stages of the neoplastic lesions and may prevent the progression of these lesions to invasive cancer. 4,5The aim of this study is to fi nd out the histopathological pattern of endoscopic biopsy.

METHODS
A descriptive study was conducted in consecutive endoscopic gastric biopsies in the Department of Pathology of Medicare National Hospital and Research Centre from 1 st April 2011 to 30 th April 2012.Patient of all ages and both sexes having undergone gastric biopsy were included in the study.The biopsy specimens were fi xed in 10% formalin and routinely processed.Paraffi n wax sections were cut at 4 micron thickness and stained with Haematoxylin and Eosin (H&E) stain and with special stain Giemsa when needed.All these biopsies were graded morphologically according to updated Sydney System.Majority of the biopsies were taken from different part of the stomach as per the recommendation (Sydney System).Activity was accounted by the presence of polymorph neutrophils in the lamina propria, within the epithelium and within the foveolarlumen. 2 Thetumors were classifi ed according to the WHO classifi cation of gastric tumors.The data were entered into Microsoft Excel 2010 and descriptive analysis was done.

RESULTS
In the present study, endoscopic biopsies were studied on patients of age ranging from 20 years female to 84 years male.Among the non-neoplastic lesions age ranged from 23 years to 84 years and in neoplastic lesions 45 to 77 years.A slight high frequency of the gastric disease in males with male to female ratio of 1.28:1 was observed.The majority of the patients were biopsied for either gastritis or tumors of stomach.The histopathology revealed non-neoplastic lesions 54 (67.5%) and neoplastic lesions 26 (32.5%).Most common non-neoplastic lesion noted was mild chronic gastritis 22 (27.5%)followed by chronic active gastritis 15 (18.75%) while H.Pylori was present in 13 (16.25%)and absent in 2 (2.5%).Atrophy was noted in 6 (7.5%) of cases of chronic active gastritis (Table1).Dysplasia and metaplasia were however not present in the cases of gastritis.Chronic superfi cial gastritis was noted in nine (11.25%), benign gastric ulcer was noted in four (5%), hyperplastic polyp was noted in three (3.75%) and granulomatous gastritis was noted in one (1.25%).Amongst the neoplastic lesions all were malignant lesions, while most malignant lesions were adenocarcinoma 19 (23.75%) followed by seven (8.75%) cases of squamous cell carcinoma (Table 2).Almost all neoplastic lesions were from antrum except for seven cases of squamous cell carcinoma taken from gastro esophageal junction.

DISCUSSION
Biopsy sampling of the gastric mucosa at diagnostic endoscopy provides useful information which helps in the diagnosis of various lesions.The most common indications for gastric biopsy are; to detect various types of gastritis along with evidence of Helicobacter pylori status, gastric ulcers and different tumors.
The present study has shown preponderance of nonneoplastic gastric lesions with 27.5% of mild chronic gastritis and 18.75% cases of chronic active gastritis.
Helicobacter pylori was positive in 16.25% cases out of 18.75% cases of chronic active gastritis.H. pylori negative chronic gastritis cases could be due to intake of proton pump inhibitors prior to endoscopic biopsy or failure to see Helicobacter pylori in the tissue specimens.
Majority of our cases of chronic active gastritis (16.25%) also showed H. pylori infection and correlated with presence of neutrophils and lymphocytes in the lamina propria which showed similar results with the study by Afzal et al. 6 Similar study by Schultz et al, showed 87% cases having chronic active gastritis, and