Histopathological Assessment of Dyspepsia in the Absence of Endoscopic Mucosal Lesions

Abstract

Introduction: Dyspepsia is a common symptom with an extensive differential diagnosis. Endoscopy alone may miss serious mucosal lesions in about 15 to 30% of cases. The aim was to determine histopathological features of gastric and duodenal mucosal biopsies in patients with dyspepsia and normal looking upper gastrointestinal (GI) endoscopy.

Materials and methods: One hundred and five adult patients presenting with dyspepsia with no endoscopic mucosal lesions in the upper GI tract were included. Gastric biopsy specimens according to Sydney-Houston system for grading gastritis and biopsy from duodenum were taken. The histopathological features were graded according to the Sydney-Houston system classification for grading gastritis.

Results: The histological lesions were found in 65.7% (69 out of 105 endoscopy free dyspeptic patients). Chronic inflammation was the commonest finding. Neutrophilic activity, glandular atrophy, and mild degree of intestinal metaplasia were present in 27, 45, and 6 patients (22.8, 42.8, and 5.7% respectively). Helicobacter pylori was present in 54 patients with histopathological lesions and in 6 patients without histopathological lesions, and the difference was significant (p = 0.045).

Conclusion: The endoscopic diagnosis of dyspepsia correlated poorly with histopathological findings. The histopathological examination allowed detection and grading of gastric pathology in dyspepsia with normal endoscopy and the commonest finding was the moderate chronic gastritis.

How to cite this article: Dawod HM, Emara MW. Histopathological Assessment of Dyspepsia in the Absence of Endoscopic Mucosal Lesions. Euroasian J Hepato-Gastroenterol 2016;6(2):97-102.

Keywords: Biopsy; Chronic gastritis; Dyspepsia; Endoscopy..

Graph 1:

Pathological variability in patients with functional dyspepsia

Figs 1A and B:

Chronic gastritis and positive H. pylori infection: (A) H&E stain; and (B) geimsa stain

Figs 2A and B:

Chronic gastritis and positive H. pylori infection: The lamina propria is moderately infiltrated by chronic inflammatory cells, mainly plasma cells and lymphocytes with few neutrophils: (A) H&E stain; and (B) geimsa stain

Figs 3A and B:

Chronic gastritis, positive H. pylori infection, and intestinal metaplasia: (A) H&E stain; and (B) geimsa stain

Figs 4A and B:

Chronic gastritis and negative H. pylori infection: (A) H&E stain; and (B) geimsa stain