gastric biopsy

Endoscopic examination with mucosal biopsy and/or cytologic sampling is regularly employed for the initial identification and monitoring of patients with various gastric conditions including gastritis, gastric atrophy, peptic ulcer disease, and neoplastic proliferations.

Gastric biopsiesarealso commonly used to evaluate the stomach for the presence or absence of Helicobacter pylori (HP).

Routine gastric biopsies may also show special forms of gastritis (eosinophilic gastritis, lymphocytic gastritis and granulomatousgastritis), giant fold disease or polyps.

Gastric biopsies can provide informationabout the grade, extent, and topography of gastritis-related and atrophy-related lesions, information that provides the opportunity to assess the patient’s risk for developing gastric carcinoma.

As noted previously, gastric histology varies from area to area and since many gastric diseases are patchy in their distribution, an adequate evaluation often requires examining biopsies from the body, antrum and any endo-scopically visible lesions.

The Sydney system requires that biopsies be obtained from five locations in the stomach (the greater and lesser curvature in the antrum, the greater and lesser curvature in the corpus and the incisura), although this seldom happens in routine clinical practice.

Typically gastroenterologists take a couple biopsies from the antrum and a couple from the corpus. Ideally these should be submitted in separate containers, although this does notalways happen either.

It is important to note that endoscopic procedures may cause variable degrees ofedema, vascular dilation, focal lamina propria hemorrhage, and surface cell flattening.

These changes are usually easily distinguishable from mucosal disease because ofthe absence ofboth epithelial degeneration and acute inflammation.

A systematic examination of gastric biopsies facilitates the diagnosis of various gastric diseases and provides the discipline of establishing a differential diagnosis so that specific diagnostic entities are considered and important entities are not over-looked.

One should determine where the biopsy comes from by looking at various mucosal components.

However, it may be difficult to determine the precise location of a biopsy because of the presence of atrophy and/or metaplasia.

Gastric epithelium may appear in the duodenum in peptic duodenitis; intestinal metaplasia occurs inthe setting of gastritis and Barrett esophagus, and pyloric glands develop in the proximal stomach in certain forms of gastritis.

One can broadly divide gastric inflammatory diseases into gastritis and gastropathy.

The major distinction between the two is the presence of inflammation in gastritis and its absence in gastropathies.

Gastritis typically results from infections, autoimmune or hypersensitivity reactions, or drugs.

Determining whether gastritis is a pangastritis or affects only the antral or corpus, whether it is focal or diffuse, and whether it is superficial or occupies the entire mucosal thickness helps distinguish among these etiologies.

Other changes that may be assessed include a determination of whether any of the following are present:
 surface epithelial damage
 superficial stromal hemorrhage
 metaplasia

• intestinal metaplasia
• pancreatic metaplasia
• antral metaplasia

 endocrine cell hyperplasia
 intraepithelial lymphocytosis
 granulomas
 apoptosis
 microorganisms.

Gastropathies result from hypovolemia, stress, ischemia, drug or alcohol ingestion, chronic congestion or alkaline reflux from the duodenum.