CLINICAL IMPACT OF ROUTINE BIOPSIES OF THE GASTRIC ANTRUM AND BODY

Biopsy sampling of gastric mucosa at diagnostic endoscopy provides inf ormation that cannot be obtained by other means. The most common indic ation for gastric biopsy is the need to know whether or not the patien t is infected with Helicobacter pylori, and whether the stomach is gas tritic or not. Microscopic examination of gastric biopsy specimens, in addition to H. pylori status, provides information about the grade, e xtent, and topography of gastritis-related and atrophy-related lesions in the stomach. This information provides further opportunities for a ssessing the risk and likelihood of various gastric disorders. These a re: a) The predominance or restriction of the H. pylori-related gastri tis in the antrum strongly correlates with an increased risk of peptic ulcer disease, and of duodenal ulcer in particular (the duodenal ulce r phenotype of gastritis). b) The presence of atrophic gastritis (loss of normal glands) in the area of the gastric body indicates a low ris k of ulcer and also a reduction in the capacity of the patient to secr ete acid. c) The occurrence of advanced atrophic gastritis and intesti nal metaplasia multifocally in the stomach (advanced multifocal atroph ic gastritis), and in the lesser curvature and angular notch in partic ular, are features suggestive of an increased risk of gastric neoplasi as (the gastric cancer phenotype of gastritis). d) The presence of nor mal and healthy gastric mucosa indicates, on the other hand, an extrem ely low risk of both peptic ulcer disease and gastric cancer. In addit ion to diagnosis of H. pylori-related gastritic lesions, routine gastr ic biopsies may reveal findings that indicate special forms of gastrit is, such as eosinophilic, lymphocytic, reactive, or granulomatous gast ritis (e.g., Crohn's gastritis), or Helicobacter heilmannii gastritis. These types of gastritis can be found incidentally in a small percent age of patients who undergo diagnostic gastroscopy for abdominal compl aints.