Gastric histologic findings in patients with nonsteroidal anti-inflammatory drug-associated gastric ulcer

The purpose of this study was to characterize gastric histologic findings i n patients with nonsteroidal anti-inflammatory drug (NSAID)-associated gast ric ulcer (GU), Gastric biopsy specimens from 136 patients with NSAID-relat ed GU were compared with those from a control population of 185 patients wi th Helicobacter pylori-related gastritis, Foveolar hyperplasia, edema, musc ular stranding, vascular ectasia, and active and chronic inflammation were semiquantitatively graded. Lymphoid aggregates, intestinal metaplasia, atro phy, and cystic gland changes were noted. No single parameter reliably dist inguished between the two populations, although moderate/severe foveolar hy perplasia, edema, and vascular ectasia were significantly more common in th e NSAID group. With use of the Dixon scoring system for reflux/reactive gas tropathy, with a threshold score of 11 or more, 39 (29%) patients in the NS AID group were correctly diagnosed as having reactive gastropathy (sensitiv ity, 29%; specificity, 100%; positive predictive value, 100%), When the Dix on scoring threshold score was decreased to 8 or more, 114 (84%) patients w ere classified as having reactive gastropathy (sensitivity, 84%; specificit y, > 99%; positive predictive value, > 99%). We conclude that a decreased t hreshold enhances the usefulness of the reactive gastropathy score in the N SAID-related GU population. Additional studies, however, must be performed to evaluate the effect of a lowered threshold relative to a normal populati on and those with other causes of reactive gastropathy.