Abstract

Background: Inflammation of the gastric mucosa is a common finding in the general population. It is also common in clinical practice for Endoscopists to make an impression of gastritis on the basis of the general endoscopic appearance of the gastric mucosa. This concept of “endoscopic gastritis” was further given credibility by the recognition of its existence by the working party that put together the Sydney System of classifying gastritis. The dilemma now is whether the presence or absence of endoscopic gastritis can be used to predict histological outcome, in terms of aetiology and morphological changes, with certainty.
Objective: To determine the correlation between endoscopic and histological gastritis in South-Western Nigerians with dyspepsia.
Method: Eighty-seven patients who underwent gastroscopy for dyspepsia were included in this study. Two or more gastric biopsies were taken from the antrum for histology from all the participants; additional biopsies were also taken from other areas with macroscopic features of inflammation other than the antrum.
Results: A total of 87 patients, made up of 40 males and 47 females with dyspepsia were included in the study. The age range was between 16 and 85 years with a mean age of 48.68 (±14.12) years. Of the 87 patients studied 54 (62.1%) had endoscopic gastritis while 84 (96.6%) had histological gastritis. Fifty three (60.9%) had both endoscopic and histological gastritis. Helicobacter pylori (H. pylori) infection was detected in 45 (51.7%) of all the patients by histology. All those that had H. pylori infection had histological gastritis. All the 3 patients that did not have histological gastritis had no H. pylori infection. Fifty-three (98%) of the 54 patients with endoscopic gastritis and 31(93.9%) of the 33 patients with normal mucosa at endoscopy had histological gastritis respectively. Endoscopic gastritis had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 63.09, 66.66, 98.14, and 6.06 respectively for histological diagnosis of gastritis.
Conclusion: The presence of endoscopic gastritis had a good association with histological gastritis. However, normal endoscopic appearance was a poor predictor of the absence of histological gastritis. Endoscopic appearance was not sufficient for diagnosing gastritis. Hence, all patients undergoing endoscopy needing evaluation for chronic gastritis should be biopsied for histology.