Dig Dis Sci. 2024 Feb;69(2):528-537. doi: 10.1007/s10620-023-08170-2. Epub 2023 Dec 13.
Histologic gastritis의 경우 임상 증상과 연관성이 있는지 longitudinal population-based study of GI symptoms with an EGD performed in 2011/2012 입니다.
결론은 "연관성이 없다" "임상 증상과 위염을 연관 시키지 말자" 입니다.
Introduction
We aimed to determine if histological gastritis, including active infammation (neutrophils) or inactive (chronic) infammation (lymphocytes, plasma cells), is associated with GI symptoms in a general population.
Method
* The sampling procedure for the 2011 mail survey and 2012 EGD study
Figure 1. Sampling procedure 2011 mail survey and 2012 population-based endoscopy study. The final study population (n&thinsp= 1924) was higher than the ASQ mail survey population (n&thinsp= 1645) because all participants in previous surveys were invited as well even if they had moved from Östhammar. Note all comers were invited for endoscopy. The details of sample selection have been published in detail previously (reference 3). (ASQ-Abdominal Symptom Questionnaire. EGD-esophagogastroduodenoscopy)
<Variables>
* Symptoms
Gastroesophageal refux symptoms (GERS) and functional dyspepsia (FD) were defned based on the ASQ, which asks if the participant has experienced the symptom during the last 3 months.
- GERS was defned as being bothered by heartburn and/or acid regurgitation in the past 3 months with daily or weekly symptoms
- FD was defned as the presence of postprandial distress syndrome (PDS)—postprandial fullness and/or early satiety; or epigastric pain syndrome (EPS)—presence of pain or discomfort in the epigastric region only (not relieved by defecation), consistent with the Rome III criteria
* Medications
a complete medical history including all medication use was recorded.
* H. pylori Serology
Blood samples were taken immediately prior to EGD for a specifc enzyme immunoassay (GastroPanel, Biohit PLC, Helsinki, Finland).
* Gastric Biopsies - pathologic report
Two biopsies were taken from both the antrum and corpus for haematoxylin and eosin (H&E) and Warthin Starry (WS) staining and assessed according to the widely used and well accepted Sydney System.
H. pylori gastritis was detected by H&E and WS stain.
Autoimmune gastritis was diagnosed by corpus atrophy with intestinal metaplasia and hyperplasia of endocrine-like cells. Autoantibodies were not measured.
Reactive gastropathy was defned by foveolar hyperplasia, prominence of smooth muscle fbers as well as vasodilatation, together with chronic infammation.
<Classifcation of Status of Gastric Mucosa>
Group1: Chronic inactive (chemical reactive gastritis or chronic not active gastritis)
Group2: Autoimmune gastritis
Group3: Active with neutrophils (H. pylori gastritis, lymphocytic gastritis)
Results
* 368 subjects (192 women; 52.2%), with a mean age of 54.1 years (SD 13.2; range 20–79 years)
* Gastritis (any type or location) was present in 40.2% (148/368).
* Antral gastritis was present in 40% (147/368) and body gastritis in 20.4% (75/368). 74 subjects had gastritis in both antrum and corpus, 73 in antrum only, and one in the corpus only. Reactive gastritis was the most common subtype (45.9%, 68/148), followed by H. pylori (29.7%, 44/148) and chronic non-H. pylori gastritis (19.6%, 29/148).
* Atrophy: 12명 (6명 antrum only, 3명 corpus only, 3명 both sites)
- 4명: autoimmune gastritis, 5명: H. pylori gastritis, 3명: chronic not active gastritis
* No pathological changes in the corpus and antrum in 59.8% (220/368)
Table 1. Histology of antrum, including age, gender, and H. pylori seropositivity status
Table 2. Histology of corpus, including age, gender, and H. pylori seropositivity status
Figure 2. Status of gastric mucosa in 10-year age groups demonstrating an increase of gastritis with age
Table 3. Odds ratio (OR; 95% CI) of likelihood of symptoms by status of gastric mucosa compared to no pathological changes; adjusted for age and sex
Conclusion
In this population-based study of 368 individuals with or without symptoms who underwent EGD, we found a gastritis prevalence of 40%, and the most common type was reactive gastritis. The prevalence of H. pylori gastritis in this study is consistent with the downward trend of infection in developed countries. Increasing age was signifcantly associated with gastritis, however, sex and use of PPIs or NSAIDs were not. While upper GI symptoms were reported in 35% of individuals, histologic gastritis should generally not be ascribed to upper GI symptoms.
Abstract
Background and Aims: Gastritis is a common histological diagnosis, although the prevalence is decreasing in developed populations, alongside decreasing prevalence of H. pylori infection. We sought to determine the prevalence of the etiology of gastritis in a Swedish population sample and to analyze any associations with symptoms, an area of clinical uncertainty.
Methods: Longitudinal population-based study based in Östhammar, Sweden. A randomly sampled adult population completed a validated gastrointestinal symptom questionnaire (Abdominal Symptom Questionnaire, ASQ) in 2011 (N=1175). Participants<80 years of age and who were eligible were invited to undergo esophagogastroduodenoscopy (EGD) (N=947); 402 accepted and 368 underwent EGD with antral and body biopsies (average 54.1 years, range 20–79 years; 47.8% male) with H. pylori serology. Results Gastritis was found in 40.2% (148/368; 95% CI 35.2–45.2%). By rank, the most common histological subtype was reactive (68/148; 45.9%), then H. pylori (44/148; 29.7%), chronic non-H. pylori (29/148; 19.6%), and autoimmune (4/148; 2.7%). Gastritis was signifcantly associated with older age and H. pylori status (p<0.01). Gastritis subjects were divided into three histological categories: chronic inactive infammation, autoimmune gastritis, and active infammation; there was no diference in the presence of upper gastrointestinal symptoms when categories were compared to cases with no pathological changes. Functional dyspepsia or gastroesophageal refux were reported in 25.7% (38/148) of those with gastritis (any type or location) versus 34.1% (75/220) with no pathological changes (p=0.32). Epigastric pain was more common in chronic H. pylori negative gastritis in the gastric body (OR=3.22, 95% CI 1.08–9.62).
Conclusion: Gastritis is common in the population with a prevalence of 40% and is usually asymptomatic. Chronic body gastritis may be associated with epigastric pain, but independent validation is required to confrm these fndings. Clinicians should not generally ascribe symptoms to histological gastritis.
Keywords: Gastritis · H. pylori · Endoscopy · Epigastric pain · Prevalence
Dig Dis Sci. 2024 Feb;69(2):528-537. doi: 10.1007/s10620-023-08170-2. Epub 2023 Dec 13.
Histologic gastritis의 경우 임상 증상과 연관성이 있는지 longitudinal population-based study of GI symptoms with an EGD performed in 2011/2012 입니다.
결론은 "연관성이 없다" "임상 증상과 위염을 연관 시키지 말자" 입니다.
Introduction
We aimed to determine if histological gastritis, including active infammation (neutrophils) or inactive (chronic) infammation (lymphocytes, plasma cells), is associated with GI symptoms in a general population.
Method
* The sampling procedure for the 2011 mail survey and 2012 EGD study
Figure 1. Sampling procedure 2011 mail survey and 2012 population-based endoscopy study. The final study population (n&thinsp= 1924) was higher than the ASQ mail survey population (n&thinsp= 1645) because all participants in previous surveys were invited as well even if they had moved from Östhammar. Note all comers were invited for endoscopy. The details of sample selection have been published in detail previously (reference 3). (ASQ-Abdominal Symptom Questionnaire. EGD-esophagogastroduodenoscopy)
<Variables>
* Symptoms
Gastroesophageal refux symptoms (GERS) and functional dyspepsia (FD) were defned based on the ASQ, which asks if the participant has experienced the symptom during the last 3 months.
- GERS was defned as being bothered by heartburn and/or acid regurgitation in the past 3 months with daily or weekly symptoms
- FD was defned as the presence of postprandial distress syndrome (PDS)—postprandial fullness and/or early satiety; or epigastric pain syndrome (EPS)—presence of pain or discomfort in the epigastric region only (not relieved by defecation), consistent with the Rome III criteria
* Medications
a complete medical history including all medication use was recorded.
* H. pylori Serology
Blood samples were taken immediately prior to EGD for a specifc enzyme immunoassay (GastroPanel, Biohit PLC, Helsinki, Finland).
* Gastric Biopsies - pathologic report
Two biopsies were taken from both the antrum and corpus for haematoxylin and eosin (H&E) and Warthin Starry (WS) staining and assessed according to the widely used and well accepted Sydney System.
H. pylori gastritis was detected by H&E and WS stain.
Autoimmune gastritis was diagnosed by corpus atrophy with intestinal metaplasia and hyperplasia of endocrine-like cells. Autoantibodies were not measured.
Reactive gastropathy was defned by foveolar hyperplasia, prominence of smooth muscle fbers as well as vasodilatation, together with chronic infammation.
<Classifcation of Status of Gastric Mucosa>
Group1: Chronic inactive (chemical reactive gastritis or chronic not active gastritis)
Group2: Autoimmune gastritis
Group3: Active with neutrophils (H. pylori gastritis, lymphocytic gastritis)
Results
* 368 subjects (192 women; 52.2%), with a mean age of 54.1 years (SD 13.2; range 20–79 years)
* Gastritis (any type or location) was present in 40.2% (148/368).
* Antral gastritis was present in 40% (147/368) and body gastritis in 20.4% (75/368). 74 subjects had gastritis in both antrum and corpus, 73 in antrum only, and one in the corpus only. Reactive gastritis was the most common subtype (45.9%, 68/148), followed by H. pylori (29.7%, 44/148) and chronic non-H. pylori gastritis (19.6%, 29/148).
* Atrophy: 12명 (6명 antrum only, 3명 corpus only, 3명 both sites)
- 4명: autoimmune gastritis, 5명: H. pylori gastritis, 3명: chronic not active gastritis
* No pathological changes in the corpus and antrum in 59.8% (220/368)
Table 1. Histology of antrum, including age, gender, and H. pylori seropositivity status
Table 2. Histology of corpus, including age, gender, and H. pylori seropositivity status
Figure 2. Status of gastric mucosa in 10-year age groups demonstrating an increase of gastritis with age
Table 3. Odds ratio (OR; 95% CI) of likelihood of symptoms by status of gastric mucosa compared to no pathological changes; adjusted for age and sex
Conclusion
In this population-based study of 368 individuals with or without symptoms who underwent EGD, we found a gastritis prevalence of 40%, and the most common type was reactive gastritis. The prevalence of H. pylori gastritis in this study is consistent with the downward trend of infection in developed countries. Increasing age was signifcantly associated with gastritis, however, sex and use of PPIs or NSAIDs were not. While upper GI symptoms were reported in 35% of individuals, histologic gastritis should generally not be ascribed to upper GI symptoms.
Abstract
Background and Aims: Gastritis is a common histological diagnosis, although the prevalence is decreasing in developed populations, alongside decreasing prevalence of H. pylori infection. We sought to determine the prevalence of the etiology of gastritis in a Swedish population sample and to analyze any associations with symptoms, an area of clinical uncertainty.
Methods: Longitudinal population-based study based in Östhammar, Sweden. A randomly sampled adult population completed a validated gastrointestinal symptom questionnaire (Abdominal Symptom Questionnaire, ASQ) in 2011 (N=1175). Participants<80 years of age and who were eligible were invited to undergo esophagogastroduodenoscopy (EGD) (N=947); 402 accepted and 368 underwent EGD with antral and body biopsies (average 54.1 years, range 20–79 years; 47.8% male) with H. pylori serology. Results Gastritis was found in 40.2% (148/368; 95% CI 35.2–45.2%). By rank, the most common histological subtype was reactive (68/148; 45.9%), then H. pylori (44/148; 29.7%), chronic non-H. pylori (29/148; 19.6%), and autoimmune (4/148; 2.7%). Gastritis was signifcantly associated with older age and H. pylori status (p<0.01). Gastritis subjects were divided into three histological categories: chronic inactive infammation, autoimmune gastritis, and active infammation; there was no diference in the presence of upper gastrointestinal symptoms when categories were compared to cases with no pathological changes. Functional dyspepsia or gastroesophageal refux were reported in 25.7% (38/148) of those with gastritis (any type or location) versus 34.1% (75/220) with no pathological changes (p=0.32). Epigastric pain was more common in chronic H. pylori negative gastritis in the gastric body (OR=3.22, 95% CI 1.08–9.62).
Conclusion: Gastritis is common in the population with a prevalence of 40% and is usually asymptomatic. Chronic body gastritis may be associated with epigastric pain, but independent validation is required to confrm these fndings. Clinicians should not generally ascribe symptoms to histological gastritis.
Keywords: Gastritis · H. pylori · Endoscopy · Epigastric pain · Prevalence