Differences in image-enhanced endoscopic findings between Helicobacter pylori-associated and autoimmune gastritis

Abstract

Background and study aims The aim of this study was to elucidate the differences in image-enhanced endoscopy (IEE) findings between Helicobacter-pylori-associated and autoimmune gastritis. Patients and methods Seven H. pylori-naïve, 21 patients with H. pylori-associated gastritis and seven with autoimmune gastritis were enrolled. Mucosal atrophy in the corpus was evaluated using autofluorescence imaging and classified into small, medium and large. In a 2 × 2-cm area of the lesser curvature of the lower corpus, micromucosal pattern was evaluated by magnifying narrow band imaging and proportion of foveola (FV)- and groove (GR)-type mucosa was classified into FV > 80 %, FV 50 % to 80 %, GR 50 % to 80 %, and GR > 80 %, then a biopsy specimen was taken. Results Fifteen of 21 (71 %) H. pylori-associated gastritis patients exhibited medium-to-large atrophic mucosa at the corpus lesser curvature. All autoimmune gastritis patients had large atrophic mucosa throughout the corpus (P < 0.001). All H. pylori-naïve patients had the FV > 80 % micromucosal pattern. Nineteen of 21 (90 %) H. pylori-associated gastritis patients had varying proportions of GR- and FV-type mucosae and five of seven (71 %) autoimmune gastritis patients showed FV > 80 % mucosa (P < 0.001). Compared with patients who were H. pylori-naïve, patients with H. pylori-associated and autoimmune gastritis exhibited a higher grade of atrophy (P < 0.001), but only patients with H. pylori-associated gastritis showed a higher grade of intestinal metaplasia (P = 0.022). Large mucosal atrophy with FV > 80 % micromucosal pattern had sensitivity of 71 % (95 % CI: 29 %–96 %) and specificity of 100 % (95 % CI: 88 % to 100 %) for diagnosis of autoimmune gastritis. Conclusions IEE findings of the gastric corpus differed between H. pylori-associated and autoimmune gastritis, suggesting different pathogenesis of the two diseases.

ENETS standardized (synoptic) reporting for endoscopy in neuroendocrine tumors

“… Anatomical localization (fundus, corpus, antrum, prepyloric region, pylorus) Location on the greater or lesser curvature; on the anterior or posterior wall. The appearance of the lesion (round, nodular, polypoid, sessile, pedunculated, tumor mass, ulcerated, haemorrhagic); if chromoendoscopy is used, it should be noted The size in mm ‐ use an open biopsy forceps (usually 4 mm wide; please refer to your specific endoscopy equipment) for measurement. The number of lesions has to be noted – If greater than 10 give a range estimate but define marker lesions precisely The shape of the lesion ‐ use the Paris classification 22 Ip pedunculated Is sessile IIa flat elevated IIb completely flat IIc central depression III ulcerated …”

“…The information to be noted during the endoscopic examination for standardised reporting is: Anatomical localization (proximal bulbar, distal bulb, proximal part of the genus superius , distal part of the genu superius , periampullary region, D3, D4). Location on anterior or posterior wall. The appearance of the lesion (round, nodular, polypoid, ulcerated, haemorrhagic). The size in mm ‐ use an open biopsy forceps for measurement. The shape of the lesion ‐ use the Paris classification 22 Ip pedunculated Is sessile IIa flat elevated IIb completely flat IIc central depression III ulcerated …”

The role of advanced endoscopy in the management of inflammatory digestive diseases (upper gastrointestinal tract)

“…One study provides a clue to solve this problem, that is, results of autofluorescence imaging and NBI of the gastric corpus differed between H. pylori-associated and autoimmune gastritis. 72…”

Endoscopic features and clinical importance of autoimmune gastritis

“…The onset of AIG also causes hypergastrinemia and hyperplasia of enterochromaffin‐like (ECL) cells, resulting in complications such as gastric cancer, 6,15–37 neuroendocrine tumors (NETs), 6,9,21,24,34–36,38–46 and hyperplastic polyps 21,34,36 . Additionally, AIG is strongly associated with autoimmune diseases of extra‐stomach glandular tissues, including those of the thyroid gland, 42,47–49 parathyroid gland, 50 and pancreas, 51,52 and a high incidence of malignant tumors in organs other than the stomach 53 .…”

“…In addition to reverse atrophy, sticky adherent dense mucus and remnant oxyntic mucosa in the corpus may be observed 6 . Moreover, magnified endoscopic findings, 7–9 such as white globe appearance (WGA) 10 and cast‐off skin appearance (CSA), 11 have been reported, with few reports of early‐stage AIG that has not completed reverse atrophy 12–14 …”