CLASSIFICATION AND DIAGNOSIS OF GASTRITIS AND GASTROPATHY INTEGRANTES: -JUNCHAYA CASTILLA PRISCILLA -LEY RAMÍREZ FREZZIA -ZEA GÓMEZ CLAUDIA.

Presentación del tema: "CLASSIFICATION AND DIAGNOSIS OF GASTRITIS AND GASTROPATHY INTEGRANTES: -JUNCHAYA CASTILLA PRISCILLA -LEY RAMÍREZ FREZZIA -ZEA GÓMEZ CLAUDIA."— Transcripción de la presentación:

1 CLASSIFICATION AND DIAGNOSIS OF GASTRITIS AND GASTROPATHY INTEGRANTES: -JUNCHAYA CASTILLA PRISCILLA -LEY RAMÍREZ FREZZIA -ZEA GÓMEZ CLAUDIA

2 INTRODUCTION  Gastritis is predominantly an inflammatory process, while the term gastropathy denotes a gastric mucosal disorder with minimal to no inflammation. The term gastritis is occasionally used to denote inflammation associated mucosal injury. However, epithelial cell injury and regeneration are not always accompanied by mucosal inflammation. This distinction has caused considerable confusion since the term "gastritis" is often used to describe endoscopic or radiologic characteristics of the gastric mucosa rather than specific histologic findings. Epithelial cell damage and regeneration with minimal or no associated inflammation is properly referred to as "gastropathy." An etiology-based classification of gastropathy and gastritis is presented.

3 INTRODUCTION The causes, natural history, and therapeutic implications of gastropathy differ from gastritis: Gastritis is commonly secondary to infectious or autoimmune etiologies Gastropathy is commonly secondary to endogenous or exogenous irritants, such as bile reflux, alcohol, or aspirin and nonsteroidal antiinflammatory drugs. However, gastropathy can also be secondary to ischemia, physical stress, or chronic congestion.aspirin "Gastritis" is a term often used by endoscopists to describe an abnormal-appearing gastric mucosa rather than representing a particular endoscopic entity. A gastric mucosal biopsy is necessary to establish a definitive diagnosis of gastritis versus gastropathy. This topic review will discuss the classification and diagnosis of gastritis and gastropathy. The causes of acute and chronic gastritis are presented separately.

4 CLASSIFICATION OF GASTRITIS AND GASTROPATHY  There is no universally accepted classification of gastritis/gastropathy, although several classifications (such as the Sydney system and the Operative Link for Gastritis Assessment [OLGA] staging system) have been proposed. The updated Sydney system does not yield actionable prognostic information concerning cancer risk in cases of chronic atrophic gastritis. The OLGA staging system may provide information about the risk of secondary gastric cancers in autoimmune gastritis. The OLGA staging system, which was proposed by an international group of pathologists for use in standardizing classification of atrophic gastritis, incorporates histologic phenotypes with extent of disease to aid in prediction of cancer risks. High stage disease (OLGA III/IV) is associated with a high risk of gastric cancer. Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM), another proposed system, shows less interobserver variability and is prognostically useful. However, OLGIM may be less sensitive than OLGA in identifying high-risk gastritis, and some experts recommend using a combination of OLGA and OLGIM for staging of chronic gastritis. Gastritis has been classified by histologic features, time course (acute versus chronic), etiology, and proposed pathophysiology.

5 A mucosal biopsy is required to distinguish between acute, chronic active, or chronic gastritis Laboratory evaluation: Two types of laboratory tests have proven to be useful for predicting gastric mucosal findings: noninvasive testing for H. pylori infection and serologic biomarker measurements Helicobacter pylori testing : Noninvasive testing for H. pylori has high sensitivity and specificity for gastritis. Stomach-specific biochemical markers : Serum pepsinogens (PGs) have been used to screen patients for gastric atrophy.

6 Serologic immunologic markers — Immunological markers may be useful in clinically asymptomatic patients with early autoimmune gastritis Biopsy — Accurate histologic assessment of gastritis and gastropathy depends upon optimizing the site and number of biopsy specimens. Magnification endoscopy may help in the identification of areas to biopsy. All gross abnormalities should be biopsied and submitted in separate containers. Normal-appearing mucosa adjacent to the lesional tissue should also be biopsied.

7  Biopsy of the incisura is also useful since it approximates the transition zone between the antrum and body, where intestinal metaplasia and atrophy are most frequently found in patients with environmental metaplastic atrophic gastritis.  In first-degree relatives of patients with early onset gastric carcinoma (age <45 years), endoscopic evaluation with at least four biopsies from the gastric antrum and corpus is suggested. Multiple biopsies with adequate sampling are necessary for scoring and staging of premalignant lesions in this subgroup of patients.  Biopsies of the duodenum may also be helpful for diagnosing some forms of chronic gastritis. As examples, duodenal biopsies may show evidence of Crohn disease in patients with granulomatous gastritis or of celiac disease in patients with lymphocytic gastritis.

8  Good communication between the endoscopist and pathologist cannot be overemphasized, and will optimize the interpretation of the biopsy specimens. This has become greatly facilitated by the availability of digital endoscopic pictures and readily available endoscopic procedural dictation in the electronic medical record.  The pathologist should include a morphologic classification of the gastritis or gastropathy in the biopsy report

9 ●Gastric inflammatory disease can be broadly categorized into gastritis and gastropathy. Gastritis is predominantly an inflammatory process while gastropathy denotes gastric mucosal pathology with minimal to no inflammation. ●There is no universally accepted classification of gastritis/gastropathy, although several classifications of gastritis and gastropathy have been proposed ●A mucosal biopsy is required to distinguish acute, chronic active, and chronic gastritis and gastropathy. ●There is general consensus among experts on a biopsy approach. ●Good communication between the endoscopist and pathologist cannot be overemphasized, and will optimize the interpretation of the biopsy specimens.

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