Histological changes in patients with chronic upper gastrointestinal ischaemia.
OBJECTIVE
Diagnosing chronic upper gastrointestinal ischaemia (CUGI) remains a challenge in clinical practice. Histological examination of biopsy material currently plays no role in the diagnosis of transient CUGI, as little is known about gastrointestinal histology in these patients. The aim of this study was to investigate upper gastrointestinal histology in patients with well-defined CUGI.


RESULTS
Consecutive patients suspected of CUGI were included prospectively and underwent a diagnostic work-up existing of upper endoscopy, gastrointestinal tonometry and computed tomography (CT) or magnetic resonance (MR) angiography. Results were discussed in a multidisciplinary team and a consensus diagnosis was made. Endoscopic biopsy samples were taken from the descending duodenum, gastric antrum and corpus, and scored using the Sydney, Vienna, Chiu, Marsh and Operative Link for Gastritis Assessment (OLGA) classifications. Gastropathy was scored present or absent. Seventy-nine patients were analysed in 8months. CUGI was diagnosed in 41 patients (52%): 36 males, mean age 60 (17-86) years. Prevalence of gastropathy was significantly higher in patients with ischaemia (P=0.025). No other differences were found between patients with and without ischaemia.


CONCLUSIONS
Histological examination of biopsy samples plays no definitive role in diagnosing CUGI, but the presence of histological signs of reactive gastropathy can be used to support the clinical diagnosis of ischaemia.
Departments of Gastroenterology and Hepatology Pathology Intervention Radiology Vascular Surgery Internal Medicine, Erasmus MC - University Medical Center, Rotterdam, the Netherlands. d.vannoord@erasmusmc.nl
Désirée
D
Van Noord
Katharina
K
Biermann
Leon Mg
LM
Moons
Peter Mt
PM
Pattynama
Hence Jm
HJ
Verhagen
Ernst J
EJ
Kuipers
Peter Bf
PB
Mensink
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D005767:Gastrointestinal Diseases / Q000473:pathology*; D006801:Humans; D007511:Ischemia / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult