title: Evolving patterns in the diagnosis of reactive gastropathy: data from a prospective Central European multicenter study with proposal of a new histologic scoring system.
abstract: Histologic examination of gastric biopsies is crucial for determining the cause of gastritis. This prospective multicenter study was undertaken to investigate different histologic parameters arguing in favor or against the diagnosis of reactive gastropathy and to correlate findings with patient's symptoms and endoscopic findings. A total of 1123 individuals aged 15-93 years participated in a prospective multicenter study (histoGERD trial). Diagnosis of Helicobacter gastritis was made following the Updated Sydney System. Diagnosis of reactive gastropathy was based upon Dixon's parameters of foveolar hyperplasia, smooth muscle fibers in the lamina propria and vasodilatation and congestion of mucosal capillaries. Including paucity of acute and chronic inflammatory cells in analysis, a new score with visual analog scales for the diagnosis of reactive gastropathy was developed. All three histologic parameters in favor of the diagnosis of reactive gastropathy were positively associated with the endoscopic diagnosis of gastritis (p < 0.001), yet negatively with Helicobacter infection (p < 0.001). In contrast, presence of acute and chronic inflammatory cells in lamina propria was positively associated with Helicobacter infection (p < 0.001), yet not with the endoscopic diagnosis of gastritis. Our score demonstrated strong association between histologic and endoscopic diagnoses (p < 0.001), yet not with patient's symptoms. In conclusion, our data prove foveolar hyperplasia, smooth muscle fibers and vasodilatation and congestion as key histologic parameters for the diagnosis of reactive gastropathy. The proposed score may enhance the diagnostic accuracy. It should be validated in future studies.
authors.affiliation: Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036 Graz, Austria. Electronic address: evamariawolf@yahoo.de.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Wolf
authors.affiliation: Department of Internal Medicine, Krankenhaus der Barmherzigen Brüder, Academic Teaching Hospital, Spitalgasse 26, 9300 Sankt Veit/Glan, Austria. Electronic address: wolfgang.plieschnegger@bbstveit.at.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Plieschnegger
authors.affiliation: Private Practice, Alexanderstr. 2, 95444 Bayreuth, Germany. Electronic address: mgmichaelgeppert@t-online.de.
authors.forename: Bertram
authors.initials: B
authors.lastname: Schmack
authors.affiliation: Private Practice, Bischofsstr. 30, 49074 Osnabrück, Germany. Electronic address: hbordel@gastropraxis-os.de.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Bordel
authors.affiliation: Department of Surgery, Division of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria. Electronic address: bernd.hoefler@medunigraz.at.
authors.forename: Bernd
authors.initials: B
authors.lastname: Höfler
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. Electronic address: andreas.eherer@medunigraz.at.
authors.forename: Andreas
authors.initials: A
authors.lastname: Eherer
authors.affiliation: Institute of Pathology, Klinikum Bayreuth, Preuschwitzer Str. 101, 95445 Bayreuth, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Schulz
authors.affiliation: Institute of Pathology, Klinikum Bayreuth, Preuschwitzer Str. 101, 95445 Bayreuth, Germany. Electronic address: vieth.lkpathol@uni-bayreuth.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.affiliation: Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036 Graz, Austria. Electronic address: cord.langner@medunigraz.at.
authors.forename: Cord
authors.initials: C
authors.lastname: Langner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D001706:Biopsy; D002908:Chronic Disease; D005260:Female; D005756:Gastritis / Q000382:microbiology / Q000473:pathology*; D005773:Gastroscopy; D005858:Germany; D016481:Helicobacter Infections / Q000382:microbiology / Q000473:pathology*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D032389:Myocytes, Smooth Muscle / Q000473:pathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013270:Stomach / Q000382:microbiology / Q000473:pathology*; D014664:Vasodilation; D055815:Young Adult
keywords: Chronic gastritis; Endoscopy; Histology; Reflux gastritis; Visual analog scale