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Title: Morphological assessment of the main parameters in chronicgastritis based on Sydney System

Małgorzata Barwijuk-Machała, Andrzej Kemona, Marian Sulik, Jacek Cylwik
Original articles
Polish Gastroenterology
Start page:
Final page:
chronic gastritis, morphology, Sydney System

Background: Endoscopy is one of the most important tools to investigate the upper gastrointestinal tract. It permits direct visualization and biopsy. The greatest value could be obtained from this method by providing a comprehensive description of histological parameters. Aim of the study: The aim of this study was histopathological assessment of the gastric mucosa using the updated Sydney System in a series of 308 patients with clinical diagnosis of chronic gastritis. The statistical analysis was performed in order to determine the relationship between the main parameters of gastric mucosal inflammation. The value of the revised version of the Sydney System in reporting chronic gastritis was evaluated. Material and methods: During endoscopy two mucosal biopsies were obtained routinely from both the gastricantrum and the gastric body from each patient and one from incisura angularis. Slides were stained with hematoxylin-eosin, Azan, alcian blue (pH 2.5) / periodic acid - Schiff and with modified Giemsa stain to visu-alize Helicobacterpylori (H.p.). Specimens were assessed histologically with the updated Sydney System. Results: 297 subjects were found to have active chronić gastritis, which was noted in both the antrum and corpus in 94%. Among patients with gastritis, H.p. was identified in 67.3%. H.p. infection in the corpus mu-cosa was distinctly associated with the presence of chronić gastritis in the antrum. The density of mono-nuclear cells and neutrophils were significantly associated with the amount of H.p. They increased with in-creasing bacteria concentration in both topographic areas of the stomach. The intensity of inflammation was found to be correlated with the severity of glandular atrophy. An increase in loss of glands was associated with an increase of the grade of intestinal metaplasia. The prevalence and the severity of the glandular atrophy and intestinal metaplasia were higher in the antrum than in the corpus and increased significantly with advancing age of patients. In both locations of the stomach, the grade of H.p. colonization tended to decre-ase with increasing severity of the glandular atrophy and intestinal metaplasia in the corpus mucosa. Conclusions: Based on the obtained data, the grade of H. pylori infection may be taken as a marker of the se-verity of inflammatory reaction. Gastric atrophy and/or intestinal metaplasia are the main determinants of bac-terial colonisation in the course of gastritis extending proximally from the antrum to the corpus. Using Sydney System with a visual analog scalę for the graded variables it is possible to generate a precise diagno-sis of chronić gastritis.