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Tu1724 Improved Interobsever Agreement of the OLGA Staging System Using Oriented Nitrocellulose Filters Gastric Biopsies
Abstracts Summary of endoscopic appearances Tu1722 Does Antibody Producibility Affect the Serum Anti-Helicobacter pylori Immunoglobulin G Antibody Titer? Hyun Ah Chung*, Sun-Young Lee, Jeong Hwan Kim, Hyung Seok Park, Chan Sup Shim, in-Kyung Sung Department of Internal Medicine, Kunkuk University School of Medicine, Seoul, Korea (the Republic of) Background/Aims: Serum antibody titer differs according to the antibody producibility of the host. Hepatitis B vaccination is performed to all Koreans in the infancy or childhood supported by the national insurance, but some do not produce hepatitis B virus surface antibody (HBsAb) after the vaccination. The aim of this study was to elucidate whether the serum anti-H. pylori IgG antibody titer is related to serum HBsAb titer in Korean adults. Methods: Consecutive Korean adults with positive Giemsa staining who underwent serum pepsinogen (PG) assay, anti-H. pylori IgG antibody test, hepatitis B virus surface antigen (HBsAg)/antibody test, and endoscopic biopsy for H. pylori evaluation on the same day were included. Subjects were excluded if they were under 20 years old, showed a positive HBsAg finding, had a recent history of medication, or were in immunocompromised state. Results: Of 158 Korean adults who fulfilled the study inclusion criteria, 107 subjects (67.7%) showed marked H. pylori infiltration based on the Updated Sydney System, whereas 33 (20.9%) and 18 (11.4%) showed moderate and mild infiltration. The serum anti-H. pylori IgG antibody titer was significantly correlated with the amount of H. pylori infiltration on gastric biopsy (p!0.001), PG II concentration (pZ0.012), and PG ratio (p!0.001), but not to the serum HBsAb titer (pZ0.649) and PG I concentration (pZ0.115). The serum HBsAb titer in the subjects with marked H. pylori infiltration on the gastric biopsy was not different from those of the subjects with moderate and mild H. pylori infiltration (pZ0.505). Conclusions: The serum anti-H. pylori IgG antibody titer is significantly linked to the bacterial load of the stomach regardless of the antibody producibility of the host. The serum anti-H. pylori IgG antibody test can be used for estimating the burden of bacteria in immunocompetent host with H. pylori infection.
Extent of atrophy by AFI Micromucosal pattern by M-NBI
Nonesmall Medium Large FV O80% FV 5080% GV 5080% GV O80%
H. pylori naive (n[6)
H. pylori associated gastritis (n[14)
Autoimmune gastritis (n[7)
Pvalue
6
4
0
!0.01
0 0 6
9 1 1
0 7 6
!0.01
0
6
1
0
3
0
0
4
0
Tu1723 Difference of Micoromucosal Patterns of the Gastric Corpus Mucosa Between Helicobacter pylori-Associated and Autoimmune Gastritis Patient Noriya Uedo*1, Ervin Toth2, Ryu Ishihara1, Tomofumi Akasaka1, Noboru Hanaoka1, Yoji Takeuchi1, Koji Higashino1, Artur Nemeth2, Gabriele W. Johansson2, Henrik Thorlacius3, Hiroyasu Iishi1 1 Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; 2Endoscopy, Skåne University Hospital, Malmö, Sweden; 3Surgery, Skåne University Hospital, Malmö, Sweden Background: Helicobacter pylori (H. pylori)-associated gastritis and autoimmune gastritis are two major entities of chronic atrophic gastritis. However, characteristic of micromucosal pattern observed by magnifying endoscopy of these diseases has not been fully investigated. Aim of this study is to compare magnifying endoscopic appearance between H. pylori-associated and autoimmune gastritis. Methods: Six H. pylori naïve, 14 H. pylori-associated gastritis and 7 autoimmune gastritis patients were enrolled in this study. A videoendoscope, EVIS GIFFQ260Z, that can be used in high-resolution white light, autofluorescence (AFI) and magnifying narrow band imaging (M-NBI) modes was used to evaluate mucosal features. Extent of mucosal atrophy in the corpus was determined as extent of greenish areas in AFI. A 22 cm area at the lesser curvature of the corpus about 4 cm proximal to the angulus was set as the region of interest for evaluation of micromucosal patterns. The micromucosal patterns were classified into Foveola and Groove type according to magnifying chromoendoscopic and M-NBI findings. The Foveola type mucosa was characterized as mucosa with round, oval, or short linear foveolae (gastric pits) on magnifying chromoendoscopy. On M-NBI, it had network of dark brown subepithelial capillary that surround light brown epithelium. The Groove type mucosa was characterized by mucosal crests or papillae that were divided by continuous grooves on magnifying chromoendoscopy, and had light brown epithelium that encase dark brown subepithelial capillary. Proportion of the micromucosal patterns were categorized as, Foveola O80%; Foveola 50-80%; Groove 50-80%; and Groove O80%. Biopsy sample was taken from the region of interest to evaluate histological grade of gastritis. Results: All H. pylori naïve patients had purple corpus mucosa and the micromucosal pattern was Foveola type. 10 of 14 (71%) patients with H. pylori-associated gastritis showed medium to large greenish atrophic mucosa at the lesser curvature of the corpus, and 13 of 14 (93%) had various proportion of groove type mucosa. All autoimmune gastritis patients had large area of greenish mucosa in the entire corpus but most (O80%) of micromucosal pattern was Foveola type. The biopsy specimen in H. pylori-associated gastritis patients had higher grade of intestinal metaplasia than that in autoimmune gastritis patients. Conclusion: Micromucosal pattern of the gastric corpus mucosa in H. pylori associated-gastritis patients was unlike to that of autoimmune gastritis patients suggesting different pathogenesis of these diseases
AB572 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
Tu1724 Improved Interobsever Agreement of the OLGA Staging System Using Oriented Nitrocellulose Filters Gastric Biopsies Bogdan Cotruta, Cristian Gheorghe, Razvan Iacob*, Mona Dumbrava, Cristina Radu, Ion Bancila, Gabriel Becheanu Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania Background&Aims: Gastric cancer is one of the most common cancers worldwide, being the third leading cause of cancer death in both sexes. Standardized evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects at high risk to develop gastric cancer. The interobsever agreement for the assessment of gastric atrophy is reported to be low. The aim of the study was to evaluate the interobserver agreement for the OLGA staging system using oriented and unoriented gastric biopsy samples. Methods: A total of 35 (12 male / 23 female, mean age 67 years) patients with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study have been prospectively enrolled. The OLGA/OLGIM gastric biopsies protocol was used. Two sets of biopsies have been obtained from each patient (four from antrum, two oriented and two unoriented, two from gastric incisure, one oriented and one unoriented, four from gastric body, two oriented and two unoriented). The orientation of the biopsy samples was made using nitrocellulose filters (EndokitÒ, BioOptica, Milan, Italy). The samples have been examined blindly by two experienced pathologists. Interobserver agreement was calculated using kappa statistics for multiple raters. Results: The kappa index values for oriented/unoriented OLGA 0, I, II, III, and IV stages have been 0.62/0.13, 0.70/0.20, 0.61/0.06, 0.62/0.46, and 0.77/0.50 respectively. For OLGIM 0, I, II, and III stages the kappa index values for oriented/unoriented samples were 0.83/0.83, 0.88/0.89, 0.70/0.80, and 0.83/1 respectively. No case of OLGIM IV stage has been found in our series. Conclusion: Orientation of gastric biopsies specimens significantly improves the interobsever agreement for assessment of gastric atrophy. If the results will be confirmed in future studies, the orientation of gastric biopsies should be used as standard protocol for gastric atrophy assessment.
www.giejournal.org
Extent of atrophy by AFI Micromucosal pattern by M-NBI
Nonesmall Medium Large FV O80% FV 5080% GV 5080% GV O80%
H. pylori naive (n[6)
H. pylori associated gastritis (n[14)
Autoimmune gastritis (n[7)
Pvalue
6
4
0
!0.01
0 0 6
9 1 1
0 7 6
!0.01
0
6
1
0
3
0
0
4
0
Tu1723 Difference of Micoromucosal Patterns of the Gastric Corpus Mucosa Between Helicobacter pylori-Associated and Autoimmune Gastritis Patient Noriya Uedo*1, Ervin Toth2, Ryu Ishihara1, Tomofumi Akasaka1, Noboru Hanaoka1, Yoji Takeuchi1, Koji Higashino1, Artur Nemeth2, Gabriele W. Johansson2, Henrik Thorlacius3, Hiroyasu Iishi1 1 Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; 2Endoscopy, Skåne University Hospital, Malmö, Sweden; 3Surgery, Skåne University Hospital, Malmö, Sweden Background: Helicobacter pylori (H. pylori)-associated gastritis and autoimmune gastritis are two major entities of chronic atrophic gastritis. However, characteristic of micromucosal pattern observed by magnifying endoscopy of these diseases has not been fully investigated. Aim of this study is to compare magnifying endoscopic appearance between H. pylori-associated and autoimmune gastritis. Methods: Six H. pylori naïve, 14 H. pylori-associated gastritis and 7 autoimmune gastritis patients were enrolled in this study. A videoendoscope, EVIS GIFFQ260Z, that can be used in high-resolution white light, autofluorescence (AFI) and magnifying narrow band imaging (M-NBI) modes was used to evaluate mucosal features. Extent of mucosal atrophy in the corpus was determined as extent of greenish areas in AFI. A 22 cm area at the lesser curvature of the corpus about 4 cm proximal to the angulus was set as the region of interest for evaluation of micromucosal patterns. The micromucosal patterns were classified into Foveola and Groove type according to magnifying chromoendoscopic and M-NBI findings. The Foveola type mucosa was characterized as mucosa with round, oval, or short linear foveolae (gastric pits) on magnifying chromoendoscopy. On M-NBI, it had network of dark brown subepithelial capillary that surround light brown epithelium. The Groove type mucosa was characterized by mucosal crests or papillae that were divided by continuous grooves on magnifying chromoendoscopy, and had light brown epithelium that encase dark brown subepithelial capillary. Proportion of the micromucosal patterns were categorized as, Foveola O80%; Foveola 50-80%; Groove 50-80%; and Groove O80%. Biopsy sample was taken from the region of interest to evaluate histological grade of gastritis. Results: All H. pylori naïve patients had purple corpus mucosa and the micromucosal pattern was Foveola type. 10 of 14 (71%) patients with H. pylori-associated gastritis showed medium to large greenish atrophic mucosa at the lesser curvature of the corpus, and 13 of 14 (93%) had various proportion of groove type mucosa. All autoimmune gastritis patients had large area of greenish mucosa in the entire corpus but most (O80%) of micromucosal pattern was Foveola type. The biopsy specimen in H. pylori-associated gastritis patients had higher grade of intestinal metaplasia than that in autoimmune gastritis patients. Conclusion: Micromucosal pattern of the gastric corpus mucosa in H. pylori associated-gastritis patients was unlike to that of autoimmune gastritis patients suggesting different pathogenesis of these diseases
AB572 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 5S : 2015
Tu1724 Improved Interobsever Agreement of the OLGA Staging System Using Oriented Nitrocellulose Filters Gastric Biopsies Bogdan Cotruta, Cristian Gheorghe, Razvan Iacob*, Mona Dumbrava, Cristina Radu, Ion Bancila, Gabriel Becheanu Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania Background&Aims: Gastric cancer is one of the most common cancers worldwide, being the third leading cause of cancer death in both sexes. Standardized evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects at high risk to develop gastric cancer. The interobsever agreement for the assessment of gastric atrophy is reported to be low. The aim of the study was to evaluate the interobserver agreement for the OLGA staging system using oriented and unoriented gastric biopsy samples. Methods: A total of 35 (12 male / 23 female, mean age 67 years) patients with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study have been prospectively enrolled. The OLGA/OLGIM gastric biopsies protocol was used. Two sets of biopsies have been obtained from each patient (four from antrum, two oriented and two unoriented, two from gastric incisure, one oriented and one unoriented, four from gastric body, two oriented and two unoriented). The orientation of the biopsy samples was made using nitrocellulose filters (EndokitÒ, BioOptica, Milan, Italy). The samples have been examined blindly by two experienced pathologists. Interobserver agreement was calculated using kappa statistics for multiple raters. Results: The kappa index values for oriented/unoriented OLGA 0, I, II, III, and IV stages have been 0.62/0.13, 0.70/0.20, 0.61/0.06, 0.62/0.46, and 0.77/0.50 respectively. For OLGIM 0, I, II, and III stages the kappa index values for oriented/unoriented samples were 0.83/0.83, 0.88/0.89, 0.70/0.80, and 0.83/1 respectively. No case of OLGIM IV stage has been found in our series. Conclusion: Orientation of gastric biopsies specimens significantly improves the interobsever agreement for assessment of gastric atrophy. If the results will be confirmed in future studies, the orientation of gastric biopsies should be used as standard protocol for gastric atrophy assessment.
www.giejournal.org