Abstract
Biopsy sampling of gastric mucosa at diagnostic endoscopy provides information that
cannot be obtained by other means. The most common indication for gastric biopsy is
the need to know whether or not the patient is infected with Helicobacter pylori, and whether the stomach is gastritic or not. Microscopic examination of gastric
biopsy specimens, in addition to H. pylori status, provides information about the grade, extent, and topography of gastritis-related
and atrophy-related lesions in the stomach. This information provides further opportunities
for assessing the risk and likelihood of various gastric disorders. These are: a)
The predominance or restriction of the H. pylori-related gastritis in the antrum strongly correlates with an increased risk of peptic
ulcer disease, and of duodenal ulcer in particular (the duodenal ulcer phenotype of
gastritis), b) The presence of atrophic gastritis (loss of normal glands) in the area
of the gastric body indicates a low risk of ulcer and also a reduction in the capacity
of the patient to secrete acid, c) The occurrence of advanced atrophic gastritis and
intestinal metaplasia multifocally in the stomach (advanced multifocal atrophic gastritis),
and in the lesser curvature and angular notch in particular, are features suggestive
of an increased risk of gastric neoplasias (the gastric cancer phenotype of gastritis),
d) The presence of normal and healthy gastric mucosa indicates, on the other hand,
an extremely low risk of both peptic ulcer disease and gastric cancer. In addition
to diagnosis of H. pylori-related gastritic lesions, routine gastric biopsies may reveal findings that indicate
special forms of gastritis, such as eosinophilic, lymphocytic, reactive, or granulomatous
gastritis (e.g., Crohn's gastritis), or Helicobacter heilmannii gastritis. These types of gastritis can be found incidentally in a small percentage
of patients who undergo diagnostic gastroscopy for abdominal complaints.
