van Grieken Nicole C T, Meijer Gerrit A, Kale Ilse, Bloemena Elisabeth, Lindeman Jan, Offerhaus G Johan A, Meuwissen Stefan G M, Baak Jan P A, Kuipers Ernst J
Department of Gastroenterology, Free University Medical Center, Amsterdam, The Netherlands.
Digestion. 2004;69(1):27-33. doi: 10.1159/000076544. Epub 2004 Jan 30.
BACKGROUND/AIMS: Grading gastric mucosal atrophy in antrum biopsy specimens remains a controversial subject because of limitations in interobserver agreement. We previously described a reliable, quantitative method for grading atrophy of the corpus mucosa with excellent reproducibility and good correlation with the Sydney scores. The aims of the present study were to evaluate the applicability of this method for the grading of antral atrophy and to study the effect of Helicobacter pylori eradication on the antral mucosa.
Antrum biopsy specimens were collected from 71 gastroesophageal reflux disease patients at baseline and after 3 and 12 months. After the first endoscopy, all subjects were treated with omeprazole 40 mg daily for 12 months. After randomization, 27 of the 48 H. pylori-positive patients additionally received eradication therapy. In 182 hematoxylin-eosin-stained specimens, which were of sufficient quality, the proportions (volume percentages) of glands (VPGL), stroma (VPS), infiltrate (VPI), and intestinal metaplasia in the glandular zone of the antrum mucosa were measured using a point-counting method. In these specimens, mucosal atrophy was assessed by two experienced gastrointestinal tract pathologists (E.B. and J.L.) according to the updated Sydney classification as either nonatrophic mucosa (n = 47) or as mild (n = 29), moderate (n = 50), or marked (n = 56) atrophy. In addition, a group of 23 cases with difficult-to-classify grades of atrophy were included.
The mean VPGL decreased with increasing Sydney grades of atrophy (p < 0.001), while the mean VPS and VPI increased (both p < 0.001). After H. pylori eradication, even the cases with the lowest VPGL regressed to normal levels.
Overall, a low VPGL correlates with increasing grades of antrum mucosal atrophy. The present data indicate that gastric mucosal atrophy is reversible, since almost all cases showed regression of VPGL after H. pylori eradication. The cases with difficult-to-classify grades of atrophy showed significantly lower VPGLs and higher VPIs than the reference cases.
背景/目的：由于观察者间一致性存在局限性，对胃窦活检标本中的胃黏膜萎缩进行分级仍是一个有争议的问题。我们之前描述了一种可靠的、定量的胃体黏膜萎缩分级方法，具有出色的可重复性，且与悉尼评分具有良好的相关性。本研究的目的是评估该方法对胃窦萎缩分级的适用性，并研究幽门螺杆菌根除对胃窦黏膜的影响。
从71例胃食管反流病患者中在基线、3个月和12个月时采集胃窦活检标本。首次内镜检查后，所有受试者接受每日40毫克奥美拉唑治疗12个月。随机分组后，48例幽门螺杆菌阳性患者中的27例额外接受了根除治疗。在182份质量足够的苏木精-伊红染色标本中，使用点计数法测量胃窦黏膜腺区的腺体比例（体积百分比，VPGL）、间质比例（VPS）、浸润比例（VPI）和肠化生情况。在这些标本中，由两位经验丰富的胃肠道病理学家（E.B.和J.L.）根据更新的悉尼分类法将黏膜萎缩评估为非萎缩性黏膜（n = 47）或轻度（n = 29）、中度（n = 50）或重度（n = 56）萎缩。此外，纳入了一组23例萎缩分级难以分类的病例。
随着悉尼萎缩分级的增加，平均VPGL降低（p < 0.001），而平均VPS和VPI增加（均p < 0.001）。幽门螺杆菌根除后，即使是VPGL最低的病例也恢复到了正常水平。
总体而言，低VPGL与胃窦黏膜萎缩程度增加相关。目前的数据表明胃黏膜萎缩是可逆的，因为几乎所有病例在幽门螺杆菌根除后VPGL都出现了下降。萎缩分级难以分类的病例的VPGL明显低于参考病例，VPI则更高。
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