Clinical Scoring versus Endoscopic and Histopathological Findings of upper Gastrointestinal Presentations
Bassem Ali Abdelrazek Moustafa;
Abstract
The upper gastrointestinal tract comprises of the oropharynx (the mouth and associated structures)the oesophagus, or gulletthe stomachthe duodenum and jejunum (part of the small bowel) These organs are all associated with specific pathologies and disease processes which give rise to a variety of symptom patterns which are vomiting,nausea,regurgitation,dysphagia,dyspepsia,diarrhea and hematemesis and melena(Quigley,2006).
Indicationsofupperendoscopyinpediatricsarediverseincludingchildrencomplainingofuppergastrointestinalsymptomslikepersistentvomiting,gastroesophagealrefluxdisease,upperGIbleeding,dysphagia,Melena,abnormalorunclearfindingsonanupperGIX-rayremovalofaforeignbodyorcheckhealingofapreviouslyfoundulcer(Kielty,2008).
Variousclinicalscoresaswellasendoscopicandhistopathologicgradingwereintroduced,inourstudywearediscussingthefrequencyandseverityofG.I.Tsymptomsbyusinguppergastrointestinalsymptomsscoreforeachsymptomusingwellknownscoringsystemasloebclassification(Loeb et al.,1992)alsoEndoscopicgradingandscoringusingModifiedlanzascore(Kobayashi et al.,1990)forgradingofgastritis,Hetzel-Dentclassificationforgradingofesophagitis,Joffe(Joffe et al.,2009)forgradingofduodenitis,theHistopatholigalgradingandscoringusingupdatedSydneysystem(Rugge et al.,2003),ESPGHAN(Dent et al., 2005),R.Whiteheadclassification(Richerad whitehead et al.,1975) .
ThepresentStudyisprospectiveobservationalstudycarriedoutonpatientspresentedtoAinShamsUniversitygastroenterologyunitwithsymptomsrelatedtoupperGItoundergoupperendoscopywithbiopsyasapartoftheirdiagnosticworkup,Itwascarriedouton133patientswhounderwentgastroesophageoduedenoscopy,clinical,endoscopicandhistopathologyscoringwasdonedoneaccordingtopreviouslymentionedscores.
The mean age ofthe patients presented range from 1 months to 180 months. Males (57.1%) females (42.9%)The present study showed that the most common complains were vomiting (36.8%),hematemesis ( 24.1% ), diarrhea (21.1%), dyspepsia (9%), melena (4.5%) and finally failure to thrive (0.8%).
According to loeb classification most of the patients came with vomiting have frequency more than 10 times (38.8%) and influences on daily activity (42.8%), hematemesis frequency 4 to 6 times (56.2%) and severity can be ignored (56.2),diarrhea frequency 7 to 9 times (57.1) and severity markedly influence on daily activity (50%),dyspepsia frequency more than 10 times (41.6%) and severity influences on daily activity ( 50%) and finally melena frequencies 1 to 3 times (50%) and severity influences in daily activity (33.3%)
The results of the present study showed that 10.5% have nodularity, 30.8 % have incompetent cardia asendoscopic esophageal findings among included patients. 51.9% have grade 030.8%have grade 14.5%have grade 2 according toHetzel-Dent classification
The results of the present study showed that 18% have nodularity as endoscopic findings in the stomach. 66.9% showed grade 1,23.3% showed grade 2 5.3% showed grade 3 3% shows grade 4, 1.5% shows grade 5 according to degree of gastritis among included patients according to modified lanza score.
The results of the presented study showed that 28.2% have nodularity, 13.5% have flat mucosa asendoscopic duodenal findings among included patients.88.8% shows grade 1 and 7.7% shows grade 2 according to joffe classification of duodenitis among included patients.
The result of the present study showed that among 37esophagealbiopsies taken from included patients (133) histopathological finding was54.1% have increased papillary height while 45.9% have normal papillary height. 81.1% has mild degree esophagitis.75.7% have no eisonophils in esophageal biopsy while 24.3% have 5to 10 eisonphils HPF in the biopsy.and finally 81.1% diagnosed as reflux esophagitis as histopatholgical diagnosis while 18.9% have normal mucosa as diagnosis.
The result of the present study showed that among89 gastricbiopsies taken from included patients (133) histopathological finding was 24.7% have Hpylori in gastric biopsy.78.7% have mild degree gastritis,15.7% have normal gastric mucosaand 5.6% have moderate degree gastritis.
39.3% have lymphocytes and plasma cells in their gastric biopsy and 25.8 have all type of cells,93.3%have no eisonophils in gastric mucosa 2.2% from 5 to 10 HPF, 4.5% more than 20% HPF,42.7%were diagnosed as non specific superficial gastritis,22.5% diagnosed as Hpylori gastritis15% normal mucosa,10.1%atrophic gastritis,4.5%gastric ulcer and finally 4.5 eisonphilic gastritis
The result of the present study showed that among 85 duodenal biopsies taken from included patients (133) histopathological finding was 15.3% have lost villi of the duodenum in the duodenal biopsy 85.9% have mild degree duodenitis,9.4% have moderate degree duodenitis and 4.7% have severe duodenitis. 47.1% have 5 to 10 eisonophils HPF, 42.4% have normal number of eisonophils 3.5% have from 10 to 15 per HPF finally 4.7% have more than 20,72.3% diagnosed as non specific duodenitis and 27.7% have allergic duodenitis.
Indicationsofupperendoscopyinpediatricsarediverseincludingchildrencomplainingofuppergastrointestinalsymptomslikepersistentvomiting,gastroesophagealrefluxdisease,upperGIbleeding,dysphagia,Melena,abnormalorunclearfindingsonanupperGIX-rayremovalofaforeignbodyorcheckhealingofapreviouslyfoundulcer(Kielty,2008).
Variousclinicalscoresaswellasendoscopicandhistopathologicgradingwereintroduced,inourstudywearediscussingthefrequencyandseverityofG.I.Tsymptomsbyusinguppergastrointestinalsymptomsscoreforeachsymptomusingwellknownscoringsystemasloebclassification(Loeb et al.,1992)alsoEndoscopicgradingandscoringusingModifiedlanzascore(Kobayashi et al.,1990)forgradingofgastritis,Hetzel-Dentclassificationforgradingofesophagitis,Joffe(Joffe et al.,2009)forgradingofduodenitis,theHistopatholigalgradingandscoringusingupdatedSydneysystem(Rugge et al.,2003),ESPGHAN(Dent et al., 2005),R.Whiteheadclassification(Richerad whitehead et al.,1975) .
ThepresentStudyisprospectiveobservationalstudycarriedoutonpatientspresentedtoAinShamsUniversitygastroenterologyunitwithsymptomsrelatedtoupperGItoundergoupperendoscopywithbiopsyasapartoftheirdiagnosticworkup,Itwascarriedouton133patientswhounderwentgastroesophageoduedenoscopy,clinical,endoscopicandhistopathologyscoringwasdonedoneaccordingtopreviouslymentionedscores.
The mean age ofthe patients presented range from 1 months to 180 months. Males (57.1%) females (42.9%)The present study showed that the most common complains were vomiting (36.8%),hematemesis ( 24.1% ), diarrhea (21.1%), dyspepsia (9%), melena (4.5%) and finally failure to thrive (0.8%).
According to loeb classification most of the patients came with vomiting have frequency more than 10 times (38.8%) and influences on daily activity (42.8%), hematemesis frequency 4 to 6 times (56.2%) and severity can be ignored (56.2),diarrhea frequency 7 to 9 times (57.1) and severity markedly influence on daily activity (50%),dyspepsia frequency more than 10 times (41.6%) and severity influences on daily activity ( 50%) and finally melena frequencies 1 to 3 times (50%) and severity influences in daily activity (33.3%)
The results of the present study showed that 10.5% have nodularity, 30.8 % have incompetent cardia asendoscopic esophageal findings among included patients. 51.9% have grade 030.8%have grade 14.5%have grade 2 according toHetzel-Dent classification
The results of the present study showed that 18% have nodularity as endoscopic findings in the stomach. 66.9% showed grade 1,23.3% showed grade 2 5.3% showed grade 3 3% shows grade 4, 1.5% shows grade 5 according to degree of gastritis among included patients according to modified lanza score.
The results of the presented study showed that 28.2% have nodularity, 13.5% have flat mucosa asendoscopic duodenal findings among included patients.88.8% shows grade 1 and 7.7% shows grade 2 according to joffe classification of duodenitis among included patients.
The result of the present study showed that among 37esophagealbiopsies taken from included patients (133) histopathological finding was54.1% have increased papillary height while 45.9% have normal papillary height. 81.1% has mild degree esophagitis.75.7% have no eisonophils in esophageal biopsy while 24.3% have 5to 10 eisonphils HPF in the biopsy.and finally 81.1% diagnosed as reflux esophagitis as histopatholgical diagnosis while 18.9% have normal mucosa as diagnosis.
The result of the present study showed that among89 gastricbiopsies taken from included patients (133) histopathological finding was 24.7% have Hpylori in gastric biopsy.78.7% have mild degree gastritis,15.7% have normal gastric mucosaand 5.6% have moderate degree gastritis.
39.3% have lymphocytes and plasma cells in their gastric biopsy and 25.8 have all type of cells,93.3%have no eisonophils in gastric mucosa 2.2% from 5 to 10 HPF, 4.5% more than 20% HPF,42.7%were diagnosed as non specific superficial gastritis,22.5% diagnosed as Hpylori gastritis15% normal mucosa,10.1%atrophic gastritis,4.5%gastric ulcer and finally 4.5 eisonphilic gastritis
The result of the present study showed that among 85 duodenal biopsies taken from included patients (133) histopathological finding was 15.3% have lost villi of the duodenum in the duodenal biopsy 85.9% have mild degree duodenitis,9.4% have moderate degree duodenitis and 4.7% have severe duodenitis. 47.1% have 5 to 10 eisonophils HPF, 42.4% have normal number of eisonophils 3.5% have from 10 to 15 per HPF finally 4.7% have more than 20,72.3% diagnosed as non specific duodenitis and 27.7% have allergic duodenitis.
Other data
| Title | Clinical Scoring versus Endoscopic and Histopathological Findings of upper Gastrointestinal Presentations | Other Titles | التصنيف السجلى السريرى مقابل نتائج المنظار وفحص الانسجة لاعراض الجهاز الهضمي العلوي | Authors | Bassem Ali Abdelrazek Moustafa | Issue Date | 2015 |
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