During the past decades, the prevalence of gastric and duodenal ulcers, as well as Helicobacter pylori infection, has markedly declined. We hypothesized that the decline in H. pylori prevalence has ...decreased the fraction of H. pylori-positive gastric and duodenal ulcers. The present study was designed to test this hypothesis in a large US population undergoing esophagogastro-duodenoscopy in community-based endoscopy centers.
The Inform Diagnostics database is a national electronic repository of histopathologic records of patients distributed throughout the United States. A cross-sectional study among 1,289,641 individual esophagogastro-duodenoscopy patients analyzed the prevalence of peptic ulcers stratified by age, sex, ethnicity, H. pylori status, year of diagnosis, and ulcer type. The joint influence of multiple predictor variables on the occurrence of gastric and duodenal ulcers was analyzed using multivariate logistic regression analysis.
Between 2009 and 2018, the general prevalence of H. pylori infection fell significantly from 11% to 9%. This decline was accompanied by a similar decline in the fraction of H. pylori-positive gastric ulcers from 17% to 14% and H. pylori-positive duodenal ulcers from 25% to 21%. Nowadays, only 17% of all patients with ulcer harbor H. pylori. The fraction of H. pylori-positive ulcers was significantly greater in duodenal than in gastric ulcers and in male than in female patients with ulcer. The prevalence of H. pylori was 2.6-fold higher among Hispanics and 3.2-fold higher among East Asians compared with the general population. The H. pylori prevalence fell from 24% to 22% among Hispanics and from 21% to 15% among East Asians. In East Asians and Hispanics, the fraction of H. pylori-positive gastric ulcers was 37% and 35%, respectively.
H. pylori infection continues to fall in the general population. Nowadays, even among patients with ulcer only a small minority harbors H. pylori infection.
Although large polyps are known to harbor more advanced neoplasia than small polyps, the extent of the relationship between size and type is not fully known. The study aim was to establish benchmarks ...for the prevalence of different histologic polyp types among varying size categories.
The Miraca Life Sciences Database is an electronic repository of histopathologic patient records from private practices throughout the United States. We extracted the records of 483,998 unique patients who underwent colonoscopy with polypectomy between January 2008 and December 2014. A total of 550,811 polyps were stratified by their endoscopic size measurement. Polyps of each size were further stratified as hyperplastic polyp (HP), tubular adenoma (TA), tubulovillous adenoma (TVA), sessile serrated adenoma/polyp, and adenocarcinoma.
Of all 550,811 polyps, 447,343 (81%) were 1-9 mm in size, and 103,517 (19%) were 10 mm or larger. A fraction of 18,591/550,811 polyps (3.4%) harbored histologic features of advanced adenoma, such as TVA, high-grade dysplasia, or cancer. Of these, 4,725/18,591 (25%) occurred in polyps 1-9 mm and 13,868/18,591 (75%) occurred in polyps 10 mm or larger. The fractions of advanced adenoma were 0.6% (0.5-0.6%) in 1-5 mm polyps and 2.1% (2.0-2.2%) in 6-9 mm polyps, as compared to 13.4% (13.2-13.6%) in polyps 10 mm or larger. The frequency of HP significantly decreased with increasing polyp size, whereas the frequency of TA remained largely unaffected by polyp size.
While advanced histopathology was found more frequently in colorectal polyps of larger than smaller size, one quarter of all advanced histopathology existed in polyps of <10 mm.
SUMMARY
Background
Lymphocytic gastritis (LyG) is a histopathologic finding of unknown clinical relevance.
Aims
To explore the clinical epidemiology of LyG and its associations with Helicobacter ...pylori (Hp) infection, coeliac disease (CD) and microscopic colitis (MC)
Methods
In a cross‐sectional study, the demographic, clinical, and histopathologic data of patients with and without LyG were compared. Between 2008 and 2020, 1.5 million patients with endoscopic biopsies of the gastroduodenal mucosa were extracted from a database. LyG diagnoses were reviewed to collect detailed information regarding its topographic distribution within the stomach. In a large subgroup of 400 000 patients, tissue samples from the colon were also available.
Results
Of 1 481 336 patients, 341 had LyG with Hp and 2697 had Hp‐negative LyG (with an overall prevalence of 0.21%). In patients with Hp‐negative LyG, 450 (17%) had corpus‐predominant LyG, 1068 antrum‐predominant LyG (40%), and 1179 pangastric LyG (44%). LyG was more common in males and in subjects aged 50‐70 years. There was no significant ethnic variation. Anaemia, diarrhoea, and weight loss were more common in patients with than without LyG. In 35% and 19% of patients, LyG was associated with CD and MC, respectively. All 72 patients with Hp‐positive LyG and 280 of 310 patients with Hp‐negative LyG with follow‐up biopsies became free of LyG within a year.
Conclusions
Most cases of LyG may represent a self‐limited expression, frequently associated with other GI conditions, such as Hp infection, CD, and MC. In most patients, LyG is likely to resolve within a year after its initial diagnosis.
Lymphocytic gastritis (LyG) is found in 0.21% of all endoscopies. In 35% and 19% of patients, LyG is associated with coeliac disease and microscopic colitis, respectively. LyG resolves in 80% of patients within one year.
The normal content of eosinophils in the adult colon and the criteria for the histopathologic diagnosis of eosinophilic colitis remain undefined. This study aimed at(1) establishing the numbers of ...eosinophils in the normal adult colon; and (2) proposing a clinicopathologic framework for the diagnosis of primary colonic eosinophilia and eosinophilic colitis. To accomplish these goals, we counted the eosinophils in the right, transverse, and left colon of 159 adults with normal colonic histology. Using a database of 1.2 million patients with colonic biopsies, we extracted all adults with a diagnosis of colonic eosinophilia. We reviewed the slides from all cases and captured demographic, clinical, and pathologic data, including information about eosinophilia in other organs. We then compared the clinical manifestations of the study patients (those with no identifiable cause of eosinophilia) to those of patients with other types of colitis. The normal eosinophil counts (per mm) were 55.7±23.4 in the right, 41.0±18.6 in the transverse, and 28.6±17.2 in the left colon. Of the 194 study patients (eosinophil counts 166–5050/mm), 63 were asymptomatic and had a normal colonoscopy. Diarrhea and abdominal pain were the commonest indications for colonoscopy (38% and 27%, respectively) among the 131 patients who had symptoms, endoscopic abnormalities, or both. Neither clinical manifestations nor endoscopic appearance were sufficiently characteristic to elicit the suspicion of colonic eosinophilia. In conclusion, primary colonic eosinophilia was extremely rare in this series (<1 in 6000 patients); one third of these patients were asymptomatic. Their clinical manifestations were not distinctive and could not have led clinicians to suspect this condition; one third of the patients were asymptomatic. We suggest that regularly reporting high colonic eosinophilia may result in increased opportunities for clinicopathologic studies that might lead to a better definition of this still elusive entity.
Editorial: the other bug Turner, Kevin O.; Genta, Robert M.
Alimentary pharmacology & therapeutics,
June 2023, 2023-06-00, 20230601, Letnik:
57, Številka:
12
Journal Article
Recenzirano
Odprti dostop
LINKED CONTENT
This article is linked to Taillieu et al paper. To view this article, visit https://doi.org/10.1111/apt.17488
Summary
Background
Non‐oesophageal gastrointestinal eosinophilic diseases (EGID) are considered rare. However, low disease awareness among clinicians and pathologists may contribute to ...underdiagnosis.
Aims
To determine how frequently requests to evaluate for EGID accompany gastrointestinal biopsies and in what proportion of suspected cases pathologists address these requests, either confirming or refuting the clinical suspicion.
Methods
All cases in which biopsy requisitions included an explicit suspicion of EGID were extracted from a large clinicopathologic database and manually reviewed for accuracy. The diagnoses for these cases were then analysed to determine whether clinical suspicions were confirmed, refuted or ignored.
Results
Eosinophilic oesophagitis (EoE) was suspected in 12.8% of 903,516 patients with biopsies and confirmed in 14.9% of them. A suspicion of eosinophilic gastritis accompanied <0.001% of 1,438,206 gastric biopsy sets and was confirmed in 11.5% of them; eosinophilic duodenitis was suspected in 0.02% of ~675,519 patients with duodenal biopsies and confirmed in 8.0% of these; eosinophilic colitis was mentioned in <0.001% of 2,504,485 patients with colonic biopsies and confirmed in 0.1% of them. Less than 3% of endoscopists mentioned non‐oesophageal EGID in the requisition, while most expressed a clinical suspicion of Barrett oesophagus, Helicobacter pylori gastritis, celiac disease and microscopic colitis (in 21.2%, 49.2%, 1% and 6.4% of the cases, respectively).
Conclusions
Gastroenterologists and pathologists commonly address and diagnose EoE. In contrast, both clinical suspicion and diagnosis of non‐oesophageal EGID are extremely rare. Increased clinical awareness might result in a better understanding of the epidemiology and improved diagnosis of these still elusive conditions.
Background
A variety of studies have shown rising trends in the occurrence of colorectal cancer in younger patients as opposed to falling trends among older patients aged 55 years or more. We ...hypothesized that the time trends of benign colonic precursor lesions would reveal similar patterns.
Aims
The present study was designed to test this hypothesis in a large nationwide sample of the US population undergoing colonoscopy in community-based endoscopy centers.
Methods
The Inform Diagnostics database is an electronic repository of histopathologic records of patients distributed throughout the USA. A cross-sectional study analyzed the detection rates of sessile serrated adenomas (SSA), hyperplastic polyps (HP), tubular adenomas (TA), traditional serrated adenomas (TSA), or adenocarcinomas (colorectal cancer, CRC) in 2,910,174 colonoscopies done 2008–2020.
Results
During the 13-year time period, the rate of SSA showed a significant rise, both in patients younger and older than 55 years. HP and TA both showed a significant decline during the same time period. The trends of CRC in the
older
age group decreased significantly between 2008 (or its peak in 2012) and 2020. The trends of CRC in the
younger
age group increased significantly between 2008 and its peak in 2017.
Conclusions
The age-specific time trends of benign and malignant colonic neoplasia are characterized by dissimilar temporal patterns. Such dissimilarity could suggest that besides a set of shared risk factors that affect all types of colonic neoplasia alike, there is yet another set of environmental risk factors that specifically influence malignant transformation.
Immunohistochemical analysis of 5547 rectal adenocarcinoma biopsy specimens showed the presence of mismatch-repair deficiency in 2.7% of rectal tumors and in 13.4% of colorectal adenocarcinomas.
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