association of atrophic gastritis with metaplasia and dysplasia in an area of low prevalence for helicobacter pylori

1. A study on histological chronic gastritis in the East Coast of Peninsular Malaysia – correlation with endoscopic findings, causes and helicobacter pylori Yeong Yeh Lee MD MRCP(UK) MMED ORAL PRESENTATION APDW 2007

8. RESULTS Figure 1 : The mean age was 53 ± 15 years old (range 15 to 94 years old).

9. Figure 2: There were no differences in the prevalence of both atrophic and non-atrophic gastritis between the two genders . The Chinese had more atrophic gastritis (22%). The Malays had more non-atrophic gastritis (87%). The prevalence of CAG was 41%.

10. Table 1 : Indications of endoscopy, causes of gastritis and medications before endoscopy Legend : N=number, %=percentage, NSAID=non-steroidal inflammatory drugs, PPI=proton pump inhibitor, H2RA=histamine receptor blocker Dyspepsia was the commonest symptom in both CAG and non-CAG. Chemical gastritis (NSAID and antiplatelet) was more common in non-atrophic gastritis (47% VS 27.5%). Proton pump inhibitors were used in 66% of chronic gastritis prior to endoscopy. 155 (66) 14 (6) 58 (67) 4 (5) 61 (63) 7 (7) PPI H2RA Medications 20 (22) 18 (20) 18 (20) 8 (25) 7 (22) 4 (12.5) 6 (15) 5 (12.5) 11 (27) NSAID Antiplatelet Previous gastric ulcers Causes 149 (64) 37 (16) 54 (63) 15 (17) 57 (59) 20 (21) Dyspepsia Malaena Indications Total N (%) Non-atrophic N (%) Atrophic N (%) Variables

11. Figure 2: The prevalence of helicobacter pylori was n=16 (7%). The histology test for helicobacter pylori appeared more sensitive than CLO test in atrophic gastritis (n=7 VS n=1). RESULTS

12. Figure 3 : There was a significant association between moderate atrophy with the risk of metaplasia (p=0.006). This was tested with multiple comparisons between different degree of atrophy and Bonferroni adjustment of p-value. Moderate atrophy increased the risk of metaplasia by 21%. 0.006 0.002 Mild Vs Moderate 0.069 0.023 No Vs Moderate 0.543 0.181 No Vs Mild Bonferroni Adjustment P value Comparisons

13. Figure 4 : There was significant association between moderate atrophy with the risk of dysplasia (p=0.003). This was tested with multiple comparisons between different degree of atrophy and Bonferroni adjustment of p-value. Moderate atrophy increased the risk of dysplasia by 18%. <0.003 <0.001 Mild Vs Moderate <0.003 <0.001 No Vs Moderate 1.0 0.687 No Vs Mild Bonferroni Adjustment P value Comparisons

14. LOGISTIC REGRESSION ANALYSIS Table 3 : Logistic regression analysis (Forward LR) of factors (age, sex, race, causes, helicobacter pylori and atrophy) associated with the risk of Metaplasia Table 4 : Logistic regression analysis (Forward LR) of factors (age, sex, race, causes, helicobacter pylori and atrophy) associated with the risk of Dysplasia

15. Table 2 : Correlation between histological gastritis and endoscopic findings Normal histology was seen in 22% of abnormal endoscopic findings. The agreement between histological gastritis and endoscopic findings was poor. 234 183 (78) 51 (22) Total 227 176 (77) 51 (22) Abnormal 7 7(100) 0 (0) Normal Total Abnormal Normal N (%) Endosocopic findings Histology Findings

16. Figure 6 : Most endoscopic and histological gastritis were mild to moderate in severity. The agreement was however poor with kappa=0.06.

20. Thank You for Attention