Evaluating the spectrum of histomorphological patterns on endoscopic biopsy in patients with upper gastrointestinal tract disorders

Introduction: The upper gastrointestinal tract (UGT) disorders are more common complaints in clinical practice and have got high degree of mortality and morbidity. Many different types of lesions can affect the upper gastrointestinal tract and can be classified as congenital anomalies, infections, inflammation and neoplastic lesions. Material and Methods: A total of 152 cases of upper gastrointestinal tract biopsies are included in this study, out of which 113 cases were gastric biopsies, 22 cases were esophageal biopsies and the remaining 17 cases were duodenal biopsies. Present study was carried out in the Department of Pathology at Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry for a period of one year between March 2018 and February 2019. All the biopsies were performed using fiberoptic endoscopy. Endoscopic biopsy in combination with histopathological examination plays an important role in the early diagnosis of determining UGT lesions. Also, special stains like Giemsa, Warthin starry stain was used to demonstrate Helicobacter pylori. Aim of the study is to evaluate the histomorphological patterns of upper gastrointestinal tract disorders on endoscopic biopsy and to correlate various upper gastrointestinal tract disorders in correspondence to clinical parameters. Results: It is reported among 152 cases of UGT biopsies 137 were non-neoplastic lesions and 15 were neoplastic. Commonly affected age group was 31-40 years followed by 41 to 50 years. As per the present study, males were affected more predominantly than females. Out of the 22 cases from esophageal biopsies, 16 cases showed non-neoplastic lesions and 6 were neoplastic. The most common non-neoplastic lesion was chronic nonspecific esophagitis and neoplastic lesion reported was squamous cell carcinoma. Among 113 gastric biopsies, 104 cases were non-neoplastic lesions and 9 were neoplastic lesions. Adenocarcinoma was the predominant neoplastic lesion of stomach. All the 17 duodenal biopsies showed non -neoplastic lesions.

All the relevant data such as age, gender, duration of symptoms of the patients were also obtained and documented. Other routine investigation results and radiological examination like X-ray and ultrasound reports of the patients were also recorded.

Results
In the present study, the frequency of distribution of  As per the gender concern, out of the total 152 cases of UGT biopsies 87 were from males and the remaining 65 were from females. Distribution of UGT lesions in esophagus, stomach and duodenum among males and females as represented in Figure   3.

Fig-3: Frequency of distribution of lesions in male and female.
The study result in relevance to the age groups revealed that, among the 152 cases of upper gastrointestinal biopsies, the commonly affected age group was 31-40 years followed by 41 to 50 years.
The youngest age included in the study was 16 years female with esophagitis. The elderly age included in the study was 72 years male with gastric carcinoma as represented in Table 1. Common non-neoplastic lesion among the esophageal biopsies were chronic non-specific esophagitis, followed by esophageal ulcer.  The common neoplastic lesion observed was squamous cell carcinoma ( Figure 4) and there are three cases of barrets esophagus was also observed In this study as represented in Table 2.
Among 113 cases of gastric biopsies 104 were nonneoplastic and 9 were neoplastic lesions. Similarly, among the non-neoplastic lesions chronic superficial gastritis observed in 24 cases followed by chronic active gastritis in 22 cases and an equal number of cases in chronic superficial gastritis with intestinal metaplasia ( Figure 5). Among the neoplastic lesion's adenocarcinoma of stomach ( Figure 6) was the commonly observed lesions shown in Table 3.  Among the17 duodenal biopsies obtained, on analysis, all of them were found as non-neoplastic.
The lesion observed was chronic nonspecific duodenitis as represented in Table 4. were from esophagus in origin and the most common non neoplastic lesion was Chronic nonspecific esophagitis. The study also confirmed that the squamous cell carcinoma of esophagus was the common neoplastic lesion.
In the case of gastric biopsies 113 as per the present study 104 (92%) were non neoplastic and only 9 (8%) cases were neoplastic, which is similar to that of the study result of Syed Imtiyaz et al [32] report showed that 57.4% of cases were non neoplastic and 42.6% were neoplastic. This result is in correlation with the study result of previous study [34].

Conclusion
The study report concluded that the upper gastrointestinal biopsies, on examination in combination with histopathological studies provides a useful information in the determination of overall extent of mucosal architecture and the use of special stains like Giemsa, Warthin starry stains made it easy to demonstrate H. Pylori in the gastric pits and mucous layer.
All the biopsies were performed using fiberoptic endoscopy which plays an important role in the improved visualization and accuracy in the UGT lesions could be directly inspected and helps to evaluate the various clinical conditions at the early stage.
Further the early result favors to correlate various disorders in correspondence to the clinical parameters and also the neoplastic and nonneoplastic lesions. Use of fiberoptic endoscopic biopsy helps to detect the site and distribution of the benign and malignant lesions.
Early and more specific diagnosis help for the management of disease which intern reduces the mortality and morbidity of patients. For better understanding of disease, its progression and associated risk factors, further studies are essential