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News

Sydney System guidelines increase the detection of Helicobacter gastritis

The latest issue of Alimentary Pharmacology & Therapeutics reports that the adherence to the Sydney System guidelines increases the detection of Helicobacter gastritis and intestinal metaplasia.

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The diagnostic yield of individual gastric biopsies and the adherence to the Sydney System guidelines in the United States are unknown.

Dr Lash and colleagues from Texas, USA evaluated the yield of different gastric sampling strategies and determine the adherence to the Sydney System guidelines in a nationwide sample of endoscopists.

The team used a database of biopsy records diagnosed at a single pathology laboratory, and analyzed the results of gastric biopsies taken to evaluate gastric inflammatory conditions in patients with no endoscopic lesions.

The researchers stratified the specimens by site of origin and number of mucosal fragments and calculated the relationship between number and origin of biopsy specimens and detection of Helicobacter pylori and intestinal metaplasia.

Of 400,738 biopsy sets, 66% were submitted as antrum, 17% as corpus; 3% as cardia, and 25% without topographic identifiers.

66% of biopsies were submitted as antrum
Alimentary Pharmacology & Therapeutics

The research team evaluated separate containers with at least 2 antral, and 2 corpus specimens were available in 15,645 cases.

For antrum, corpus, and unspecified sites, each additional tissue fragment was associated with an incremental increase in the yield for both H. pylori and intestinal metaplasia.

Sydney System-compliant sets had significantly greater yield than most of the unspecified or single-site sets.

The incisura angularis, rarely sampled, yielded minimal additional diagnostic information.

Dr Lash's team concluded, "In the absence of lesions, the acquisition of at least 2 biopsy specimens from antrum and corpus, essentially following the Sydney System recommendations, is a sensible strategy that guarantees the maximum diagnostic yield for the most common gastric inflammatory conditions."

Aliment Pharm & Ther 2013: 38(4): 424431
30 July 2013

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