Background: Gastritis is the histological presence of gastric mucosal inflammation, which is usually treated with proton pump inhibitors (PPIs). Although commonly diagnosed endoscopically, this could lead to inaccurate diagnosis. We aim to highlight the discrepancy between endoscopically vs. histologically diagnosed gastritis and potentially inappropriate prescribing of PPIs.
Methods: A retrospective study was carried out on all gastroscopies performed in Naas General Hospital, over a 12-month period. Demographic variables were considered, as well as the indication for the gastroscopy, endoscopic findings and histological findings. Data was gathered via Endorad software and histological reports via Alpha Operating Systems. Data was analyzed using SPSS.
Results: Of the 1,221, 57.2% had endoscopic gastritis diagnosed, 51.4% (/1,221) were biopsied (P<0.05), and 25.4% had histological gastritis confirmed (P<0.05). However, despite only 25.4% having histologically proven gastritis, 55.9% of the cohort were prescribed a PPI on discharge (P<0.01). On analysis, an exceeding number of endoscopic gastritis diagnoses and PPI prescribing was seen, compared to that expected. Interestingly, of 210 patients with findings of only gastritis on endoscopy, 100% were prescribed a PPI, but when biopsied, 42.4% had histologically normal mucosa.
Conclusions: Our study highlights the poor correlation between endoscopic and histological diagnosis of gastritis, and the need for both to be used in parallel. Currently, the term “gastritis” is used frivolously to describe endoscopic abnormal appearing gastric mucosa. However, this results in misdiagnosis, failure to address the cause of patients’ symptoms, inappropriate prescribing and exposure to potential side effects of PPIs. Ultimately, consideration has to be given to routine biopsy on endoscopy in order to aid accurate diagnosis.
