Stomach Biopsy - Small <1cm

Biopsy

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Histology of stomach tissue.

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Stomach Biopsy - Small <1cm

Why is it done?
- Detects presence of Helicobacter pylori (H. pylori) bacteria in the stomach lining
- Diagnoses peptic ulcer disease, chronic gastritis, and other inflammatory conditions of the stomach
- Identifies intestinal metaplasia, dysplasia, and early gastric cancer
- Evaluates chronic abdominal pain, persistent nausea, vomiting, and dyspepsia unresponsive to treatment
- Assesses for malignancy when gastric lesions or suspicious areas are identified on endoscopy
- Performs histopathological analysis to classify the type and severity of gastric pathology
- Typically performed during upper endoscopy (esophagogastroduodenoscopy/EGD) when suspicious lesions or erosions are visualized
Normal Range
- Normal (Negative) Result: Absence of H. pylori bacteria, no malignant cells, no dysplasia, normal gastric mucosa with intact epithelium
- Normal histology may show: Intact mucosa without significant inflammation, normal glandular architecture, appropriate cellular differentiation
- No special staining required: Standard hematoxylin and eosin (H&E) stain shows normal gastric tissue
- Units: Histopathology report (qualitative, not quantitative)
- Interpretation: Normal result indicates absence of clinically significant pathology; patient is H. pylori negative unless proven otherwise
Interpretation
- H. pylori Positive: Indicates active or recent H. pylori infection; requires antibiotic therapy and acid suppression; significantly increases risk of peptic ulcer disease and gastric malignancy
- Acute Gastritis: Moderate to severe inflammation of gastric mucosa with possible neutrophilic infiltration; suggests active infection, NSAIDs use, or stress-related injury
- Chronic Gastritis: Persistent inflammation characterized by lymphocytic and plasma cell infiltration; associated with H. pylori or autoimmune conditions
- Intestinal Metaplasia: Replacement of gastric mucosa with intestinal-type epithelium; indicates precancerous change and increased gastric cancer risk
- Dysplasia (Low-Grade or High-Grade): Abnormal cellular changes with architectural disarray; high-grade dysplasia requires close surveillance or intervention due to malignant potential
- Adenocarcinoma: Malignant tumor cells present; indicates gastric cancer diagnosis requiring oncologic management and staging
- Peptic Ulcer Disease: Evidence of ulceration with granulation tissue and muscle layer involvement; may show H. pylori organisms or features of NSAID-related damage
- Factors affecting interpretation: Timing of biopsy (H. pylori may not be visible if recently treated), sampling location (antrum vs. body), specimen size and adequacy
- Sydney Classification: Used to grade gastritis severity (0-3 scale) for inflammation, activity, and atrophy; guides clinical management decisions
Associated Organs
- Primary Organ: Stomach (gastric mucosa); specifically targets lesions <1cm for precise tissue analysis
- Duodenum: May be affected by H. pylori or ulcer disease; inflammation can extend from stomach into duodenum
- Esophagus: May develop Barrett's esophagus or metaplasia related to chronic gastric disease and acid reflux
- Conditions Associated with Abnormal Results: Helicobacter pylori infection, peptic ulcer disease, gastric adenocarcinoma, lymphoma, Crohn's disease, Zollinger-Ellison syndrome, pernicious anemia, gastric polyps
- Potential Complications: Bleeding at biopsy site (risk <1% for small biopsies), perforation (rare, <0.1%), infection, aspiration
- Malignancy Risks: H. pylori is Class I carcinogen; chronic infection increases gastric cancer risk 2-6 fold; intestinal metaplasia indicates precancerous state
Follow-up Tests
- H. pylori Eradication Confirmation: Urea breath test, stool antigen test, or serology performed 4+ weeks after completing antibiotic therapy
- Repeat Endoscopy with Biopsy: Indicated if dysplasia or malignancy detected; surveillance intervals depend on severity and patient risk factors
- High-Grade Dysplasia: Requires endoscopic ultrasound (EUS), CT chest/abdomen/pelvis staging, and gastroenterology/oncology consultation
- Gastric Cancer Diagnosis: PET-CT scan, CT staging, endoscopic ultrasound (EUS) for depth assessment, tumor markers (CEA, CA 19-9)
- Immunohistochemistry: May be performed for HER2 testing in gastric adenocarcinoma to guide targeted therapy
- Iron Studies: If achlorhydria or atrophic gastritis suspected (may indicate pernicious anemia risk)
- Vitamin B12 and Folate Levels: Assess for nutritional deficiencies associated with chronic atrophic gastritis or H. pylori
- Surveillance Schedule: Low-grade dysplasia requires repeat endoscopy in 6 months; intestinal metaplasia requires endoscopy every 1-3 years; normal findings do not require routine follow-up unless H. pylori positive
Fasting Required?
- Yes - Fasting is required
- Duration: Minimum 6 hours; preferably 8-12 hours fasting prior to procedure (typically overnight)
- Special Instructions: NPO (nothing by mouth) status required; water and clear liquids acceptable up to 2-4 hours before procedure per facility protocol
- Medications to Avoid: Discontinue aspirin and NSAIDs 3-7 days prior if possible; hold anticoagulants (warfarin, dabigatran) per provider; proton pump inhibitors (PPIs) should be discontinued 2 weeks prior for accurate H. pylori detection
- Additional Preparation: Arrange transportation as sedation will be used; sign informed consent; remove dentures and jewelry; empty bladder before procedure
- Post-Procedure: Nothing by mouth for 1-2 hours until gag reflex returns; soft diet recommended for remainder of day; avoid alcohol and driving for 24 hours due to sedation

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