Stomach Biopsy - XL

Biopsy

Report in 288Hrs

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No Fasting Required

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Histology of stomach tissue.

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Stomach Biopsy - XL: Complete Medical Guide

Why is it done?
- Detects and identifies pathological tissue samples from the stomach lining to diagnose various gastric conditions and diseases
- Diagnose H. pylori (Helicobacter pylori) infection, a bacterial pathogen associated with ulcers and gastric cancer
- Identify chronic gastritis, inflammation of the stomach lining requiring specific treatment
- Detect gastric cancer or malignant tumors in their early stages
- Investigate chronic abdominal pain, persistent nausea, vomiting, or dyspepsia not responding to standard treatment
- Assess suspicious lesions, ulcers, or abnormalities identified during upper endoscopy (EGD)
- Evaluate intestinal metaplasia, dysplasia, or precancerous changes in the gastric mucosa
- Monitor for complications in patients with autoimmune gastritis or pernicious anemia
- Typically performed during endoscopy when visual abnormalities or unexplained gastric symptoms warrant tissue examination
Normal Range
- Normal Findings: Benign gastric mucosa with normal histological architecture, intact epithelium, normal glandular structures, and absence of dysplasia, malignancy, or significant inflammation
- H. pylori Status: Negative (no bacteria present on histology, immunohistochemistry, or special stains)
- Inflammation Grade: Absent or minimal (0-1 on standard grading scales such as Sydney Classification)
- Activity Score: Absent (no acute inflammatory cells such as neutrophils in the mucosa)
- Dysplasia: Negative (no precancerous cellular changes present)
- Malignancy: Negative (no cancerous cells identified)
- Special Stains: Negative for acid-fast bacilli (AFB), fungi, and other organisms as appropriate
Interpretation
- H. pylori Positive: Confirms active H. pylori infection; requires eradication therapy with combination antibiotics; associated with increased risk of peptic ulcer disease and gastric cancer
- Acute Gastritis: Increased neutrophils and acute inflammatory infiltrate; may indicate active infection, medication-induced injury, or stress-related changes; usually reversible with appropriate treatment
- Chronic Gastritis: Chronic inflammatory cells (lymphocytes, plasma cells) with possible glandular atrophy; indicates long-standing inflammation from H. pylori, autoimmune disease, or chronic irritation; requires monitoring and treatment
- Intestinal Metaplasia: Replacement of normal gastric mucosa with intestinal-type epithelium; precancerous finding indicating increased risk for gastric cancer; requires follow-up surveillance and H. pylori eradication if present
- Low-Grade Dysplasia (LGD): Abnormal cellular changes with maintained nuclear orientation but increased dysplasia; 15-30% risk of progression to high-grade dysplasia or cancer; requires close endoscopic surveillance every 3-6 months
- High-Grade Dysplasia (HGD): Severe cellular atypia and loss of normal architecture; significant precancerous lesion with 30-50% risk of concurrent or future cancer; typically warrants endoscopic resection or gastrectomy
- Adenocarcinoma: Malignant tumor cells present; pathologist assesses histological type (intestinal, diffuse, mixed), grade (well, moderately, poorly differentiated), and invasion depth; requires urgent surgical consultation and staging
- Autoimmune Gastritis: Chronic atrophic gastritis with loss of parietal cells and glands; associated with intrinsic factor deficiency and vitamin B12 malabsorption; requires B12 supplementation and gastric cancer surveillance
- Lymphoma: Abnormal lymphoid infiltrate; may indicate gastric lymphoma (often associated with H. pylori); requires immunophenotyping, flow cytometry, and gene rearrangement studies for classification
- Atrophic Gastritis: Loss of normal gastric glands and reduced mucosal thickness; can be caused by chronic H. pylori infection, autoimmune disease, or bile reflux; increases cancer risk and impairs nutrient absorption
Associated Organs
- Primary Organ: Stomach (gastric mucosa, epithelium, submucosa)
- Gastrointestinal System: Esophagus, duodenum, and small intestine may be involved in metastatic or systemic disease
- Peptic Ulcer Disease: H. pylori infection is leading cause; can progress to perforation, hemorrhage, or gastric outlet obstruction
- Gastric Cancer Risk: H. pylori associated with 2-6 fold increased risk; intestinal metaplasia, dysplasia, and atrophic gastritis are stepwise progression to malignancy
- MALT Lymphoma: Mucosa-associated lymphoid tissue lymphoma; frequently H. pylori-associated; localizes to gastric mucosa and can involve mesenteric lymph nodes
- Vitamin B12 Deficiency: Results from loss of intrinsic factor-producing parietal cells in autoimmune gastritis; leads to megaloblastic anemia and neurological complications
- Iron Deficiency Anemia: Can result from chronic gastritis-induced achlorhydria impairing iron absorption or ongoing bleeding from ulcers
- Gastric Ulcers and Erosions: H. pylori or NSAID-related; potential complications include perforation causing peritonitis and hemorrhage causing hemodynamic instability
- Systemic Inflammation: Chronic H. pylori infection may contribute to systemic inflammatory conditions and cardiovascular disease through molecular mimicry
Follow-up Tests
- H. pylori Treatment Confirmation: Urea breath test, stool antigen test, or serology performed 4 weeks after completing eradication therapy to confirm successful treatment
- Repeat Endoscopy: May be indicated 4-6 weeks post-treatment to confirm H. pylori eradication and assess healing of ulcers; particularly important for gastric ulcers
- Surveillance Endoscopy: For dysplasia or intestinal metaplasia: every 3-6 months for low-grade dysplasia, every 2-3 months for high-grade dysplasia with close surveillance and consideration of endoscopic resection
- CT/EUS Imaging: For confirmed gastric cancer; CT staging assesses local invasion and distant metastases; endoscopic ultrasound (EUS) evaluates tumor depth and lymph node involvement
- Immunophenotyping and Flow Cytometry: For suspected lymphoma or unusual lymphoid infiltrates to characterize lymphocyte populations and determine monoclonality
- Molecular Studies: PCR for clonality studies, cytomegalovirus (CMV), or other organisms; HER2 testing for gastric cancer to determine trastuzumab eligibility
- Vitamin B12 and Folate Levels: For autoimmune gastritis with parietal cell loss; assess for deficiency requiring supplementation
- Complete Blood Count (CBC): Assess for anemia, particularly megaloblastic (autoimmune) or microcytic iron deficiency patterns
- Serological Testing: Parietal cell and intrinsic factor antibodies for autoimmune gastritis; consider thyroid peroxidase antibodies given association with autoimmune thyroiditis
- PET-CT or PET-MRI: For staging advanced gastric malignancies or suspected metastatic disease; particularly useful for detecting distant lymph node and organ involvement
- Surgical Consultation: For high-grade dysplasia or cancer; gastroenterology and surgical oncology evaluation for treatment planning (endoscopic resection, gastrectomy, or systemic therapy)
Fasting Required?
- Fasting: Yes - Required
- Fasting Duration: Minimum 6 hours prior to the procedure; typically 8-12 hours overnight fasting is recommended
- Dietary Restrictions: NPO (nothing by mouth) after midnight the night before; no solid foods, liquids, or clear liquids for 2-4 hours prior to procedure depending on institutional protocol
- Medications to Avoid: Proton pump inhibitors (omeprazole, lansoprazole) should be discontinued 2 weeks prior; H2-blockers (ranitidine, famotidine) discontinued 48-72 hours prior to optimize H. pylori visualization; NSAIDs should be avoided for 2 weeks before biopsy
- Antibiotic Discontinuation: Any antibiotics should be stopped at least 4 weeks prior to ensure accurate H. pylori detection; bismuth compounds should be discontinued 4 weeks before
- Anticoagulation Management: Discuss with physician regarding warfarin, dabigatran, or other anticoagulants; may need bridging or temporary discontinuation depending on bleeding risk assessment
- Aspirin and Antiplatelets: Generally may be continued; however, consult with endoscopist and cardiologist if on high-dose or dual therapy; clopidogrel may require temporary discontinuation
- Sedation Preparations: Typical conscious sedation with midazolam and fentanyl or propofol; arrange responsible adult to drive home as sedation impairs judgment and coordination
- Additional Preparation: Dentures and eyeglasses should be removed; void bladder before procedure; wear comfortable loose clothing; inform provider of allergies, particularly to medications; have valid informed consent regarding risks including bleeding, perforation, and infection

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