Research Article: The role of high sensitive C-reactive protein and histopathological evaluation in chronic gastritis patients with or without Helicobacter pylori infection1

Date Published: March 21, 2019

Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em
Cirurgia

Author(s): Eren Altun, Ayla Yildiz, Celalettin Cevik, Gulay Turan.

http://doi.org/10.1590/s0102-865020190030000010

Abstract

To evaluate serum levels of high-sensitivity C-reactive protein (hs-CRP) in
chronic gastritis patients to predict Helicobacter pylori (HP) infection,
inflammatory activity, and precancerous lesions.

A total of 811 patients with upper gastrointestinal symptoms and
histopathological diagnosis of chronic gastritis were enrolled in the study.
On endoscopy, five gastric biopsies were taken according to Modified Sydney
protocol, which were stained with hematoxylin & eosin and Giemsa

HP infection was found in 28.6% of patients, being significantly more common
in specimens with acute and chronic inflammatory activity. Mucosal atrophy,
intestinal metaplasia, and dysplasia were found in 20.2%, 18.8% and 2.7% of
biopsy specimens. Mean hs-CRP was 1.9±1.6 mg/dl for males and 2.2±1.9 mg/dl
for females. hs-CRP average were significantly higher in patients with
severe acute inflammation (p:0.049), in patients with severe chronic
inflammation (p:0.015) and in those with HP (p: 0.001) . The severity of HP
infection increased significantly with the increased degree of acute
inflammation, chronic inflammation and hs-CRP level (p=0.001 for both).

Serum hs-CRP level increases in patients with chronic gastritis, it could be
an indicator of severity of acute or chronic mucosal inflammation, and
presence of HP infection. Therefore, hs-CRP may aid the diagnosis of chronic
gastritis, but it is not associated with pre-cancerous lesions.

Partial Text

Helicobacter pylori (HP) affects over half of the population worldwide and is the
major etiology of chronic gastritis1. It colonizes in gastric mucosa and causes chronic mucosal inflammation
leading to gastritis. HP-associated chronic gastritis is considered precancerous and
has a high potential of progression into gastric cancer unless effectively
treated2. The histolopathological evidence of precancerous lesions of chronic
gastritis, such as gastric atrophy and intestinal metaplasia has been well known to
be associated with HP infection3,4.

On histopathological evaluation, acute and chronic inflammation in any severity was
detected in 31.4% and 64% of patients, respectively. Of 811 patients, 28.6% had HP
infection. Mucosal atrophy, intestinal metaplasia, and dysplasia were found in
20.2%, 17.8%, and 2,7% of biopsy specimens obtained from 811 patients.

In this extensive retrospective research study, we examined endoscopic biopsy
specimens and serum hs-CRP levels in 811 patients. We found that in patients acute
inflammation, chronic inflammation, and HP infection, hs-CRP levels were above
normal levels. As acute and chronic inflammation increases, the level of hs-CRP
increases. However, we have indicated that precancerous lesions, metaplasia and
atrophy are not associated with the level of hs-CRP.

In conclusion, in the literature, commonly serum hs-CRP level have been claimed that
it can be used as a simple and easily accesible laboratory test to predict
inflammatory activity and precancerous lesions. Thus for treatment response
monitoring and cancer screening in chronic gastritis patients could be easy. In this
extensive study, we studied the endoscopical biopsy specimens and serum hs-CRP
levels of 811 patients with chronic gastritis.

 

Source:

http://doi.org/10.1590/s0102-865020190030000010

 

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