ABSTRACT
Conditions affecting the upper digestive system are often seen in clinical practice and are associated with a high rate of death and disability. Histopathological confirmation is one of the foundations for good treatment planning and the definite diagnosis of illnesses of the upper gastrointestinal tract. The numerous methods employed in the diagnosis of gastrointestinal lesions have come a long way in the previous 25 years. The identification and diagnosis of gastrointestinal lesions have been substantially aided by the development of endoscopy, endoscopic biopsy, and other surgical techniques. This research aimed to examine the variety of gastrointestinal tract (GI) lesions and to draw connections between the clinical and pathological manifestations of these conditions.
Materials and Methods:
A two-year cross-sectional study was conducted in the Department of Pathology, from June 2018 to May 2020, which included surgical specimens of 140 cases from the upper gastrointestinal tract, of which 111 cases were biopsy, and 29 cases were resected surgical specimens. The data were analyzed using SPSS software. Furthermore, P values, sensitivity, specificity, positive predictive value, and negative predictive value were calculated.
Results:
This study was a two-year cross-sectional study conducted in the Department of Pathology during the period of June 2018–May 2020.
KEYWORDS: Gastric cancers, lesions in GIT, upper gastrointestinal tract disorders
INTRODUCTION
Tobacco users who also drink heavily have a far higher chance of developing esophageal carcinoma, according to a meta-analysis of data conducted by Ernst Wydner[1] and colleagues, who also found that alcohol use alone does not raise the risk of this disease. According to Schottenfield’s research, these two environmental variables are responsible for almost 80% of instances in industrialized nations. Cigarette use and length of smoking habit are both correlated with increased danger.[2] Cigarette smokers had an elevated risk of proximal gastric cancer of two to three times that of nonsmokers, according to research conducted by Devesa SS et al.[3] In certain regions of India, it is customary to chew betel nut and betel leaf, sometimes mixed with tobacco. According to research conducted by Nayar D et al. at the All India Institute of Medical Sciences (AIIMS), everyday betel leaf and tobacco chewing increases the chance of getting esophageal cancer by a factor of 3.16. Esophageal and stomach malignancies have been linked to certain dietary variables.
Objectives
This study aimed to study histopathologically the spectrum of lesions (nonneoplastic and neoplastic) in patients undergoing upper gastrointestinal biopsy and various upper gastrointestinal surgeries and to correlate clinical details with an emphasis on dietary, personal habits, and endoscopic findings with histopathology.
Review of literature
The esophagus, the stomach, and the first half of the duodenum are all considered to be components of the upper GI tract. Mucosa, submucosa, muscularis propria, and serosa make up the gastrointestinal tract (GIT) wall, with the exception of the esophagus, which only has the mucosal and submucosal layers.
Diseases of the esophagus
Esophageal leukoplakia/epidermoid metaplasia: Leukoplakia is a term used to describe a persistent white patch that is often seen in the buccal mucosa and that is histologically identical to regions of hyperkeratosis. Until recently, when Singhi AD et al.[4] brought attention to this fascinating result, corresponding esophageal lesions were infrequently observed and intermittently noted in the literature. Several of the documented instances show esophageal dysmotility combined with distal constriction and stasis, suggesting a role for chronic irritation.[5]
MATERIALS AND METHODS
Study design and time period
A two-year cross-sectional study was conducted in the Department of Pathology from June 2018 to May 2020, which included surgical specimens of 140 cases from the upper gastrointestinal tract, of which 111 cases were biopsy and 29 cases were resected surgical specimens.
Inclusion criteria
All surgically resected specimens and endoscopic biopsies of the upper gastrointestinal tract received in the Department of Pathology.
All slides and blocks for review of upper gastrointestinal tract lesions received in the Department of Pathology.
Exclusion criteria
All lesions of the mouth and pharynx.
Statistical analysis
Data were analyzed using SPSS software, and P value, sensitivity, specificity, positive predictive value, and negative predictive value were calculated.
Observation and results
This study was a two-year cross-sectional study conducted in the Department of Pathology during the period of June 2018–May 2020. Surgically resected specimens and endoscopic biopsies of the upper gastrointestinal tract formed the basis of the study. Of 140 cases, 36 cases were from the esophagus, eight cases were from the gastroesophageal (GE) junction, 82 cases were from the stomach, and 14 cases were from the duodenum.
The following data were obtained:
Of the 140 cases studied, 111 were endoscopic biopsies and 29 were resected surgical specimens from the upper gastrointestinal tract.
In this study, it was observed that most of the patients were tobacco users (smoking and smokeless tobacco), accounting for 61%, and nontobacco users were 39% [Table 1].
Table 1.
Distribution of cases based on tobacco use
| Tobacco use | Total number of cases |
|---|---|
| Percentage | Yes |
| 85 | 60.71% |
| No | 55 |
| 39.29% | Total |
| 140 | 100% |
P value – 0.003
In this study, endoscopic presentation was found in a total of 111 cases. The most common endoscopic presentation was erosions seen in 30 cases (27.03%), followed by diffuse growth seen in 16 cases, ulcer in 15 cases, erythema in 12 cases, nodular growth in 11 cases, ulceroproliferative growth in 10 cases, and polypoid growth in eight cases. Sessile polyp was seen in six cases, and two cases showed a normal picture, and one case of ulcerative growth was seen [Table 2].
Table 2.
Distribution of cases based on endoscopy findings
| Endoscopy findings | Number of cases | Percentage |
|---|---|---|
| Diffuse growth | 16 | 14.41% |
| Erosions | 30 | 27.03% |
| Erythema | 12 | 10.81% |
| Nodular growth | 11 | 9.91% |
| Normal | 2 | 1.80% |
| Polypoid growth | 8 | 7.21% |
| Sessile polyp | 6 | 5.41% |
| Ulcer | 15 | 13.51% |
| Ulcerative growth | 1 | 0.90% |
| Ulceroproliferative growth | 10 | 9.01% |
| Total | 111 | 100% |
DISCUSSION
Both esophageal and gastric cancers are more common in the age group of 50 years and above. The various factors considered in our study were age group and sex, male: female ratio, history of smoking and alcohol, dietary habits, the different complaints for which patient underwent endoscopy and surgery, different sites from which biopsies and resected surgical specimens were obtained, different endoscopic findings obtained, and their histopathological presentation on microscopy. polycyclic aromatic hydrocarbons (PAHs) affect immune system development, humoral immunity, and host resistance, and these can be connected with the symptoms of chronic intoxication, carcinogenic, mutagenic, and teratogenic effects, and genotoxicity.[6] Direct baking of tandoori roti and jowar roti in coal or flame can induce a great amount of carcinogenic PAHs.[7] Direct baking in coal fire or flame for a longer duration (60–90s) becomes the main reason for PAH content in jowar roti and tandoori roti. Tandoor roti and jowar roti are found to be 3.7 times more carcinogenic than tawa roti.[8] The result of dietary habit shows clearly that 61% of neoplastic cases were following the mixed diet. The popular nonvegetarian food here in this area is chicken and mutton. Similar observations were given by Butler LM et al.[9,10]
Summary
In this study, overall, the stomach (58.57%) was found to be the most common site for upper gastrointestinal tract lesion followed by the esophagus. Endoscopically, the most common presentation was erosions in 30 cases (27.03%), followed by diffuse growth (14.41%). On histopathology, of 140 cases studied, 74 cases (52.86%) were nonneoplastic and 66 cases had neoplastic lesions (47.14%).
CONCLUSION
Results from this clinicopathological study of lesions of the upper gastrointestinal tract show that a spectrum of lesions ranging from chronic nonspecific gastritis, chronic gastric ulcer, H. pylori gastritis, chronic duodenal ulcer, reflux esophagitis, chronic duodenitis, Barrett’s esophagus, celiac disease, squamous cell carcinoma esophagus, adenocarcinoma stomach, adenocarcinoma periampullary region, gastrointestinal stromal tumors (GIST), and neuroendocrine neoplasm were seen in the upper gastrointestinal tract.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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