Page 122 - Helicobacter pylori and Gastric Cancer: From Tumor microenvironment to Immunotherapy

directly to concordance between endoscopic and histological diagnosis are necessary to substantiate this notion.
We observed that older age predisposes for discordance between the endoscopic assessment and the histological diagnosis, The histological structures of the normal antral and corpus mucosa differ, with the border between these two areas located at the angulus. This anatomically defined border is difficult to detect clearly using conventional endoscopy[27, 28][27, 28][27, 28] although it can be better detected using high definition equipment. However, a slight difference in color between the antrum and the corpus may occur in the absence of histological atrophy. Mistaking this anatomical border for the atrophic border may result in over-diagnosis. We found that older patients, particularly older Iranians, tended to be over-diagnosed. Two possibilities may explain this finding. The first may have been bias in the endoscopist prompted by the notion that elderly Iranians are more likely to be infected with H. pylori. The second reason is that gastric mucosal blood flow decreases with age[29, 30], which may affect mucosal appearance. Because of the slight differences in mucosal color, the endoscopist may mistake normal for atrophic antral mucosa in older patients. It is clear, however, that special care should be taken in older patients and that the practitioner should not submit to the temptation to rely solely on endoscopic diagnosis.
Conclusion
Although routine endoscopy can assess precancerous conditions by evaluating the extent of gastric atrophy, agreement between endoscopic and histological atrophy is unclear and always requires local validation. Endoscopic atrophy grading can predict extensive histological atrophy and may serve as a practical assessment of precancerous conditions during endoscopy in routine clinical practice, especially for patients in Western countries.
Competing interests
The authors declare that they have no competing interests.
Acknowledgements
Chapter 5
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