HISTOPATHOLOGICAL SPECTRUM OF UPPER GASTROINTESTINAL TRACT ENDOSCOPIC BIOPSIES IN A TERTIARY CARE HOSPITAL IN RURAL POPULATION IN NORTH INDIA

Background: Upper GI endoscopy when combined with biopsy, the diagnostic accuracy get increased manifold. The objective of the present study is to diagnose the lesions of upper GIT by studying endoscopic biopsies in relation to age and sex distribution, correlating them with presenting complaints. Method: The study included 200 endoscopic biopsies of upper GIT received in the hospital. Result: There were 26 esophageal, 130 gastric, 44 duodenal biopsies. Most patients presented in the age group of 31-40 years with a male-female ratio of 1.94:1 and the most common presenting complaint was pain in abdomen. The neoplastic lesions commonly presented as carcinoma whereas the non-neoplastic lesions presented as inflammatory lesions on endoscopy. Non-neoplastic lesions were found to be common (83.0%) out of which gastritis was the most common lesion.Majority of the lesions of upper GIT were non-neoplastic, presenting with pain in abdomen & inflammatory findings on endoscopy. Lesions were more common in males and in the 31-40 years age group. The most common neoplasm was squamous cell carcinoma followed by adenocarcinoma. 4 cases of signet ring cell carcinoma were noted along with a single case of ampullary carcinoma. Conclusion: The conclusion of the study was that histological examination in adjunct with endoscopy should be considered as much more valuable diagnostic tool rather than endoscopy alone.

946 endoscopic biopsies, especially of malignancies greatly improves the survival rate 4 . The objective of this study include studying the spectrum of histopathological lesions both non-neoplastic and neoplastic in patients undergoing upper gastrointestinal biopsy and the overall frequency, age and sex distribution of upper gastrointestinal tract lesions.

Materials And Methods:-
The present study was a prospective study conducted on 200 patients over a period of 2 years.
Inclusion Criteria: 1. Patients presenting with ulcers, abnormal growths, precancerous conditions and malabsorption syndrome (MAS). 2. Lesions present in esophagus, stomach and up to second part of duodenum. Brief clinical data was noted from the case records, endoscopic findings were noted and presumptive clinical diagnosis was made. The endoscopic biopsy specimens so obtained were put in saline, placed on the filter paper with mucosal surface upwards and fixed in 10% formalin. All the bits were embedded together for ideal visualization. Then, sections 4-6 microns were stained routinely with Haematoxylin and Eosin. Additional sections were stained with special stain, Giemsa stain, to look for the presence of H. Pylori. The neoplastic lesions were diagnosed as per WHO classification of tumours 5 . The cases of MAS were graded as per modified MARSH criteria 6 . (Statistical package for social sciences v21.0) was used to perform statistical analyses.

Discussion:-
Upper GI symptoms like dyspepsia, dysphagia, abdominal pain, etc. are a very common cause of discomfort among patients & form the common reasons for referral to hospitals. Endoscopy, when combined with biopsy is a cost effective procedure when it comes to arriving at a specific diagnosis of a patient with non-specific symptoms.In the present study, majority of patients presented between 31-40 years of age in contrast to study done by Froehlich et al 7 , where the age group was found to be over 60 years. The youngest patient being 03 years of age & oldest being 80 years. This relative variation could be due to different risk factors prevalent among different age groups.The nonneoplastic lesions included cases of esophagitis, gastritis, GAVE, polyps, duodenitis, villous atrophy& lymphangectasia. The peak age group of non-neoplastic lesions was found to be 31-40 years. These findings were in contrast to the study done by Wei et al where mean age group was 56 years 8 . Gastritis was found to be common in 31-40 years age group in the present study similarly, it was found to be common in 31-40 years in other studies & the incidence was also found to increase with age 9,10 . In the present study, gastric polyps were found more in females over 31-  19 .In all the three studies the men out numbered women due to more prevalence of smoking, alcoholism and stressful life.
The non-neoplastic lesions were also commonly seen in males (69.3%), which was similar to Lee et al 20 . Gastritis was also more common in males in the present study similar to Afzal et al but in contrast to Adisa et al where it was more common in females 21,22. This could be due to more number of males attending the hospital and also due to higher consumption of alcohol in males.In the present study, gastric polyps were found to occur more in frequency in females than males while Ljubicic et al showed a slight male preponderance 11 .Overall, the neoplastic lesions were similar in males (50.0%) and females (50.0%) in contrast to Vidyavathi 25 In the present study, the most common presenting complaint was pain abdomen (71.7%) followed by diarrhoea (20.5%). Gastritis presented as pain in abdomen, in contrast to dyspepsia in a study by Al-Ammaret al 9 . In the present study, the most common presenting symptom of neoplastic lesions was pain abdomen (47.1%) followed by dysphagia (23.5%) similar to that found by Hammadi et al 14 . Dysphagia was highest among SCC of the esophagus (40.0%), similar to that found by Pedram et al 15 .

Conclusion:-
Few of the lesions in the present study emerged to be benign, which were otherwise visualized as atypical/ suspicious on endoscopy. Thus, endoscopy should be adjuncted with biopsy for better detection of lesions. Bibliography:-