Incisura Angularis Represents the More Severe Atrophic and Chronic Inflammatory Changes Compared to Antrum Mucosa and Characterized by Higher Interobserver Agreement

Abstract

Background: The value of the diagnostic yield of biopsy of incisura angularis has been addressed in several studies. Despite being considered the earliest location of the onset of metaplastic transformation, some studies concluded that few histological findings were detectable only in biopsies of the incisura angularis. Objective: The aim of our study was to compare the atrophic, metaplastic, acute and chronic inflammatory changes as well the colonization of H. pylori in incisura angularis and antrum mucosa. Methods: Seven hundred and thirty-one patients undergoing upper endoscopy were enrolled in the study. Three expert pathologists graded biopsy specimens according to the Sydney classification and evaluated atrophy, intestinal metaplasia and H. pylori colonization in antrum and incisura angularis. Results: Overall, atrophic mucosa changes in antrum was observed in 20.6% of cases, whereas atrophic changes in incisura angularis was found in 17.4%. However, the moderate and severe atrophy stage (II–III) was more frequently found in incisura angularis compared to antrum mucosa. In addition, the incisura angularis was characterized by frequent incidence of moderate and severe intestinal metaplasia compared to antrum. Furthermore, the frequency of acute inflammatory responses (mucosal leukocytes’ infiltration) was higher in antrum mucosa compared to incisura angularis, whereas the frequency of chronic inflammatory responses (mucosal lymphocytes infiltration) was higher in incisura angularis compared to antrum mucosa. H. pylori by Giemsa staining was detected slightly often in incisura angularis compared to antrum (respectively, 46.36% vs 47.79% of cases). In addition, the interobserver agreement between pathologists was higher for incisura angularis compared to antrum mucosal changes. Conclusion: Incisura angularis represents the more severe atrophic and chronic inflammatory changes compared to antrum mucosa and cha...