Gastric Atypia – A Cause for Concern?

Category: Upper Gastrointestinal Aims: Aypia is literally translated as “departure from typical normal appearance“ and describes cytologic change, which may be reactive (i.e from inflammation) or pre-malignant. Determining the course of this descriptive feature can be problematic; our aim is to detemine the significance of gastric atypia. Methods: All patients with histological description of gastric atypia between 2001 and 2005 were reviewed. (n-52) Results: Endoscopically, ulceration was found in 29 (56%), gastritis in 23 (44%), polyps in 7 (13%) and 'abnormal appearing' mucosa in 7 (13%). One had a neoplastic lesion. Histologically 48 patients (92%) had inflammation (69% acute, 93% chronic, 65% both). 39 patients (75%) had follow-up endoscopy. 8 (21%) were endoscopically normal, 14 (36%) had ulceration, 18 (46%) had gastritis, 1 (3%) had polyps and 1 (3%) had 'abnormal appearing' mucosa. Two had a neoplastic lesion. Histology showed 29 patients (74%) had inflammation (39% acute, 69% chronic, 21% both) and 2 had gastric carcinoma. 5 (13%) had persistent atypia, follow-up of which showed resolution in all. Conclusions: Most cases with 'atypia' had an inflammatory process, which resolved. Two had gastric carcinoma diagnosed on follow-up, one of which was suspected on initial endoscopy. Given the difficulties with definition and subjectivity, our findings highlight the problem of determining appropriate follow-up of gastric atypia.