Gastric histologic findings in patients with nonsteroidal anti-inflammatory drug-associated gastric ulcer.

The purpose of this study was to characterize gastric histologic findings in patients with nonsteroidal anti-inflammatory drug (NSAID)-associated gastric ulcer (GU). Gastric biopsy specimens from 136 patients with NSAID-related GU were compared with those from a control population of 185 patients with Helicobacter pylori-related gastritis. Foveolar hyperplasia, edema, muscular stranding, vascular ectasia, and active and chronic inflammation were semiquantitatively graded. Lymphoid aggregates, intestinal metaplasia, atrophy, and cystic gland changes were noted. No single parameter reliably distinguished between the two populations, although moderate/severe foveolar hyperplasia, edema, and vascular ectasia were significantly more common in the NSAID group. With use of the Dixon scoring system for reflux/reactive gastropathy, with a threshold score of 11 or more, 39 (29%) patients in the NSAID group were correctly diagnosed as having reactive gastropathy (sensitivity, 29%; specificity, 100%; positive predictive value, 100%). When the Dixon scoring threshold score was decreased to 8 or more, 114 (84%) patients were classified as having reactive gastropathy (sensitivity, 84%; specificity, > 99%; positive predictive value, > 99%). We conclude that a decreased threshold enhances the usefulness of the reactive gastropathy score in the NSAID-related GU population. Additional studies, however, must be performed to evaluate the effect of a lowered threshold relative to a normal population and those with other causes of reactive gastropathy.