Can the diagnosis of NSAID-induced or Hp-associated gastric ulceration be predicted from histology?

We studied the question whether NSAID/ASA-induced ulcerations can be identified in human gastric biopsy material on the basis of ischaemic necrosis. Biopsies of 208 patients with gastric ulcers were assessed histologically. 29 patients were excluded from the study. NSAID/ASA ulcers were diagnosed when a homogeneous eosinophilic ischaemic necrosis was found. Helicobacter pylori-(Hp-) induced ulcers were diagnosed when non-homogeneous fibrinoid necrotic material containing granulocytes and cell debris was noted. The histological diagnosis was compared with the data on medication use, endoscopy and clinical history. 121 of the 179 patients included had a medical history on NSAIDS/ASA. From the 60 patients taking NSAIDS/ASA with no histologic evidence of Hp all (100 %) were identified by the histology of the necrosis. From the 61 patients taking NSAID/ASA and histologic evidence of H. pylori 40 (66 %) were identified by histology. From the 58 patients with no such medication 41 were Hp-positive and correctly identified by histology in 31 cases (76 %). The sensitivity of the histologic diagnosis of NSAID/ASA-induced ulceration was 85 %, and its specificity 53 %. The results of our study show that a high percentage of the NSAID/ASA-induced ulcers of the stomach can indeed be correctly diagnosed at histology. In conclusion the underlying aetiopathogenesis of gastric ulcerations (NASID/ASA vs. Hp) can be uncovered in a large proportion of patients based on histological examination.