Introduction: Dyspepsia is a common symptom with an extensive differential diagnosis. Endoscopy
alone may miss serious mucosal lesions in about 15 to 30% of cases. The aim was to determine histopathological
features of gastric and duodenal mucosal biopsies in patients with dyspepsia and normal
looking upper gastrointestinal (GI) endoscopy.
Materials and methods: One hundred and five adult patients presenting with dyspepsia with no endoscopic
mucosal lesions in the upper GI tract were included. Gastric biopsy specimens according to
Sydney–Houston system for grading gastritis and biopsy from duodenum were taken. The histopathological
features were graded according to the Sydney–Houston system classification for grading gastritis.
Results: The histological lesions were found in 65.7% (69 out of 105 endoscopy free dyspeptic patients).
Chronic inflammation was the commonest finding. Neutrophilic activity, glandular atrophy, and mild
degree of intestinal metaplasia were present in 27, 45, and 6 patients (22.8, 42.8, and 5.7% respectively).
Helicobacter pylori was present in 54 patients with histopathological lesions and in 6 patients without
histopathological lesions, and the difference was significant (p = 0.045).
Conclusion: The endoscopic diagnosis of dyspepsia correlated poorly with histopathological findings.
The histopathological examination allowed detection and grading of gastric pathology in dyspepsia with
normal endoscopy and the commonest finding was the moderate chronic gastritis.
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