THE UTILITY OF TRANS-ABDOMINAL ULTRASONOGRAPHY IN DIAGNOSIS OF GASTRITIS IN SYMPTOMATIC ADULT PATIENTS

Background: Gastritis is characterized by inflammation of the stomach and impacts approximately half of the global population. While it can be triggered by factors such as medication use, including NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) and corticosteroids, viral infections, and severe stress, the most common cause remains infection by Helicobacter pylori. Aim of the Work: to evaluate the utility of trans-abdominal ultrasound (US) in the diagnosis of gastritis and determine diagnostic parameters in known cases of gastritis who underwent endoscopy. Patients and Methods: our study was a prospective study, that was conducted at Ain Shams University Hospitals over the course of seven months from April 2023 to October 2023. This study was conducted on 56 subjects divided equally into two study groups (confirmed cases of gastritis by endoscopy and healthy controls), The main source of data that was involved were the patients referred to the Radiology Department of Ain Shams University Hospitals for transabdominal ultrasonography after undergoing endoscopy in the Gastroenterology Unit of Internal Medicine Department of the same institution.
Results: The demographic data for the two groups (cases and controls) namely the age, sex, BMI, and smoking habits were recorded, and their sonographic parameters were compared. The recorded sonographic data included total antral wall thickness and its respective layers (musculosa, submucosa, mucosal layers), total gastric body wall thickness and its respective layers (musculosa, submucosa, and mucosal layers), presence of vascularity and lymph nodes. A statistically significant difference was observed in total antral wall thickness and the thickness of its respective layers, with a P value of <0.001. A statistically significant difference was also found in gastric body measurements, with P values of 0.005, 0.004, and 0.008 in total gastric body thickness, body musculosa, and body submucosal layers respectively, yet no statistically significant difference was observed in gastric body mucosal layer thickness. Positive vascularity on colour Doppler was noted in 8 out of 28 cases of gastritis with a P value of 0.004 and was not seen in any of our control patients, rendering it a specific parameter for diagnosis of gastric inflammation. The total wall thickness of the gastric antrum is a perfect diagnostic test for gastritis, as it has an AUC of 1.00 and a sensitivity and specificity of 100% at a cut-off value of 3.8 mm. Total wall thickness of the gastric body is also a good diagnostic test, but not as accurate as the antral measurements, as it has an AUC of 0.804 and a sensitivity and specificity of 78.57% and 85.71%, respectively, at a cut-off value of 2.9 mm.
Conclusion: Trans-abdominal gastric ultrasound can be used in the diagnosis of gastritis with the mentioned parameters and characteristic features such as thickening of total and separate antral layers, thickening of total gastric body and its layers except for mucosal layer, with detected vascularity on colour Doppler, and is a valuable addition as a cost-effective, non-invasive, less time-consuming alternative compared to upper GI endoscopy, which is the current standard of diagnosis.