The relationship of neuroendocrine cell hyperplasia detected in stomach biopsy with hypergastrinemia and evaluation of the accompanying endoscopic and histopathological findings

Objective: In our study, patients with neuroendocrine cell hyperplasia (NEHH) were diagnosed with hypergastrinemia; We aimed to investigate whether there is a relationship between the accompanying endoscopic findings and NEHH subtypes and to contribute to the literature. Materials and Methods: The study was conducted in 511 patients, who were followed up in Akdeniz University Hospital Gastroenterology Department, underwent upper GIS endoscopy between 01.07.2021 and 01.07.2022 and were found to have NEHH in the pathological examination of gastric biopsy materials, and gave consent, including age, gender, Hashimoto's thyroiditis and Type 1 DM. Histological subtypes of neuroendocrine cell hyperplasia were examined, including other accompanying autoimmune diseases, chronic ppi use, smoking and alcohol use, presence of obesity, gastrin level, endoscopic accompanying findings. Statistical method: Data IBM SPSS Statistics 18 © Copyright SPSS Inc. It was analyzed using 1989, 2010 software. The conformity of continuous variables to the normal distribution was examined using the Shapiro-Wilk test. Categorical variables in the study were presented with frequency (n) and percentage (%), and continuous variables with mean±standard deviation (SD), median (IQR: 25th-75th percentile) values. Pearson Chi-square, Yates correction, FisherExact Test, Monte Carlo test and Bonferroni corrections were used in the analysis of categorical variables. One Way ANOVA and post hoc LSD test were used in cases where parametric test assumptions were met, and Kruskal Wallis H test and post hoc Bonferroni correction were used when they were not provided in the mean comparisons of more than two independent groups. The statistical significance level was accepted as 0.05 in the study. vi Results: 64.4% of 511 patients with NEHH were women, and the frequency of NEHH was found to be higher in women. The mean age of patients with NEHH was calculated as 54.59±14.46 years. In our study, gastric atrophy was not found in 81.6% of the patients with NEHH. Helicobacter pylori was detected in 50.9% of the patients. NEHH subtypes were found 13.9% diffuse, 39.5% linear, 15.5% micronodular, 3.3% adenomatoid, 27.8% mixed (Linear+Nodular) and the most common subtype was linear. The mean age was lower in those with normal gastrin level, and it was calculated as 47.73±13.66 years, 56.5±13.33 years in those between 115-400, and 56.1±11.94 years in those with 400 and over (p=0.001). ). 55.2% of the group with a normal gastrin level, 72.7% of the group with a gastrin level of 115-400, and 79.5% of the group with a gastrin level of 400 and above consisted of female patients, which is statistically significant (p=0.019). There was no significant relationship between gastrin levels and the presence of atrophic gastritis and helicobacter pylori. Intestinal metaplasia, dysplasia, presence of tumor and presence of polyps were found to be significantly lower in patients with normal gastrin levels compared to other patients (p<0.001). Linear type gastrin levels of NEHH subtypes were higher in patients with normal, while it was higher in patients with adenomotide and mixed type gastrin levels of 400 and above (p<0.001). No statistically significant results were found with factors such as gastrin level and NEHH subtypes, smoking, alcohol use, obesity, chronic ppi use, autoimmune diseases. When the NEHH subtypes and the median age were examined, the age of the diffuse type patients was significantly lower than the age of the mixed type patients (p=0.015). The median age was 49 (38-62) in the diffuse NEHH subtype, 57 (45-67) in the linear group, 53 (45-64) in the micronodular group, 53 (45-61) in the adenomotide group, and 58 in the mixed group. It is calculated as (49-67) years. There was no significant difference between NEHH subtypes and the presence of atrophic gastritis (p=0.576), helicobacter pylori (p=0.674) and polyps. Intestinal metaplasia and dysplasia were found to be significantly lower in linear type compared to adenomotide and mixed type (p=0.001). Tumor presence was found to be lowest in linear type and highest in adenomotide type compared to all other groups (p<0.001). Conclusion: Neuroendocrine cell hyperplasia was found to be more common in women over 50 years of age. The mean age was higher in patients with high gastrin levels, and it was more likely to be seen in women. The most common linear type was found among the NEHH subtypes. When the subtypes were examined, the age of the patients with the diffuse type was significantly lower than the age of the patients with the mixed type (p=0.015). Intestinal metaplasia, dysplasia, polyps and tumors were found more frequently in patients with a gastrin level >400 (p<0.001). When factors such as smoking, alcohol use, obesity, chronic ppi use, autoimmune diseases were examined according to gastrin level and NEHH subtypes, no statistically significant results were found. Keywords: Neuroendocrine cell hyperplasia, Gastrin, Neuroendocrine Tumor