Gastrointestinal illnesses constitute a significant burden in clinical practice, contributing to both morbidity and mortality [1]. Specimens obtained from the mucosa of the esophagus, stomach, and duodenum play a crucial role in diagnostic procedures. In the realm of surgery, endoscopy-guided biopsies are the recommended method, providing essential information for diagnosis and subsequent treatment decisions [2]. Histopathological diagnosis becomes particularly critical in cases involving polypoid lesions, ulcerative lesions, and ambiguous findings during endoscopy. Combined with biopsy, upper gastrointestinal (GI) endoscopy is indispensable for the early detection of GI neoplasms, offering various therapeutic options, including potential curative interventions [3]. The development of an appropriate treatment plan relies, in part, on histological confirmation of the final diagnosis of gastrointestinal lesions.

The esophagus and stomach are susceptible to a diverse range of conditions, including infections, inflammatory disorders, vascular issues, mechanical problems, and chemical or physical reactions, such as radiation damage and neoplasms [4]. The current gold standard for evaluating individuals presenting with gastrointestinal symptoms involves endoscopic biopsy examination, a generally safe procedure followed by histopathologic assessment [5].

This study aims to characterize the spectrum of histopathological lesions affecting the gastrointestinal tract.

This cross-sectional study was conducted in the Department of Pathology at A.C.S Medical College and Hospital over one year, from July 2022 to July 2023. The study included 55 individuals with gastrointestinal complaints who underwent endoscopic biopsies for diagnostic purposes.

Inclusion Criteria

• Endoscopic biopsies from the stomach, duodenum, and esophagus in both male and female patients of all ages.

Exclusion Criteria

• Individuals with a history of prior treatment for gastrointestinal tract cancer.
• Pharyngeal and oral cavity biopsies.
• Recurrent malignancies of the upper gastrointestinal tract.
• Specimens from esophagectomy, colectomy, stomach resections, and colon resections.

Upon receipt in appropriately labeled, securely sealed containers with 10% formalin, the biopsies underwent a thorough examination to assess their quantity and appearance. Following sufficient fixation, the entire sample underwent standard processing before being embedded in paraffin, with the mucosal surface positioned on top. Sections, five microns thick, were cut perpendicular to this surface using a rotating microtome, resulting in the preparation of three to four serial sections per slide. Sections were mounted with cover slips using Distyrene Plasticizer Xylene (DPX) as the mountant after being stained with Hematoxylin and Eosin. Special stains, such as Gomori’s methenamine silver (GMS) and periodic-Schiff (PAS) stains for fungi, the reticulin stain for assessing the degree of atrophy in the stomach mucosa, and the Giemsa stain for identifying organisms like Helicobacter pylori, were used when necessary.

The collected data were compiled in a master chart, and analysis and computations were performed as required. Quantitative and qualitative variables were represented as percentages.

The age range of the participants in this study varied from 20 to 70 years. The majority, 45.4% (25/40), belonged to the 61-70 age group, followed by 36.3% (20/55) in the 51-60 age group and 18.1% (10/55) in the 40-50 age group.

In this study, 81.8% of the participants were male (45/55), while 18.1% were female (10/55).

A total of 55 biopsy samples from the Upper Gastrointestinal Tract (UGIT), including those from the esophagus (27.2%, 15/55), stomach (54.5%, 30/55), and duodenum (18.1%, 10/55), were examined.

The majority of patients in the third decade underwent esophageal and stomach biopsies, with a higher frequency of biopsies from both sites in males than in females. In the fourth decade, duodenal biopsies were performed on patients most frequently, with men predominating over women in this setting as well.

Distribution of Cases Based on the Site

Thirty patients (18.7%) had duodenal lesions, 80 cases (50%) had stomach lesions, and 50 cases (31.2%) had esophageal lesions. The majority of UGIT endoscopic biopsies originated from the stomach (Table 1).

In the present study, among oesophageal biopsies, 66.6% (10/15) were non-neoplastic, and 33.3% (5/15) were neoplastic. Among the non-neoplastic lesions, 53.3% (8/15) had persistent non-specific esophagitis. Neoplastic lesions included adenocarcinoma and high-grade dysplasia. Two cases (13.3%) of squamous cell carcinoma of the oesophagus were identified, exhibiting cellular characteristics of malignancy and penetration into the underlying stroma.

The distribution of biopsy sites in the oesophagus was as follows: middle esophagus (20%), upper esophagus (14%), and lower end of the esophagus (66.6%). The majority of esophageal biopsies were taken from individuals in their sixth decade (35%) and seventh decade (10%), with a male-to-female ratio (M:F) of 2:1 (Table 2).

In the present study, among gastric biopsies, 66.6% (20/30) were non-neoplastic, and 33.3% (10/30) were neoplastic. Among the non-neoplastic lesions, 10% (3/30) were acute gastric ulcers at the body, 16.6% (5/30) were chronic peptic ulcers at the pylorus, 33.3% (10/30) were chronic non-specific antral gastritis at the antrum, and 6.6% (2/30) were hyperplastic polyps at the pylorus. Neoplastic lesions included three cases (1%) of signet ring cell adenocarcinoma and seven (23.3%) cases of stomach adenocarcinoma (Table 3).

In our study, it was observed that a majority of the patients, constituting eighty percent (8/10), exhibited chronic duodenitis, whereas a smaller proportion, specifically two percent (2/10), presented with H. pylori-associated duodenitis. Notably, in the fourth decade, duodenal biopsies were most frequently conducted, and a notable male predominance over females was evident in this demographic context.