Erosive Prepyloric Changes (EPC) — A New Entity

Abstract

Erosive prepylocic changes (EPC) is an endoscopic diagnosis based on the presence of standing prepyloric folds, with erosions (grade 3), red spots/streaks (grade 2), or without visible macroscopic lesions (grade 1). The results show that EPC is a highly reproducible finding, the endoscopic grades being interrelated. EPC grade 2 or 3 (‘active’ EPC) is shown to be associated with non-ulcer dyspepsia (NUD) and is a frequent finding at routine upper endoscopy when this is performed as a primary examination (instead of X-ray) in dyspeptic patients (1). We do not believe that EPC and ulcer are aspects of the same disease. Several observations contribute to distinguishing EPC from ulcer: Most patients have a long disease history without peptic ulcer, and the symptomatic response to cimetidine treatment is less striking than that generally found in ulcer patients. Concerning the pathogenesis of EPC, no fundamental disturbance has yet been disclosed. Maximal acid output and intragastric bile acid concentrations are not significantly different from those in normal subjects. Histologically, EPC grade 3 is ‘the acute grade’ characterized by erosion and acute inflammation. EPC grade 2 and 1 show inflammatory changes in only about 50% of the cases, indicating that the permanent basis of EPC, the standing mucosal folds, is independent of ongoing inflammatory activity. Therefore, EPC cannot be considered merely as a form of antral gastritis. Whether spasms in deeper muscular layers contribute to fold formation needs further investigation. The symptoms and the endoscopic findings may be due to some common underlying physiological abnormality.