Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 21, 2013; 19(27): 4374-4379
Published online Jul 21, 2013. doi: 10.3748/wjg.v19.i27.4374
Predictive findings for Helicobacter pylori-uninfected, -infected and -eradicated gastric mucosa: Validation study
Kazuhiro Watanabe, Naoyoshi Nagata, Ryo Nakashima, Etsuko Furuhata, Takuro Shimbo, Masao Kobayakawa, Toshiyuki Sakurai, Koh Imbe, Ryota Niikura, Chizu Yokoi, Junichi Akiyama, Naomi Uemura
Kazuhiro Watanabe, Naoyoshi Nagata, Ryo Nakashima, Etsuko Furuhata, Masao Kobayakawa, Toshiyuki Sakurai, Koh Imbe, Ryota Niikura, Chizu Yokoi, Junichi Akiyama, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Takuro Shimbo, Department of Clinical Research and Informatics, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Naomi Uemura, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa City, Chiba 272-8516, Japan
Author contributions: Watanabe K collected clinical information and mainly wrote the manuscript; Shimbo T contributed to the statistical analysis; Nagata N and Akiyama J edited the manuscript; Kobayakawa M and Sakurai T performed the endoscopic assessments; Nakashima R, Furuhata E, Imbe K, Niikura R and Yokoi C helped with data acquisition; Nagata N and Uemura N designed the study.
Supported by A Grant from the National Center for Global Health and Medicine
Correspondence to: Dr. Naoyoshi Nagata, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. nnagata_ncgm@yahoo.co.jp
Telephone: +81-3-32027181 Fax: +81-3-32071038
Received: February 22, 2013
Revised: April 1, 2013
Accepted: May 18, 2013
Published online: July 21, 2013
Abstract

AIM: To validate the usefulness of screening endoscopy findings for predicting Helicobacter pylori (H. pylori) infection status.

METHODS: H. pylori infection status was determined by histology, serology, and the urea breast test in 77 consecutive patients who underwent upper endoscopy. Based on the findings, patients were categorized as H. pylori-uninfected, -infected, or -eradicated cases. Using six photos of certain sites in the stomach per case, we determined the presence or absence of the following endoscopic findings: regular arrangement of collecting venules (RAC), linear erythema, hemorrhage, fundic gland polyp (FGP), atrophic change, rugal hyperplasia, edema, spotty erythema, exudate, xanthoma, and mottled patchy erythema (MPE). The diagnostic odds ratio (DOR) and inter-observer agreement (Kappa value) for these 11 endoscopic findings used in the determination of H. pylori infection status were calculated.

RESULTS: Of the 77 patients [32 men and 45 women; mean age (SD), 39.7 (13.4) years] assessed, 28 were H. pylori uninfected, 28 were infected, and 21 were eradicated. DOR values were significantly high (< 0.05) for the following H. pylori cases: uninfected cases with RAC (11.5), linear erythema (24.5), hemorrhage (4.1), and FGP (34.5); for infected cases with atrophic change (8.67), rugal hyperplasia (15.8), edema (14.2), spotty erythema (11.5), and exudate (3.52); and for eradicated cases with atrophic change (32.4) and MPE (103.0). Kappa values were excellent for FGP (0.93), good for RAC (0.63), hemorrhage (0.79), atrophic change (0.74), and MPE (0.75), moderate for linear erythema (0.51), rugal hyperplasia (0.49), edema (0.58), spotty erythema (0.47), and exudate (0.46), and poor for xanthoma (0.19).

CONCLUSION: The endoscopic findings of RAC, hemorrhage, FGP, atrophic change, and MPE will be useful for predicting H. pylori infection status.

Keywords: Diagnostic odds ratio, Endoscopic finding, Eradication therapy, Helicobacter pylori, Inter-observer agreement

Core tip: To determine useful findings for predicting Helicobacter pylori (H. pylori)-uninfected, -infected, or -eradicated cases, we evaluated following 11 endoscopic findings, regular arrangement of collecting venules (RAC), linear erythema, hemorrhage, fundic gland polyp (FGP), atrophic change, rugal hyperplasia, edema, spotty erythema, exudate, xanthoma, and mottled patchy erythema (MPE). Among these, RAC, hemorrhage, FGP, atrophic change, and MPE were found to be predictive findings for H. pylori infection status on screening endoscopy. The knowledge of these findings may contribute to the early detection of gastric cancer.