Brief Article
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World J Gastroenterol. Dec 28, 2013; 19(48): 9392-9398
Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9392
Clinical significance of white gastric crypt openings observed via magnifying endoscopy
Masashi Kawamura, Hitoshi Sekine, Shu Abe, Daisuke Shibuya, Katsuaki Kato, Takayuki Masuda
Masashi Kawamura, Hitoshi Sekine, Department of Gastroenterology, Sendai City Hospital, Miyagi 984-8501, Japan
Shu Abe, Department of Gastroenterology, JR Sendai Hospital, Miyagi 980-0022, Japan
Daisuke Shibuya, Katsuaki Kato, Cancer Detection Center, Miyagi Cancer Society, Miyagi 980-0011, Japan
Takayuki Masuda, Division of Pathology, Tohoku University School of Health Sciences, Miyagi 980-8575, Japan
Author contributions: Kawamura M and Sekine H contributed equally to this work; Kawamura M, Sekine H, Abe S, Shibuya D and Kato K designed the research; Kawamura M performed the endoscopic procedures, collected tissue samples, analyzed the data, and wrote the manuscript; Masuda T contributed to the histological analysis.
Correspondence to: Masashi Kawamura, MD, PhD, Department of Gastroenterology, Sendai City Hospital, Shimizukoji, Sendai, Miyagi 984-8501, Japan. dq8m-kwmr@asahi-net.or.jp
Telephone: +81-22-2667111 Fax: +81-22-2118972
Received: August 1, 2013
Revised: October 7, 2013
Accepted: November 3, 2013
Published online: December 28, 2013
Abstract

AIM: To evaluate the relationship between Helicobacter pylori (H. pylori)-induced gastritis and white gastric mucosal crypt openings (COs) in the gastric corpus.

METHODS: A total of 175 consecutive patients (including 69 patients with gastric cancer) were enrolled in this study. We used magnifying endoscopy (ME) to observe the mucosa microsurface of the lesser and greater curvature of the gastric corpus (350 areas in all). We focused on areas with a round pit microstructure (primarily observed in non-atrophied areas) and evaluated the white openings of these gastric pits. We classified the whiteness of the COs as the “white-edged dark spot” type (consisting of a dark spot bordered by white); the “white” type (pure white with no dark spot); and the “dense white pit (DWP)” type (dense white, resembling a snowball). Gastritis was also histologically evaluated according to the updated Sydney System.

RESULTS: We detected round COs using ME in 246 of the 350 areas examined. The histological examination showed significantly more mononuclear cells and neutrophil infiltration in the “white” and “DWP” types than the “white-edged dark spot” type (P < 0.001). Furthermore, significantly high-grade inflammation and evidence of active H. pylori-induced gastritis was observed in the “DWP” type (P < 0.001). Significant differences were observed in the whiteness of COs between H. pylori-positive (n = 139) and negative (n = 36) patients (P < 0.001). The sensitivity and specificity of the “white” and “DWP” types for predicting H. pylori infection were 78.5% and 81.7%, respectively. Of the patients with gastric cancer, 22.5% (18/80) had “white-edged dark spots”, 51.3% (41/80) had “white” COs, and 26.3% (21/80) had “DWP”-type COs. “DWPs” were frequently observed among patients with undifferentiated gastric cancer [45.7% (16/35)].

CONCLUSION: CO whiteness detected via ME was associated with histological evidence of gastritis and helps to predict the severity of inflammation and H. pylori-induced activity.

Keywords: Magnifying endoscopy, Helicobacter pylori, Gastritis, Gastric cancer, Inflammation

Core tip: Recent studies have reported that advances in magnifying endoscopy (ME) have led to better correlations between histopathological findings and the ME features of Helicobacter pylori (H. pylori)-induced gastritis. However, the ME findings regarding H. pylori-induced severe inflammation are insufficient. Therefore, we evaluated the relationship between H. pylori-induced gastritis and the whiteness of gastric mucosal crypt openings (COs) in the gastric corpus using ME. Our results showed that mononuclear cell and neutrophil infiltration differed significantly among the CO subtypes. CO whiteness detected via ME was associated with histological evidence of gastritis and helps to predict the severity of inflammation or activity induced by H. pylori in the gastric corpus.