Published online Apr 7, 2018. doi: 10.3748/wjg.v24.i13.1419
Peer-review started: February 25, 2018
First decision: March 9, 2018
Revised: March 13, 2018
Accepted: March 18, 2018
Article in press: March 18, 2018
Published online: April 7, 2018
To investigate the clinicopathological features of the patients testing negative for high titer serum anti-Helicobacter pylori (H. pylori) antibody.
The antibody titers were measured using antigens derived from Japanese individuals. 13C-urea breath test-positive individuals were defined as having H. pylori infection. We investigated the demographic characteristics, laboratory data, endoscopic findings including Kyoto classification of gastritis, and histology in negative-high titer patients without H. pylori eradication therapy. Kyoto classification consisted of scores for gastric atrophy, intestinal metaplasia, enlarged folds, nodularity, and redness.
Of the 136 subjects enrolled, 23 (17%) had H. pylori infection. Kyoto classification had an excellent area under the receiver operating characteristics curve (0.886, 95% confidence interval: 0.803-0.968, P = 3.7 × 10-20) for predicting H. pylori infection with a cut-off value of 2. Further, Kyoto classification, H. pylori density, and neutrophil activity had high accuracies (89.7%, 96.3%, and 94.1%, respectively). Kyoto classification was independent of the demographic and laboratory parameters in multivariate analysis.
Endoscopic Kyoto classification of gastritis is a useful predictor of H. pylori infection in negative-high titer antibody patients.
Core tip: Compared with negative-low titer (< 3 U/mL on E-plate Eiken kit), negative-high titer (3-9.9 U/mL) have been reported to be at higher risk for intestinal gastric cancer. Helicobacter pylori (H. pylori)-infected patients accounted for 94% of gastric cancer patients with an antibody titer of < 10 U/mL. Seventeen percent of subjects with negative-high titer serum anti-H. pylori antibody tested positive for H. pylori infection. Endoscopic Kyoto classification of gastritis was an excellent predictor of H. pylori infection with large area under the receiver operating characteristics curve (0.886), cut-off value of 2, and high accuracy (89.7%), indicating its high confidence.