Published online Sep 21, 2020. doi: 10.3748/wjg.v26.i35.5354
Peer-review started: May 7, 2020
First decision: May 15, 2020
Revised: May 17, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: September 21, 2020
We have previously reported that Helicobacter pylori (H. pylori)-associated nodular gastritis could occur in both the antrum and the cardia. Cardiac nodularity-like appearance (hereafter, called as cardiac nodularity) had a high predictive accuracy for the diagnosis of H. pylori infection. In the previous study, we included only the patients who were evaluated for H. pylori infection for the ﬁrst time, and excluded patients with a history of eradication. Therefore, the prevalence and clinical features of cardiac nodularity remains unknown.
To perform this cross-sectional study to explore the characteristics of cardiac nodularity.
Consecutive patients who underwent esophagogastroduodenoscopy between May, 2017 and August, 2019 in the Toyoshima Endoscopy Clinic were enrolled in this study. We included H. pylori-negative, H. pylori-positive, and H. pylori-eradicated patients, and excluded patients with unclear H. pylori status and eradication failure. H. pylori infection was diagnosed according to serum anti-H. pylori antibody and the urea breath test or histology. Cardiac nodularity was defined as a miliary nodular appearance or the presence of scattered whitish circular small colorations within 2 cm of the esophagogastric junction. Nodularity was visualized as whitish in the narrow-band imaging mode. We collected data on the patients’ baseline characteristics.
A total of 1078 patients were finally included. Among H. pylori-negative patients, cardiac nodularity and antral nodularity were recognized in 0.14% each. Among H. pylori-positive patients, cardiac nodularity and antral nodularity were recognized in 54.5% and 29.5%, respectively. Among H. pylori-eradicated patients, cardiac nodularity and antral nodularity were recognized in 4.5% and 0.6%, respectively. The frequency of cardiac nodularity was significantly higher than that of antral nodularity in H. pylori-positive and -eradicated patients. The frequencies of cardiac nodularity and antral nodularity in H. pylori-eradicated patients were significantly lower than those in H. pylori-positive patients (P < 0.001). The patients with cardiac nodularity were significantly younger than those without cardiac nodularity (P = 0.0013). Intestinal metaplasia score of the patients with cardiac nodularity were significantly lower than those without cardiac nodularity (P = 0.0216). Among H. pylori-eradicated patients, the patients with cardiac nodularity underwent eradication significantly more recently compared with those without cardiac nodularity (P < 0.0001).
This report outlines the prevalence and clinical features of cardiac nodularity, and confirm its close association with active H. pylori infection.
Core Tip: The prevalence of cardiac and antral nodularity in Helicobacter pylori (H. pylori)-negative, -positive, and -eradicated patients were 0.14% and 0.14%, 54.5% and 29.5%, and 4.5% and 0.6%, respectively. Cardiac nodularity was more frequent than antral nodularity in H. pylori-positive and -eradicated patients. Cardiac nodularity was often found in younger patients and patients with less intestinal metaplasia. Cardiac nodularity decreased after eradication, especially in patients who underwent eradication a long time ago.