Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2020; 26(35): 5354-5361
Published online Sep 21, 2020. doi: 10.3748/wjg.v26.i35.5354
Clinical features of cardiac nodularity-like appearance induced by Helicobacter pylori infection
Toshihiro Nishizawa, Kosuke Sakitani, Hidekazu Suzuki, Shuntaro Yoshida, Yosuke Kataoka, Yousuke Nakai, Hirotoshi Ebinuma, Takanori Kanai, Osamu Toyoshima, Kazuhiko Koike
Toshihiro Nishizawa, Kosuke Sakitani, Shuntaro Yoshida, Yosuke Kataoka, Osamu Toyoshima, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 1570066, Japan
Toshihiro Nishizawa, Hirotoshi Ebinuma, Department of Gastroenterology, Narita Hospital, International University of Health and Welfare, Chiba 2868520, Japan
Kosuke Sakitani, Department of Gastroenterology, Sakitani Endoscopy Clinic, Chiba 2740825, Japan
Hidekazu Suzuki, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa 2591193, Japan
Yousuke Nakai, Osamu Toyoshima, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 1138655, Japan
Takanori Kanai, Department of Internal Medicine, Keio University School of Medicine, Tokyo 1608582, Japan
Author contributions: Nishizawa T analyzed data, and wrote the manuscript; Sakitani K and Yoshida S reviewed endoscopic images; Kataoka Y collected the data; Suzuki H, Nakai Y, Ebinuma H, and Kanai T critically revised the manuscript; Koike K supervised the study; Toyoshima O recruited patients, designed the study.
Institutional review board statement: This retrospective study was approved by the Ethical Review Committee of Hattori Clinic on September 6, 2019 (approval no. S1909-U06).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Osamu Toyoshima, MD, Doctor, Department of Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 1570066, Japan. t@ichou.com
Received: May 7, 2020
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.

Keywords: Cardia, Nodularity, Helicobacter pylori, Diagnosis, Gastritis

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.