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
Patients who test negative but in the negative-high titer range of serum anti-Helicobacter pylori (H. pylori) antibodies are at a high risk for gastric cancer, especially the intestinal type, and sometimes have H. pylori infection. Patients with negative-high titers with H. pylori infection have higher risk for gastric cancer than do those without H. pylori infection.
The clinicopathological features including H. pylori infection rate in the negative-high titer patients are unclear.
The objective of this research was to elucidate the clinicopathological features of the negative-high titer patients.
The antibody titers were measured using antigens derived from Japanese individuals, E-plate Eiken. 13C-urea breath test (UBT)-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 history of H. pylori eradication therapy.
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) for predicting H. pylori infection, with a cut-off value of 2. Further, Kyoto classification had high accuracy (89.7%). Kyoto classification was independent of the demographic and laboratory parameters in multivariate analysis.
In this study, 17% of patients with negative-high titer had H. pylori infection. Endoscopic Kyoto classification of gastritis with a score of 2 or more could predict H. pylori infection in negative high-titer patients. Further investigations including UBT should be considered in these patients.
Long-term prospective studies are expected to investigate the role of serum antibody titer and Kyoto classification of gastritis in predicting not only H. pylori infection but also the risk of gastric cancer.