title: Association of endoscopic appearances with dyspeptic symptoms.
abstract: BACKGROUND
  The relationship between endoscopic appearances such as endoscopic gastritis and duodenitis and dyspeptic symptoms has not been clearly demonstrated. We aimed to clarify the association of endoscopic appearances with Helicobacter pylori infection, histological severity of gastritis, and dyspeptic symptoms in a Japanese population.
  
  
  METHODS
  We enrolled 87 dyspeptic and 93 nondyspeptic subjects in this study. All subjects underwent gastroscopy, and patients with active peptic ulcer disease, reflex esophagitis with erosion, polyps >1 cm, or cancer were excluded. Endoscopic appearances in patients with dyspeptic symptoms and in those without were assessed retrospectively on the basis of endoscopic images. The degree of atrophy by the Kimura-Takemoto classification system was also assessed. Helicobacter pylori infection status was examined by histology or antibody against H. pylori. Histological severity of inflammation and glandular atrophy in the antrum were assessed according to the updated Sydney System. The odds ratio (OR) and 95% confidence interval (CI) were calculated by logistic regression using the variables age, sex, H. pylori infection status, and all endoscopic appearances.
  
  
  RESULTS
  The degree of atrophy tended to be lower among dyspeptic patients (P = 0.06). Among all endoscopic appearances, the liner redness (friability) in the antrum (OR = 3.90, 95% CI = 1.20-12.64) and duodenal ulcer (DU) scarring (OR = 3.41, 95% CI = 1.08-10.79) were independently associated with dyspepsia. Histological severity of inflammation and glandular atrophy were not associated with dyspeptic symptoms. Also, no correlation was found between endoscopic appearances and any of the different subgroups of dyspeptic symptoms. Patients with friability in the antrum and DU scar, which correlated with dyspeptic symptom showed some of communal symptoms such as epigastric pain, epigastric discomfort, hypochondriac pain, early satiation/postprandial fullness, and belching, but they differed considerably with respect to H. pylori positivity and the histological severity of gastritis.
  
  
  CONCLUSIONS
  Some endoscopic appearances such as friability in the antrum and DU scarring may be associated with dyspeptic symptoms, and endoscopic appearances may be useful markers to perform clinical implementation reflecting an individual's pathophysiology of dyspeptic symptoms.
authors: Department of Gastroenterology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Toyoake, 470-1192, Japan.
authors: Tomomitsu
authors: T
authors: Tahara
authors: Tomiyasu
authors: T
authors: Arisawa
authors: Tomoyuki
authors: T
authors: Shibata
authors: Masakatsu
authors: M
authors: Nakamura
authors: Masaaki
authors: M
authors: Okubo
authors: Daisuke
authors: D
authors: Yoshioka
authors: Fangyu
authors: F
authors: Wang
authors: Hiroshi
authors: H
authors: Nakano
authors: Ichiro
authors: I
authors: Hirata
mesh_terms: D000368:Aged; D001284:Atrophy / Q000473:pathology; D016001:Confidence Intervals; D004381:Duodenal Ulcer / Q000473:pathology; D004415:Dyspepsia / Q000382:microbiology / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000473:pathology*; D016480:Helicobacter pylori; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012720:Severity of Illness Index