Diagnosis of Helicobacter pylori infection in gastric mucosa by endoscopic features: a multicenter prospective study.
BACKGROUND
Endoscopic features corresponding to pathological findings in the Sydney System have not been identified, and endoscopic diagnosis of chronic gastritis has not yet been established. To establish the diagnosis of Helicobacter pylori (H. pylori) infection in gastric mucosa by endoscopic features, a prospective multicenter study was carried out.


METHODS
Two hundred and ninety-seven registered patients from 24 facilities between March 2008 and February 2009 were enrolled. Association between endoscopic findings (conventional findings and indigocarmine contrast (IC) method findings) and diagnosis of H. pylori infection made by microscopic observation of biopsy specimens was investigated in the corpus and antrum and their diagnostic accuracies were investigated.


RESULTS
Two hundred and seventy-five patients were analyzed. The area under the receiver operating characteristic (ROC) curve for H. pylori infection of conventional endoscopy was 0.811 in thecorpus and 0.707 in the antrum (P = 0.006). Evaluation of diffuse redness, spotty redness and mucosal swelling by conventional endoscopy and swelling of areae gastricae by the indigocarmine contrast (IC) method were useful for diagnosing H. pylori infection. Regular arrangement of collecting venules (RAC) in the angle, fundic gland polyposis, hemorrhagic erosion and bleeding spot in the corpus and red streaks, and erosions (flat, raised, hemorrhagic and bleeding spot) in the antrum may be used as diagnostic features suggesting negative H. pylori infection.


CONCLUSIONS
It is suggested that endoscopic diagnosis of H. pylori infection in gastric mucosa by conventional endoscopy and the IC method is mostly possible.
Department of Gastroenterology, Murakami Memorial Hospital, Asahi University, Gifu, Japan. caatk@murakami.asahi-u.ac.jp
Takahiro
T
Kato
Nobuaki
N
Yagi
Tomoari
T
Kamada
Takuro
T
Shimbo
Hidenobu
H
Watanabe
Kazunori
K
Ida
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001707:Biopsy, Needle; D002908:Chronic Disease; D003287:Contrast Media; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D005756:Gastritis / Q000175:diagnosis / Q000382:microbiology*; D005773:Gastroscopy / Q000379:methods*; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D007203:Indigo Carmine; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
D003287:Contrast Media; D007203:Indigo Carmine
H. pylori infection; conventional endoscopy; endoscopic diagnosis; indigocarmine contrast method; multicenter prospective study