title: Predictive findings for Helicobacter pylori-uninfected, -infected and -eradicated gastric mucosa: validation study.
abstract: OBJECTIVE
  To validate the usefulness of screening endoscopy findings for predicting Helicobacter pylori (H. pylori) infection status.
  
  
  METHODS
  H. pylori infection status was determined by histology, serology, and the urea breast test in 77 consecutive patients who underwent upper endoscopy. Based on the findings, patients were categorized as H. pylori-uninfected, -infected, or -eradicated cases. Using six photos of certain sites in the stomach per case, we determined the presence or absence of the following endoscopic findings: regular arrangement of collecting venules (RAC), linear erythema, hemorrhage, fundic gland polyp (FGP), atrophic change, rugal hyperplasia, edema, spotty erythema, exudate, xanthoma, and mottled patchy erythema (MPE). The diagnostic odds ratio (DOR) and inter-observer agreement (Kappa value) for these 11 endoscopic findings used in the determination of H. pylori infection status were calculated.
  
  
  RESULTS
  Of the 77 patients [32 men and 45 women; mean age (SD), 39.7 (13.4) years] assessed, 28 were H. pylori uninfected, 28 were infected, and 21 were eradicated. DOR values were significantly high (< 0.05) for the following H. pylori cases: uninfected cases with RAC (11.5), linear erythema (24.5), hemorrhage (4.1), and FGP (34.5); for infected cases with atrophic change (8.67), rugal hyperplasia (15.8), edema (14.2), spotty erythema (11.5), and exudate (3.52); and for eradicated cases with atrophic change (32.4) and MPE (103.0). Kappa values were excellent for FGP (0.93), good for RAC (0.63), hemorrhage (0.79), atrophic change (0.74), and MPE (0.75), moderate for linear erythema (0.51), rugal hyperplasia (0.49), edema (0.58), spotty erythema (0.47), and exudate (0.46), and poor for xanthoma (0.19).
  
  
  CONCLUSIONS
  The endoscopic findings of RAC, hemorrhage, FGP, atrophic change, and MPE will be useful for predicting H. pylori infection status.
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.forename: Ryo
authors.initials: R
authors.lastname: Nakashima
authors.forename: Etsuko
authors.initials: E
authors.lastname: Furuhata
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Masao
authors.initials: M
authors.lastname: Kobayakawa
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sakurai
authors.forename: Koh
authors.initials: K
authors.lastname: Imbe
authors.forename: Ryota
authors.initials: R
authors.lastname: Niikura
authors.forename: Chizu
authors.initials: C
authors.lastname: Yokoi
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005748:Gastric Fundus / Q000473:pathology; D005753:Gastric Mucosa / Q000382:microbiology*; D005756:Gastritis / Q000175:diagnosis; D005773:Gastroscopy / Q000379:methods*; D016481:Helicobacter Infections / Q000175:diagnosis*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013270:Stomach / Q000473:pathology
keywords: Diagnostic odds ratio; Endoscopic finding; Eradication therapy; Helicobacter pylori; Inter-observer agreement