title: Clinical significance of white gastric crypt openings observed via magnifying endoscopy.
abstract: OBJECTIVE
  To evaluate the relationship between Helicobacter pylori (H. pylori)-induced gastritis and white gastric mucosal crypt openings (COs) in the gastric corpus.
  
  
  METHODS
  A total of 175 consecutive patients (including 69 patients with gastric cancer) were enrolled in this study. We used magnifying endoscopy (ME) to observe the mucosa microsurface of the lesser and greater curvature of the gastric corpus (350 areas in all). We focused on areas with a round pit microstructure (primarily observed in non-atrophied areas) and evaluated the white openings of these gastric pits. We classified the whiteness of the COs as the "white-edged dark spot" type (consisting of a dark spot bordered by white); the "white" type (pure white with no dark spot); and the "dense white pit (DWP)" type (dense white, resembling a snowball). Gastritis was also histologically evaluated according to the updated Sydney System.
  
  
  RESULTS
  We detected round COs using ME in 246 of the 350 areas examined. The histological examination showed significantly more mononuclear cells and neutrophil infiltration in the "white" and "DWP" types than the "white-edged dark spot" type (P < 0.001). Furthermore, significantly high-grade inflammation and evidence of active H. pylori-induced gastritis was observed in the "DWP" type (P < 0.001). Significant differences were observed in the whiteness of COs between H. pylori-positive (n = 139) and negative (n = 36) patients (P < 0.001). The sensitivity and specificity of the "white" and "DWP" types for predicting H. pylori infection were 78.5% and 81.7%, respectively. Of the patients with gastric cancer, 22.5% (18/80) had "white-edged dark spots", 51.3% (41/80) had "white" COs, and 26.3% (21/80) had "DWP"-type COs. "DWPs" were frequently observed among patients with undifferentiated gastric cancer [45.7% (16/35)].
  
  
  CONCLUSIONS
  CO whiteness detected via ME was associated with histological evidence of gastritis and helps to predict the severity of inflammation and H. pylori-induced activity.
authors.affiliation: Masashi Kawamura, Hitoshi Sekine, Department of Gastroenterology, Sendai City Hospital, Miyagi 984-8501, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kawamura
authors.affiliation: Masashi Kawamura, Hitoshi Sekine, Department of Gastroenterology, Sendai City Hospital, Miyagi 984-8501, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekine
authors.affiliation: Masashi Kawamura, Hitoshi Sekine, Department of Gastroenterology, Sendai City Hospital, Miyagi 984-8501, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Abe
authors.affiliation: Masashi Kawamura, Hitoshi Sekine, Department of Gastroenterology, Sendai City Hospital, Miyagi 984-8501, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shibuya
authors.affiliation: Masashi Kawamura, Hitoshi Sekine, Department of Gastroenterology, Sendai City Hospital, Miyagi 984-8501, Japan.
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Kato
authors.affiliation: Masashi Kawamura, Hitoshi Sekine, Department of Gastroenterology, Sendai City Hospital, Miyagi 984-8501, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Masuda
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology*; D005756:Gastritis / Q000382:microbiology / Q000473:pathology*; D005773:Gastroscopy / Q000379:methods*; D016481:Helicobacter Infections / Q000150:complications / Q000382:microbiology / Q000473:pathology*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000382:microbiology / Q000473:pathology*
keywords: Gastric cancer; Gastritis; Helicobacter pylori; Inflammation; Magnifying endoscopy