title: Gastric precancerous conditions and Helicobacter pylori infection in dyspeptic patients with or without endoscopic lesions.
abstract: OBJECTIVE
  In dyspeptic patients, esophagogastroduodenoscopy is often negative for visible lesions. Biopsies of the normal-appearing mucosa for Helicobacter pylori detection are not routinely obtained. Diagnostic gain of routine biopsies is still debated. This study aimed to assess the occurrence of H. pylori infection and related gastric premalignant conditions in dyspeptic patients without visible lesions at esophagogastroduodenoscopy and whether the presence/absence of endoscopically visible lesions may address the endoscopist to obtain gastric biopsies.
  
  
  METHODS
  Post hoc study on endoscopic-histological data from 589 patients with dyspepsia (median age 57 years) obtained during a prospective nationwide study. Patients with dyspepsia as indication for esophagogastroduodenoscopy, never treated for H. pylori, were included. All the patients underwent esophagogastroduodenoscopy with biopsies according to Sydney system. Clinical data were collected using a structured questionnaire.
  
  
  RESULTS
  In 66.4% patients, the gastricduodenal mucosa appeared normal at esophagogastroduodenoscopy. In patients with or without visible lesions at esophagogastroduodenoscopy, H. pylori infection (51.5% vs. 50.1%, p = 0.82) and atrophic-metaplastic gastritis (33.3% vs. 27.6%, p = 0.18) were similar. Endoscopically visible lesions were poor predictors for H. pylori infection or gastric precancerous conditions showing positive and negative predictive values of 51.5% and 49.8% for H. pylori and 33.3% and 72.3% for atrophic-metaplastic gastritis. At logistic regression, the presence of H. pylori infection showed a negative association with ongoing antisecretory treatment (OR: 0.67), the presence of visible gastroduodenal lesions was not associated.
  
  
  CONCLUSIONS
  Dyspeptic patients with or without visible endoscopic lesions had the same occurrence of H. pylori infection and related premalignant conditions, which might be missed without biopsies, in particular, in patients on anti-secretory treatment.
authors.affiliation: a Medical-Surgical Department of Clinical Sciences and Translational Medicine , Sant'Andrea Hospital, School of Medicine, University Sapienza , Rome ;
authors.forename: Edith
authors.initials: E
authors.lastname: Lahner
authors.affiliation: a Medical-Surgical Department of Clinical Sciences and Translational Medicine , Sant'Andrea Hospital, School of Medicine, University Sapienza , Rome ;
authors.forename: Gianluca
authors.initials: G
authors.lastname: Esposito
authors.affiliation: b Department of Gastroenterology and Digestive Endoscopy , 'Nuovo Regina Margherita' Hospital , Rome ;
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.affiliation: b Department of Gastroenterology and Digestive Endoscopy , 'Nuovo Regina Margherita' Hospital , Rome ;
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: c Department of Internal Medicine and Medical Specialties , University Sapienza , Rome , Italy.
authors.forename: Marilia
authors.initials: M
authors.lastname: Carabotti
authors.affiliation: a Medical-Surgical Department of Clinical Sciences and Translational Medicine , Sant'Andrea Hospital, School of Medicine, University Sapienza , Rome ;
authors.forename: Gloria
authors.initials: G
authors.lastname: Galli
authors.affiliation: a Medical-Surgical Department of Clinical Sciences and Translational Medicine , Sant'Andrea Hospital, School of Medicine, University Sapienza , Rome ;
authors.forename: Bruno
authors.initials: B
authors.lastname: Annibale
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D004415:Dyspepsia / Q000209:etiology / Q000473:pathology*; D005260:Female; D005757:Gastritis, Atrophic / Q000453:epidemiology* / Q000473:pathology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000453:epidemiology* / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011446:Prospective Studies
keywords: Dyspepsia; Helicobacter pylori; endoscopic biopsy; gastroscopy