<b><i>Background:</i></b> Regular arrangement of collecting venules (RAC) in gastric mucosa accurately identifies patients without <i>Helicobacter pylori</i> (<i>H pylori</i>) infection. The aim of our study was to evaluate the reproducibility of RAC using white light endoscopy without magnification, in a European country, and to assess the impact of proton pump inhibitors (PPIs). <b><i>Methods:</i></b> A multicenter prospective study with image capture of the distal lesser gastric curvature and gastric biopsies was performed. The presence of starfish-like minute points regularly distributed throughout lesser curvature was considered as RAC positive (RAC+). A set of 20 images was used for the training phase and inter and intra-observer agreements were calculated. <b><i>Results:</i></b> 174 patients were included and 85 (48.9%) were taking PPIs. Kappa values for interobserver and intra-observer agreements were substantial (0.786) and excellent (0.906), respectively. <i>H</i>. <i>pylori</i> infection was diagnosed in 29 patients (16.7%): 10/85 with PPIs and 19/89 without PPIs (11.8% vs. 21.3%; <i>p</i> = 0.09). All RAC + patients were free of <i>H</i>. <i>pylori</i> infection, with a sensitivity and negative predictive value of 100%, regardless of PPI intake. <b><i>Conclusion:</i></b> The endoscopic diagnosis of <i>H</i>. <i>pylori</i> by RAC is an easy-to-learn and highly reproducible technique, even with PPI intake. Our results warrant RAC as a real-time diagnostic method for <i>H</i>. <i>pylori</i>-negative infection in Western practice.

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