Association between regular arrangement of collecting venules and Helicobacter pylori status in routine endoscopy

Abstract

Background The sensitivity of regular arrangement of collecting venules (RAC)-positive pattern for predicting Helicobacter pylori (H. pylori)-negative status greatly altered from 93.8 to 48.0% in recent two decades of various studies, while the reason behind it remained obscure. The aim of this study was to investigate the value of RAC as an endoscopic feature for judging H. pylori status in routine endoscopy and reviewed the underlying mechanism. Methods A prospective study with high-definition non-magnifying endoscopy was performed. RAC-positive and RAC-negative patients were classified according to the collecting venules morphology of the lesser curvature in gastric corpus. Gastric biopsy specimens were obtained from the lesser and greater curvature of corpus with normal RAC-positive or abnormal RAC-negative mucosal patterns. Helicobacter pylori status was established by hematoxylin and eosin staining and immunohistochemistry. Results 41 RAC-positive and 124 RAC-negative patients were enrolled from June 2020 to September 2020. The prevalence of H. pylori infection in patients with RAC-positive pattern and RAC-negative pattern was 7.3% (3/41) and 71.0% (88/124), respectively. Among all 124 RAC-negative patients, 36 (29.0%) patients were H. pylori-negative status. Ten patients (32.3%) demonstrated RAC-positive pattern in 31 H. pylori-eradicated cases. The sensitivity, specificity, positive predictive value, and negative predictive value of RAC-positive pattern for predicting H. pylori-negative status were 51.4% (95% CI, 0.395–0.630), 96.7% (95% CI, 0.900–0.991), 92.7% (95% CI, 0.790–0.981), and 71.0% (95% CI, 0.620–0.786), respectively. Conclusions RAC presence can accurately rule out H. pylori infection of gastric corpus, and H. pylori-positive status cannot be predicted only by RAC absence in routine endoscopy. Trial registration The present study is a non-interventional trial.

Predicting Helicobacter pylori infection from endoscopic features

“…The findings of the Kyoto classification of gastritis indicate H. pylori infection and non-infection. In addition, several studies have suggested that mucosal edema, spotty redness, diffuse redness, nodularity, and RAC loss are associated with H. pylori infection [ 7 , 10 , 15 , 16 ]. In our study, these endoscopic features were considerably more apparent in H. pylori -infected patients, whereas uninfected patients showed increased RAC presence, fundic gland polyp, linear streak, and raised erosion.…”

Unveiling early stage autoimmune gastritis: novel endoscopic insights from two case reports

“…CVs represent blood vessels that begin at the level of the gastric foveolar layer and descend to merge with the submucosal plexus to form a complex and tree-like three-dimensional structure. Their morphology and arrangement are intricately linked to the presence and organization of gastric foveoli and body glands (18). Kishino et al (19) documented a case of early-stage AIG.…”

Kyoto classification of gastritis: Advances and future perspectives in endoscopic diagnosis of gastritis

“…Evidence of RAC as an indicator of non-infection has been reported in both in Japan[ 17 , 18 ] and several other countries[ 19 - 21 ], including in the west[ 22 - 24 ], as shown in Table 2 . Two recent meta-analyses reported that the sensitivity and specificity of RAC for predicting non-infection were 78%-80% and 94%-97%, respectively[ 25 , 26 ].…”

“…Further research is required to confirm these findings. RAC provides high kappa values of intra-observer and inter-observer agreements of 0.88-0.91 and 0.74-0.79, respectively[ 21 , 68 ]; however, agreement between the other endoscopic findings needs to be clarified.…”