Improved Detection of Helicobacter pylori Infection and Premalignant Gastric Mucosa Using Conventional White Light Source Gastroscopy

Abstract

Background: The gold standard diagnosis of H. pylori related gastritis is evidence of bacteria on histopathological examination of gastric mucosa. Our aim was to study the correlation between gastric mucosal morphology and histopathological severity of H. pylori related gastritis. Materials and Methods: Division was made on morphological features into:Type 1, showing regular arrangement of red dots; Type 2, showing cleft-like appearance; Type 3, with a mosaic appearance; and Type 4, having a mosaic appearance with focal or diffuse hyperemia. Results: Types 1 and 2 gastric mucosal morphologies were statistically significant in predicting an H. pylori negative status (137/145, p<0.01), while Types 3 and 4 were significant a positive status (139/155, p<0.01). The sensitivity, specificity, positive and negative predictive values of Type 3 and 4 morphologies for predicting H. pylori positive were 94.6%, 89.5%, 89.7% and 94.5%, respectively, with a good correlation with inflammation grading (p<0.01). Conclusions: Our study suggests that gastric mucosal morphology can be reliably identified using conventional white light source gastroscopy with good correlation between findings and inflammation grading.

Ivth Brazilian Consensus Conference on Helicobacter Pylori Infection

“…The Japanese school divides the status of the gastric mucosa into three categories based on endoscopic findings: normal gastric mucosa without HP infection (absence of gastritis), active HP infection (active gastritis), and previous HP infection (inactive gastritis). The endoscopic classification of Kyoto for endoscopic gastritis lists 19 endoscopic findings to characterize gastric mucosa inflammation and the presence of HP infection with high accuracy, depending on the methods used (70)(71)(72)(73)(74)(75) .…”

A systematic review of the role of non-magnified endoscopy for the assessment of H. pylori infection

“…Although patient recruitment was prospective, analysis of the images and categorization was performed retrospectively, after the time of endoscopy. A similar classification was developed by Matrakool et al, who also demonstrated good correlation between the different endoscopic appearances and histological grade of inflammation [13].…”

Diagnosis of Helicobacter pylori infection

“…A more simplified classification would be much more attractive to the less‐experienced endoscopist community who do not use IEE in their daily practice. Using conventional WLE, endoscopic morphological findings that correlate with H. pylori infection include mucosal erythema, erosions, antral nodularity, thickened gastric folds, and visible submucosal vessels . However, these findings lack reliability due to low sensitivity and specificity.…”

“…However, these findings lack reliability due to low sensitivity and specificity. Matrakool et al . proposed an interesting simplified classification for WLE diagnosis of H. pylori infection‐related gastritis, dividing the gastric morphological features into four types: 1—regular arrangement of red dots; 2—cleft‐like appearance; 3—mosaic appearance; 4—mosaic appearance with focal or diffuse hyperemia.…”

“…Matrakool et al 10 However, it should be emphasized that there are inherent difficulties in interpretation and reproducibility of these classifications in the community by less-experienced endoscopists, and in many parts of the world, the availability of high resolution ME endoscopes remains limited to referral centers or academic institutions.…”