Regular arrangement of collecting venules (RAC) as an endoscopic marker for exclusion of Helicobacter pylori (H. pylori) infection: A systematic review and meta‐analysis

Abstract

Helicobacter pylori (H. pylori) is a gram-negative bacterium with an overall global prevalence of 44.3%, ranging from 50.8% in developing countries to 34.7% in developed countries. 1 H. pylori has been categorised as a class I carcinogen for gastric cancer in 1994 and is the most common cause of gastric cancer. [2][3][4][5] It is estimated that H. pylori infection contributes to 89% of non-cardiac gastric cancers, which accounts for 78% of gastric cancer cases. 6,7 Studies have consistently shown that eradication of chronic H. pylori infection significantly reduces gastric cancer risk. 5,7,8,9,10 Graham et al conducted a meta-analysis including 48,064 individuals with a total follow-up of 340,255 person-years, demonstrating that gastric cancer risk reduces by about 50% after the eradication of H. pylori. 7 A similar finding that the eradication of H. pylori was associated with an odds ratio of 0.46 for gastric cancer risk has also been verified in an updated metaanalysis. 11 Therefore, the strong association between H. pylori and gastric cancer risk highlights the importance of adequate detection and eradication of H. pylori in clinical practice.Conventional examinations for the diagnosis of H. pylori infection include non-invasive tests such as urea breath tests, faecal antigen tests, and serological parameters, and invasive tests such as

Precision endoscopy in the era of climate change and sustainability

“…In a meta-analysis of 15 observational studies, the sensitivity and specificity of RAC to H. pylori-uninfected status was 98% and 75%, which indicates that the presence of RAC is associated with a very low risk of GC. 45 The Kimura-Takemoto classification is widely used to assess endoscopic atrophy in Japan, and an association between an increased risk of GC and the extent of atrophy has been reported. 29,46,47 A cross-sectional study evaluated the correlation between Kimura-Takemoto classification and OLGA classification and described a moderate correlation between endoscopic and histologic atrophy severity (r = 0.6, P < 0.001).…”

“…Japanese guidelines 44 suggest stratifying the risk of GC based on endoscopic findings of an H. pylori ‐uninfected status, such as the presence of a regular arrangement of collecting venules (RAC), and gastric mucosal atrophy. In a meta‐analysis of 15 observational studies, the sensitivity and specificity of RAC to H. pylori ‐uninfected status was 98% and 75%, which indicates that the presence of RAC is associated with a very low risk of GC 45 . The Kimura–Takemoto classification is widely used to assess endoscopic atrophy in Japan, and an association between an increased risk of GC and the extent of atrophy has been reported 29,46,47 .…”