Assessment of Helicobacter pylori status by examination of gastric mucosal patterns: diagnostic accuracy of white-light endoscopy and narrow-band imaging

Ben Glover, Julian Teare, Nisha Patel, Ben Glover, Julian Teare, Nisha Patel

Abstract

Objectives: Helicobacter pylori infection is a common cause of chronic gastritis worldwide and an established risk factor for developing gastric malignancy. The endoscopic appearances predicting H. pylori status are an ongoing area of research, as are their diagnostic accuracies. This study aimed to establish the diagnostic accuracy of several mucosal features predictive of H. pylori negative status and formulate a simple prediction model for use at the time of endoscopy.

Design: Patients undergoing high-definition upper gastrointestinal (GI) endoscopy without magnification were recruited prospectively. During the endoscopy, the presence or absence of specific endoscopic findings was noted. Sydney protocol biopsies were used as the diagnostic reference standard, and urease test if taken. The results informed a logistic regression model used to produce a simple diagnostic approach. This model was subsequently validated using a further cohort of 30 patients.

Results: 153 patients were recruited and completed the study protocol. The prevalence of active H. pylori infection was 18.3% (28/153). The overall diagnostic accuracy of the simple prediction model was 80.0%, and 100% of patients with active H. pylori infection were correctly classified. The presence of regular arrangement of collecting venules (RAC) showed a positive predictive value for H. pylori naïve status of 90.7%, rising to 93.6% for patients under the age of 60.

Conclusion: A simple endoscopic model may be accurate for predicting H. pylori status of a patient, and the need for biopsy-based tests. The presence of RAC in the stomach is an accurate predictor of H. pylori negative status, particularly in patients under the age of 60.

Trial registration number: The study was registered with ClinicalTrials.gov, No. NCT02385045.

Keywords: helicobacter pylori - assessment; helicobacter pylori - gastritis; helicobacter pylori infection.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
The endoscopic appearance of the RAC in the distal stomach, in a Helicobacter pylori naïve patient. Examined at medium distance without magnification under white-light endoscopy (WLE) (A) and narrow-band imaging (B), and on closer inspection without magnification under WLE (C) and NBI (D). NBI, narrow-band imaging.
Figure 2
Figure 2
The endoscopic appearances of diffuse redness, in a Helicobacter pylori infected patient.
Figure 3
Figure 3
The endoscopic appearances of mucosal oedema, in a Helicobacter pylori infected patient. (A) The gastric body and (B) under closer inspection near the antrum.
Figure 4
Figure 4
The endoscopic appearances of map-like redness, in a patient with previous Helicobacter pylori eradication.
Figure 5
Figure 5
Participant flow diagram.
Figure 6
Figure 6
The diagnostic algorithm used for the second cohort of patients to predict classification of Helicobacter pylori status. RAC, regular arrangement of collecting venules.

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