Close observation endoscopy of gastric mucosal pattern in predicting Helicobacter pylori infection: A single-center cross-sectional study

Abstract

Background:
Helicobacter pylori (Hp) is a major health problem causing chronic gastritis, peptic ulcer disease, gastric cancer, and affects 60% of dyspeptic patients in the Philippines. Advanced techniques such as magnifying chromoendoscopy and narrow band imaging increase detection rates but are not available in most endoscopy centers in the country. Our aim is to apply the Cho et al. classification on gastric mucosal pattern by close observation with standard white light endoscopy to identify Hp infection status.

Methodology:
This is a single-center cross-sectional study of 205 dyspeptic patients undergoing gastroscopy, all without gastrointestinal bleeding, gastric mass, or liver cirrhosis. Close observation of the gastric mucosa of the corpus, rapid urease test (RUT) and histopathology were done. Patterns were categorized according to the Cho et al. criteria: without Hp infection (normal RAC (regular arrangement of collecting venules) pattern); or with Hp infection (mosaic pattern (Type A); diffuse redness (Type B); or atypical pattern (Type C)).

Results:
97 of 205 (47%) patients were positive for Hp. The technique is 98.75% sensitive, 85.6% specific, PPV 81.44%, NPV 99.7%, and 90.7% overall diagnostic accuracy.

Conclusion:
Normal RAC pattern has good agreement with Hp status and, for these patients, further testing for Hp may no longer be necessary. Abnormal RAC and presence of Types A, B and C mucosa suggest Hp positivity but is less specific compared to RUT. Overall, Hp screening by close observation of the corpus mucosa is a cost-effective approach in Hp diagnosis and can be
reliably used in clinical practice.