The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Predicting Helicobacter pylori infection from endoscopic features

  • Jun-young Seo (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ji Yong Ahn (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seonok Kim (Department of Clinical Epidemiology and Biostatics, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hee Kyong Na (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeong Hoon Lee (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kee Wook Jung (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Do Hoon Kim (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kee Don Choi (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ho June Song (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Gin Hyug Lee (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hwoon-Yong Jung (Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2023.07.14
  • Accepted : 2023.12.04
  • Published : 2024.05.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Helicobacter pylori infection, prevalent in more than half of the global population, is associated with various gastrointestinal diseases, including peptic ulcers and gastric cancer. The effectiveness of early diagnosis and treatment in preventing gastric cancer highlights the need for improved diagnostic methods. This study aimed to develop a simple scoring system based on endoscopic findings to predict H. pylori infection. Methods: A retrospective analysis was conducted on 1,007 patients who underwent upper gastrointestinal endoscopy at Asan Medical Center from January 2019 to December 2021. Exclusion criteria included prior H. pylori treatment, gastric surgery, or gastric malignancies. Diagnostic techniques included rapid urease and 13C-urea breath tests, H. pylori culture, and assessment of endoscopic features following the Kyoto gastritis classification. A new scoring system based on endoscopic findings including regular arrangement of collecting venules (RAC), nodularity, and diffuse or spotty redness was developed for predicting H. pylori infection, utilizing logistic regression analysis in the development set. Results: The scoring system demonstrated high predictive accuracy for H. pylori infection in the validation set. Scores of 2 and 3 were associated with 96% and 99% infection risk, respectively. Additionally, there was a higher prevalence of diffuse redness and sticky mucus in cases where the initial H. pylori eradication treatment failed. Conclusions: Our scoring system showed potential for improving diagnostic accuracy in H. pylori infection. H. pylori testing should be considered upon spotty redness, diffuse redness, nodularity, and RAC absence on endoscopic findings as determined by the predictive scoring system.

Keywords

References

  1. Malfertheiner P, Megraud F, O'Morain CA, et al. Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report. Gut 2012;61:646-664. https://doi.org/10.1136/gutjnl-2012-302084
  2. Hooi JKY, Lai WY, Ng WK, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology 2017;153:420-429. https://doi.org/10.1053/j.gastro.2017.04.022
  3. Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001;345:784-789. https://doi.org/10.1056/NEJMoa001999
  4. Graham DY. Helicobacter pylori infection in the pathogenesis of duodenal ulcer and gastric cancer: a model. Gastroenterology 1997;113:1983-1991. https://doi.org/10.1016/S0016-5085(97)70019-2
  5. Kamada T, Hata J, Sugiu K, et al. Clinical features of gastric cancer discovered after successful eradication of Helicobacter pylori: results from a 9-year prospective follow-up study in Japan. Aliment Pharmacol Ther 2005;21:1121-1126. https://doi.org/10.1111/j.1365-2036.2005.02459.x
  6. Fukase K, Kato M, Kikuchi S, et al. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet 2008;372:392-397. https://doi.org/10.1016/S0140-6736(08)61159-9
  7. Haruma K, Kato M, Inoue K, Murakami K, Kamada T. Kyoto classification of gastritis. Tokyo: Nihon Medical Center, 2017.
  8. Kim DB, Chung WC. Accuracy of endoscopic diagnosis of mild atrophic gastritis with Helicobacter pylori infection. Clin Endosc 2018;51:310-312.
  9. Alaboudy A, Elbahrawy A, Matsumoto S, Galal GM, Chiba T. Regular arrangement of collecting venules: does patient age affect its accuracy? World J Gastrointest Endosc 2011;3:118-123. https://doi.org/10.4253/wjge.v3.i6.118
  10. Garces-Duran R, Garcia-Rodriguez A, Cordova H, et al. Association between a regular arrangement of collecting venules and absence of Helicobacter pylori infection in a European population. Gastrointest Endosc 2019;90:461-466. https://doi.org/10.1016/j.gie.2019.05.027
  11. Watanabe K, Nagata N, Shimbo T, et al. Accuracy of endoscopic diagnosis of Helicobacter pylori infection according to level of endoscopic experience and the effect of training. BMC Gastroenterol 2013;13:128.
  12. Garces-Duran R, Galdin-Ferreyra M, Delgado-Guillena PG, et al. Diagnosis of Helicobacter pylori infection by the arrangement of collecting venules using white light endoscopy: evaluation of interobserver agreement. Dig Dis 2022;40:376-384. https://doi.org/10.1159/000518100
  13. Chen MJ, Wang TE, Chang WH, Liao TC, Lin CC, Shih SC. Nodular gastritis: an endoscopic indicator of Helicobacter pylori infection. Dig Dis Sci 2007;52:2662-2666. https://doi.org/10.1007/s10620-006-9281-3
  14. Kim OZ, Rhee KH, Oh H, et al. [Prediction of Helicobacter pylori infection by endoscopic severity of erythematous/exudative gastritis in asymptomatic adults]. Korean J Gastroenterol 2022;80:135-141. Korean. https://doi.org/10.4166/kjg.2022.042
  15. Hojo M, Nagahara A, Kudo T, et al. Endoscopic findings of Helicobacter pylori gastritis in children and young adults based on the Kyoto classification of gastritis and age-associated changes. JGH Open 2021;5:1197-1202. https://doi.org/10.1002/jgh3.12652
  16. Yuan C, Lin XM, Ou Y, et al. Association between regular arrangement of collecting venules and Helicobacter pylori status in routine endoscopy. BMC Gastroenterol 2021;21:389.
  17. Appelman HD. Gastritis: terminology, etiology, and clinicopathological correlations: another biased view. Hum Pathol 1994;25:1006-1019. https://doi.org/10.1016/0046-8177(94)90059-0
  18. Kaiserling E, Heinle H, Itabe H, Takano T, Remmele W. Lipid islands in human gastric mucosa: morphological and immunohistochemical findings. Gastroenterology 1996;110:369-374. https://doi.org/10.1053/gast.1996.v110.pm8566582
  19. Kitamura S, Muguruma N, Okamoto K, et al. Clinicopathological assessment of gastric xanthoma as potential predictive marker of gastric cancer. Digestion 2017;96:199-206. https://doi.org/10.1159/000481346
  20. Isomoto H, Mizuta Y, Inoue K, et al. A close relationship between Helicobacter pylori infection and gastric xanthoma. Scand J Gastroenterol 1999;34:346-352. https://doi.org/10.1080/003655299750026344
  21. Yi SY. Dyslipidemia and H pylori in gastric xanthomatosis. World J Gastroenterol 2007;13:4598-4601. https://doi.org/10.3748/wjg.v13.i34.4598
  22. Toyoshima O, Nishizawa T, Arita M, et al. Helicobacter pylori infection in subjects negative for high titer serum antibody. World J Gastroenterol 2018;24:1419-1428. https://doi.org/10.3748/wjg.v24.i13.1419
  23. Kishikawa H, Ojiro K, Nakamura K, et al. Previous Helicobacter pylori infection-induced atrophic gastritis: a distinct disease entity in an understudied population without a history of eradication. Helicobacter 2020;25:e12669.
  24. Kato T, Yagi N, Kamada T, Shimbo T, Watanabe H, Ida K. Diagnosis of Helicobacter pylori infection in gastric mucosa by endoscopic features: a multicenter prospective study. Dig Endosc 2013;25:508-518. https://doi.org/10.1111/den.12031
  25. Li P, Chen X, Shen Y, et al. Mucus penetration enhanced lipid polymer nanoparticles improve the eradication rate of Helicobacter pylori biofilm. J Control Release 2019;300:52-63. https://doi.org/10.1016/j.jconrel.2019.02.039
  26. Ensign LM, Cone R, Hanes J. Oral drug delivery with polymeric nanoparticles: the gastrointestinal mucus barriers. Adv Drug Deliv Rev 2012;64:557-570.  https://doi.org/10.1016/j.addr.2011.12.009