Objectives During esophagogastroduodenoscopy, a red linear scrape‐like appearance with white deposits sometimes appears on the gastric mucosa at the lower greater curvature of the gastric body, a finding we named the “scratch sign.” We aimed to clarify the clinical significance of this new endoscopic finding in the endoscopic evaluation of the Helicobacter pylori infection status. Methods Among patients who underwent esophagogastroduodenoscopy at our hospital between October 2016 and June 2017, 437 patients were included in the study. We first examined the overall scratch sign positivity rate, and then this was compared according to the H. pylori infection status. Subsequently, other variables were compared and examined between the positive and negative scratch sign groups. Results Overall, 437 patients were included in the analysis. The scratch sign was observed in 1.4% of 71 patients with current infections, 26.9% of 290 patients with past infections, and 31.6% of 76 uninfected patients. In the multivariate analysis, H. pylori ‐negative, severe gastric mucosal atrophy, and acid secretion depressant were independent factors that significantly affected the appearance of the scratch sign. Conclusions A novel endoscopic finding, the scratch sign, was found to be a good endoscopic predictor of H. pylori ‐negative gastric mucosa. Furthermore, combined with atrophic changes and xanthomas that persisted after eradication, these findings were found to be useful in accurately diagnosing H. pylori past‐infected gastric mucosa endoscopically.

Mitochondrial disease is induced by mutations in both mitochondrial DNA and DNA of nuclear genes that encode mitochondrial proteins, and there is a general lack of genotype-phenotype correlation in many mitochondrial disorders, which makes the diagnosis of mitochondrial disease difficult. We treated a 37-year-old woman with congenital cataract, bilateral sensory deafness, severe bilateral ptosis, oculomotor disorder in all directions and systemic muscular atrophy and weakness. These clinical characteristics made us perform further examinations, and we found ischemic change in brain and remarkable atrophy of extraocular muscles by magnetic resonance imaging (MRI), optic atrophy by fundus examination and high levels of serum lactate and lactate/pyruvate ratio, which confirmed the diagnosis of mitochondrial disease. Finally, she was diagnosed with having mitochondrial disease for over 30 years after onset.