Accuracy of Endoscopic Diagnosis of Helicobacter pylori Based on the Kyoto Classification of Gastritis: A Multicenter Study

Abstract

BackgroundThere is lack of clinical evidence supporting the value of the Kyoto classification of gastritis for the diagnosis of Helicobacter pylori (H. pylori) infection in Chinese patients, and there aren’t enough specific features for the endoscopic diagnosis of past infections, which is of special significance for the prevention of early gastric cancer (GC).MethodsThis was a prospective and multicenter study with 650 Chinese patients. The H. pylori status and gastric mucosal features, including 17 characteristics based on the Kyoto classification and two newly-defined features unclear atrophy boundary (UAB) and RAC reappearance in atrophic mucosa (RAC reappearance) were recorded in a blind fashion. The clinical characteristics of the subjects were analyzed, and the diagnostic odds ratio (DOR), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the receiver operating characteristics curve (ROC/AUC), and 95% confidence intervals were calculated for the different features, individually, and in combination.ResultsFor past infection, the DOR of UAB was 7.69 (95%CI:3.11−19.1), second only to map-like redness (7.78 (95%CI: 3.43−17.7)). RAC reappearance showed the highest ROC/AUC (0.583). In cases in which at least one of these three specific features of past infection was considered positive, the ROC/AUC reached 0.643. For current infection, nodularity showed the highest DOR (11.7 (95%CI: 2.65−51.2)), followed by diffuse redness (10.5 (95%CI: 4.87−22.6)). Mucosal swelling showed the highest ROC/AUC (0.726). Regular arrangement of collecting venules (RAC) was specific for no infection.ConclusionsThis study provides evidence of the clinical accuracy and robustness of the Kyoto classification of gastritis for the diagnosis of H. pylori in Chinese patients, and confirms UAB and RAC reappearance partly supplement it for the diagnosis of past infections, which is of great benefit to the early prevention of GC.

Endoscopic Diagnosis for H. pylori Infection: White Light Imaging (WLI) vs. Image-Enhanced Endoscopy (IEE)

“…Figure 1 demonstrates patterns of H. pylori-positive gastric mucosae. On the other hand, the presence of RAC in the corpus10 (Figure 2), fundic gland polyps, and red streaks (Figure 3) were associated with H. pylorinegative gastric mucosa with a sensitivity/specificity of 92.4%/94.5%, 20.4%/96.9%, and 19.5%/95.4%, respectively (Zhao et al, 2020).…”

Diagnosis of Helicobacter pylori Infection and Recent Advances

“…Nodularity, diffuse redness, mucosal swelling, enlarged fold and sticky mucus were significantly associated with current infection. Map-like redness was responsible for past infection, and the overall diagnostic accuracy rate of Kyoto classification of gastritis was more than 80% [41][42][43][44]. Furthermore, with regard of uninfected status, one study showed RAC had excellent negative predictive value (NPV) of about 90% and sensitivity value of up to 85% [45].…”

Helicobacter pylori eradication: Exploring its impacts on the gastric mucosa

“…The Kyoto Classification of Gastritis, categorizing H. pylori infection into three phases (non-gastritis, active gastritis, and inactive gastritis[ 54 ]), was proposed to better assess the status of H. pylori infection and GC risk by endoscopy[ 55 ] (Figure 1 ). In a healthy stomach, an easily detectable feature, non-gastritis, was the regular arrangement of collecting venules (RAC), featured as small red spots on the mucosal surface[ 56 , 57 ]. However, after being infected with H. pylori , the stomach was characterized as irregular arrangement or absence of the so-called collecting venules[ 58 ].…”