Close observation of gastric mucosal pattern by standard endoscopy can predict H elicobacter pylori infection status

Background and Aim Common endoscopic findings in stomachs with H elicobacter pylori infections include antral nodularity, thickened gastric folds, and visible submucosal vessels. These findings are suggestive but not diagnostic of H . pylori infection. Magnifying endoscopy can reveal more precisely the abnormal mucosal patterns in an H . pylori‐ infected stomach; however, it requires more training, expertise, and time. We aimed to establish a new classification for predicting H . pylori ‐infected stomachs by non‐magnifying standard endoscopy alone. Methods A total of 617 participants who underwent gastroscopy were prospectively enrolled from A ugust 2011 to J anuary 2012. We performed a careful close‐up examination of the corpus at the greater curvature maintaining a distance ≤ 10 mm between the endoscope tip and the mucosal surface. We classified gastric mucosal patterns into four categories: normal regular arrangement of collecting venules (numerous minute red dots), mosaic‐like appearance (type A ; swollen areae gastricae or snakeskin appearance), diffuse homogenous redness (type B ), and untypical pattern (type C ; irregular redness with groove) to predict H . pylori infection status. Results The frequencies of H . pylori infection in patients with a normal regular arrangement of collecting venules pattern and types A , B , and C patterns were 9.4%, 87.7%, 98.1%, and 90.9%, respectively. The sensitivity, specificity, and positive and negative predictive values of all abnormal patterns for prediction of H . pylori infection were 93.3%, 89.1%, 92.3%, and 90.6%, respectively. The overall accuracy was 91.6%. Conclusions Careful close‐up observation of the gastric mucosal pattern with standard endoscopy can predict H . pylori infection status.