Association between mucosal surface pattern under near focus technology and Helicobacter pylori infection

Felipe Fiuza; Fauze Maluf-Filho; Edson Ide; Carlos Kiyoshi Furuya Jr; Sonia Nadia Fylyk; Jennifer Nakamura Ruas; Luciana Stabach; Gabriela Albuquerque Araujo; Sergio Eiji Matuguma; Ricardo Sato Uemura; Christiano Makoto Sakai; Kendi Yamazaki; Sergio Shiguetoshi Ueda; Paulo Sakai; Bruno Costa Martins

doi:10.4253/wjge.v13.i10.518

Association between mucosal surface pattern under near focus technology and Helicobacter pylori infection

World J Gastrointest Endosc. 2021 Oct 16;13(10):518-528. doi: 10.4253/wjge.v13.i10.518.

Authors

Felipe Fiuza¹, Fauze Maluf-Filho², Edson Ide², Carlos Kiyoshi Furuya Jr², Sonia Nadia Fylyk², Jennifer Nakamura Ruas², Luciana Stabach², Gabriela Albuquerque Araujo², Sergio Eiji Matuguma², Ricardo Sato Uemura², Christiano Makoto Sakai², Kendi Yamazaki², Sergio Shiguetoshi Ueda², Paulo Sakai², Bruno Costa Martins²

Affiliations

¹ Department of Endoscopy, Hospital Alemão Oswaldo Cruz, São Paulo 01323-020, Brazil. felipesorfiuza@gmail.com.
² Department of Endoscopy, Hospital Alemão Oswaldo Cruz, São Paulo 01323-020, Brazil.

Abstract

Background: Many studies evaluated magnification endoscopy (ME) to correlate changes on the gastric mucosal surface with Helicobacter pylori (H. pylori) infection. However, few studies validated these concepts with high-definition endoscopy without ME.

Aim: To access the association between mucosal surface pattern under near focus technology and H. pylori infection status in a western population.

Methods: Cross-sectional study including all patients referred to routine upper endoscopy. Endoscopic exams were performed using standard high definition (S-HD) followed by near focus (NF-HD) examination. Presence of erythema, erosion, atrophy, and nodularity were recorded during S-HD, and surface mucosal pattern was classified using NF-HD in the gastric body. Biopsies were taken for rapid urease test and histology.

Results: One hundred and eighty-seven patients were analyzed from August to November 2019. Of those, 47 (25.1%) were H. pylori+, and 42 (22.5%) had a previous H. pylori treatment. In the examination with S-HD, erythema had the best sensitivity for H. pylori detection (80.9%). Exudate (99.3%), nodularity (97.1%), and atrophy (95.7%) demonstrated better specificity values, but with low sensitivity (6.4%-19.1%). On the other hand, the absence of erythema was strongly associated with H. pylori- (negative predictive value = 92%). With NF-HD, 56.2% of patients presented type 1 pattern (regular arrangement of collecting venules, RAC), and only 5.7% of RAC+ patients were H. pylori+. The loss of RAC presented 87.2% sensitivity for H. pylori detection, 70.7% specificity, 50% positive predictive value, and 94.3% negative predictive value, indicating that loss of RAC was suboptimal to confirm H. pylori infection, but when RAC was seen, H. pylori infection was unlikely.

Conclusion: The presence of RAC at the NF-HD exam and the absence of erythema at S-HD were highly predictive of H. pylori negative status. On the other hand, the loss of RAC had a suboptimal correlation with the presence of H. pylori.

Keywords: Diagnosis; Endoscopy; Gastric infection; Gastritis; Helicobacter pylori; Sensitivity and specificity.