Differences in image-enhanced endoscopic findings between Helicobacter pylori -associated and autoimmune gastritis

Minoru Kato; Noriya Uedo; Ervin Toth; Satoki Shichijo; Akira Maekawa; Takashi Kanesaka; Yoji Takeuchi; Sachiko Yamamoto; Koji Higashino; Ryu Ishihara; Artur Nemeth; Henrik Thorlacius; Yasuhiko Tomita; Gabriele Wurm Johansson

doi:10.1055/a-1287-9767

Differences in image-enhanced endoscopic findings between Helicobacter pylori -associated and autoimmune gastritis

Endosc Int Open. 2021 Jan;9(1):E22-E30. doi: 10.1055/a-1287-9767. Epub 2021 Jan 1.

Affiliations

¹ Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
² Department of Endoscopy, Skåne University Hospital, Lund University, Malmö, Sweden.
³ Department of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden.
⁴ Department of Pathology, Osaka International Cancer Institute, Osaka, Japan.
⁵ Department of Pathology, International University of Health and Welfare, Japan.

Abstract

Background and study aims The aim of this study was to elucidate the differences in image-enhanced endoscopy (IEE) findings between Helicobacter - pylori -associated and autoimmune gastritis. Patients and methods Seven H. pylori -naïve, 21 patients with H. pylori -associated gastritis and seven with autoimmune gastritis were enrolled. Mucosal atrophy in the corpus was evaluated using autofluorescence imaging and classified into small, medium and large. In a 2 × 2-cm area of the lesser curvature of the lower corpus, micromucosal pattern was evaluated by magnifying narrow band imaging and proportion of foveola (FV)- and groove (GR)-type mucosa was classified into FV > 80 %, FV 50 % to 80 %, GR 50 % to 80 %, and GR > 80 %, then a biopsy specimen was taken. Results Fifteen of 21 (71 %) H. pylori -associated gastritis patients exhibited medium-to-large atrophic mucosa at the corpus lesser curvature. All autoimmune gastritis patients had large atrophic mucosa throughout the corpus ( P < 0.001). All H. pylori -naïve patients had the FV > 80 % micromucosal pattern. Nineteen of 21 (90 %) H. pylori -associated gastritis patients had varying proportions of GR- and FV-type mucosae and five of seven (71 %) autoimmune gastritis patients showed FV > 80 % mucosa ( P < 0.001). Compared with patients who were H. pylori -naïve, patients with H. pylori -associated and autoimmune gastritis exhibited a higher grade of atrophy ( P < 0.001), but only patients with H. pylori -associated gastritis showed a higher grade of intestinal metaplasia ( P = 0.022). Large mucosal atrophy with FV > 80 % micromucosal pattern had sensitivity of 71 % (95 % CI: 29 %-96 %) and specificity of 100 % (95 % CI: 88 % to 100 %) for diagnosis of autoimmune gastritis. Conclusions IEE findings of the gastric corpus differed between H. pylori -associated and autoimmune gastritis, suggesting different pathogenesis of the two diseases.

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