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.
Highlights
Gastric cancer (GC) is a highly lethal malignancy, with only one in five patients surviving longer than five years after diagnosis [1]
The exclusion criteria were as follows: severe brain, liver, or cardiopulmonary dysfunction, end-stage renal disease requiring dialysis, schizophrenia, or other mental diseases interfering with patient cooperation, pregnancy, patients with pyloric obstruction or poor preparation, treatment with antibiotics or proton pump inhibitors (PPIs) four weeks prior to study initiation, previous diagnosis of early or advanced gastric cancer, gastrectomy, or hemorrhagic tendency
In this study we investigated the association between endoscopic features and a positive diagnosis of H. pylori infection made by traditional detection methods, as well as the patient’s past history
Summary
Gastric cancer (GC) is a highly lethal malignancy, with only one in five patients surviving longer than five years after diagnosis [1]. Clarifying the H. pylori infection status of patients is of great importance for the detection of early GC. Different invasive and non-invasive tests are available to detect H. pylori infection. Invasive methods are based on gastric biopsy samples and include H. pylori culture, histological staining, rapid urease test (RUT) and PCR methods. The accuracy of the invasive methods is affected by inevitable external factors, like the location, size, and quantity of biopsy samples, the staining method, use of proton pump inhibitors, antibiotic administration, and experience of the examiners [5]. Non-invasive examinations are cheap, fast, and easy to perform, but there are factors that can affect their diagnostic accuracy, such as the use of antibiotics, bismuth agents, some traditional Chinese medicines for the treatment of H. pylori, as well as the test reaction time [6]. There 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)
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