Diagnostic Value of Fundic Red Spots in Helicobacter pylori (Hp) Infection

Abstract

Purpose: Hp-related endoscopic features are under-emphasised in clinical practice, with their use as supportive diagnostic criteria contentious1,2. Numerous studies associate gastric nodularity with Hp infection, however, other mucosal features are yet to be fully investigated. We report the predictive nature of fundic red spots (FRS) in Hp infection and discuss their potential role as an additional diagnostic tool during endoscopic mucosal inspection. Methods: A retrospective analysis of patients displaying FRS on gastroscopy was conducted. FRS appeared as areas of focal hyperemia with mosaic mucosal patterning (Figure A). A total of 73 patients (37F, m: 56.1±13.7yrs; 36M, m: 54.6±13.1yrs) were included. Hp infection was confirmed by positive culture, or positive results for 2 of the following: urease biopsy test, urease breath test, histology.Figure A: Characteristic fundic red spots.Results: Of 73 FRS patients, 78% (57/73) were Hp-positive. Of these, only 10 patients displayed gastric nodularity. FRS did not appear influenced by current or recent proton-pump inhibitor (PPI) or antibiotic use, with 16 such patients displaying FRS. Conclusion: Our analysis reveals a strong positive correlation between FRS and Hp infection. In our experience, FRS can indicate the presence of Hp even with PPI or antibiotic use, a clinically important observation as such agents can compromise even gold standard tests. Despite some investigation of other Hp-related mucosal appearances, the majority of published work has focused on gastric nodularity. While such nodularity is highly specific for Hp infection, sensitivity can be low1,3. Önal et al (2009) reported that only 65.4% (121/185) of nodular gastritis cases were positive for Hp, notably less than the 78% positivity seen here. As such, the observation of FRS with or without nodularity during endoscopy may enhance our diagnostic ability. This study highlights the importance of endoscopic observations in Hp detection and supports the use of such observations as additional diagnostic tools, particularly in cases of concurrent PPI use. 1. Khan et al (1999) Saudi J Gastroenterol 5:9-14 2. Yan et al (2010) World J Gastroenterol 16:496-500 3. Chen et al (2008) Dig Dis Sci 52:2662-6 4. Önal et al (2009) Turk J Med Sci 39:719-23. Disclosure: Professor Borody has a pecuniary interest in the Centre for Digestive Diseases.