Abstract:

Objective  To investigate the clinical value of endoscopic signs for diagnosing Helicobacter pylori(Hp) infection by white light endoscopy.

Methods  In total, 786 patients who underwent ordinary white light gastroscopy and 13C urea breath test were included. The endoscopic images were reviewed to judge whether there were various endoscopic signs. Taking the results of 13C urea breath test as the diagnostic standard of Hp infection, they were divided into Hp positive group(n=386) and Hp negative group(n=400). The detection rates of various endoscopic signs in the two groups were compared. The statistically significant endoscopic signs were further analyzed by binary logistic regression. Finally, the area under the receiver operating characteristic(ROC) curve of subjects with various endoscopic signs and the sensitivity, specificity, positive predictive value and negative predictive value of diagnosing Hp infection were calculated.

Results  The Hp infection rate in 786 patients was 49.1%. The proportion of diffuse redness, punctate redness, mucosal swelling, fold enlargement, chicken skin like changes, hyperplastic polyps, gastric ulcer, duodenal ulcer and closed atrophy in Hp positive group was higher than that in Hp negative group(P＜0.05). The proportion of regular arrangement of collecting venules(RAC), ridge redness, gastric fundus gland polyps and old bleeding points in Hp negative group was higher than that in Hp positive group(P＜0.05). Binary logistic regression analysis showed that diffuse redness, punctate redness, mucosal swelling, fold enlargement and duodenal ulcer were independent risk factors of Hp infection(P＜0.05). RAC and gastric fundus gland polyps were negatively correlated with Hp infection(P＜0.05). The are aunder the ROC curve(AUC) showed that the areas under the ROC curve of diffuse redness and mucosal swelling to predict Hp infection were 0.729 and 0.751 respectively, the corresponding sensitivity was 71.8% and 65.5% respectively, and the specificity was 74.5% and 85.3% respectively. The AUC of RAC in predicting non-Hp infection was 0.804, the sensitivity was 68.5%, and the specificity was 92.5%.

Conclusion  The endoscopic signs by white light endoscopy can accurately diagnose Hp infection，especially the diffuse redness，mucosal swelling and RAC.

Key words: Helicobacter pylori, endoscopy, endoscopic signs