KEY POINTS IN THE DIAGNOSIS OF HELICOBACTER PYLORI INFECTION IN GASTRIC MUCOSA BY ENDOSCOPIC FEATURES

Abstract

The Helicobacter pylori (H. pylori) infection status is related to the risk for gastric diseases. Endoscopists should carefully observe the gastric areas where high-risk disease is more likely to occur according to the H. pylori infection status. The method of diagnosis of H. pylori infection by endoscopy is to evaluate characteristic features of gastric mucosal change related to H. pylori infection according to the Kyoto classification of endoscopic gastritis. RAC (regular arrangement of collecting venules) is characteristic of patients who are not infected with H. pylori. Diffuse redness of the gastric mucosa and the degree of endoscopic atrophy are useful markers for detecting patients with H. pylori infection. The presence of map-like redness is useful for detecting patients with previous H. pylori infection. However, some patients who are receiving a PPI (proton pump inhibitor) have faint RAC because of thickened gastric mucosa and may be mistakenly diagnosed with H. pylori infection. Some patients with H. pylori infection or previous H. pylori infection have visible collecting venules in the corpus and the diagnosis of present or past H. pylori infection may be missed. In some other patients, it is difficult to diagnose diffuse redness of the gastric mucosa. Therefore, multi-point analysis of gastric mucosal change should be used for endoscopic diagnosis of H. pylori infection. However, endoscopists should take a balance of observation for H. pylori infection status and for other diseases to avoid overlooking clinically more important diseases including malignancies.