Abstract
Background and Purpose: Recent studies have suggested that Helicobacter pylori (HP) infection is the major cause of gastric cancer and that gastric cancer is not found in the normal gastric mucosa without HP infection. Efficacy in the interpretation of gastric X-ray screening for gastric cancer is important. The purpose of this study was to test the hypothesis that gastric X-ray examination can detect“normal gastric mucosa without Helicobacter pylori infection”.
Methods: The systemic HP status was determined by enzyme immunoassay (EIA) for specific IgG-HP circulating antibodies. One hundred and fifty nine subjects were evaluated serologically and by X-ray examination. Criteria used in evaluation of normal gastric mucosa without HP infection included: “smoothness of gastric surface; evenness of barium coating; almost no depiction of gastric area, particularly in gastric corpus; measurements of gastric folds less than 4 mm; and an abundance of smooth folds”. Two observers, blinded to the clinical information, reviewed all images. The results were statistically compared with the serological HP antibody titers.
Results: The sensitivity, specificity, total predictive value, negative predictive value, positive predictive value were 79.6%, 96.2%, 90.6%, 91.5%, 90.2% for one observer and 79.6%, 90.5%, 86.8%, 81.1%, 89.6% for the other. The sensitivity, and specificity, total predictive value, negative predictive value, positive predictive value were each in a 95% confidence interval. In addition, there was no statistically significant difference between two observers in all values. Furthermore, the kappa ratio of the two observers was 0.621 suggesting high agreement between reviewers. The likelihood ratio and odds ratio for detecting normal gastric mucosa without HP infection were 20.9 and 10.7 for the doctor and 8.4 and 4.3 for the technician.
Conclusion: Gastric X-ray examination can be used in the diagnosis of normal gastric mucosa without HP infection by the above criteria.
