Clinical Study Of Gastric Mucosal Morphology In Predicting Helicobacter Pylori Infection Under White Gastroscopy

BackgroundHelicobacter pylori is classified as a class I carcinogen by the World Health Organization（WHO）.Helicobacter pylori infection is closely related to the occurrence and development of chronic gastritis,peptic ulcer and gastric cancer.At present,gastric cancer is the fifth and third malignant tumor in the world in terms of incidence and mortality,and it is one of the most common cancers in the world.If gastric cancer can be detected in the early stage,complete removal of the focus by endoscopic mucosal exfoliation and even complete cure can be achieved,which can significantly improve the quality of life of patients and reduce the medical burden of the society,which has important social value.Helicobacter pylori infection plays a key role in the development of chronic non-atrophic gastritis to gastric cancer,and it has been widely recognized as the main pathogenic factor of gastric cancer.Studies have shown that eradication of Helicobacter pylori through antibiotic therapy can stop the progress of this pathway and reduce the incidence of gastric cancer.Therefore,it is of great significance to accurately evaluate the status of Helicobacter pylori infection.At present,these diagnostic methods are mainly involved in clinic,including serological detection,urea breath test（UBT）,fecal antigen detection and endoscopic examination.Among them,¹³C urea breath test is still the gold standard for diagnosis.In 2013,the Kyoto classification advocated by the Japanese Gastrointestinal Endoscopy Society is the latest endoscopic gastritis classification system.The global consensus report points out that endoscopic assessment of Helicobacter pylori infection status is an ideal method for the diagnosis of Helicobacter pylori infection.With the improvement of resolution and image quality of modern endoscope,people can see more fine mucosal manifestations,so the state of Helicobacter pylori infection can be predicted by mucosal morphology even without magnification under gastroscopy.At present,according to the Kyoto Classification of gastritis,there are few studies on the accuracy of endoscopic evaluation of Helicobacter pylori infection in China,and there is no unified conclusion.Therefore,the purpose of this study is to explore the diagnostic performance of endoscopic evaluation of Helicobacter pylori and infection status in Chinese population through the Kyoto Classification of gastritis.ObjectiveBy using Kyoto Gastritis Classification,To study the direct diagnosis of Helicobacter pylori infection by observing the morphological changes of gastric mucosa by ordinary white light gastroscopy.To evaluate the clinical value of ¹³C urea breath test in the diagnosis of Helicobacter pylori infection by observing the morphology of gastric mucosa with ordinary white light gastroscopy.MethodsA total of patients aged 18-80 who were hospitalized in the Department of Gastroenterology,Qingdao Municipal Hospital,Shandong Province from September2019 to December 2020 were included in the study.All patients were examined by endoscopy,histopathology and ¹³C urea breath test.Patients who underwent white light gastroscopy and ¹³C urea breath test were selected at the same time.All patients were examined by gastroscopy,using the diagnostic criteria of"Kyoto Classification of gastritis".The morphological manifestations of gastric mucosa were observed under high-definition gastroscopy,and the status of Helicobacter pylori infection was judged according to the morphological characteristics.All patients（without previous history of Helicobacter pylori infection and eradication）underwent ¹³C urea breath test on an empty stomach.¹³C urea breath test was used as the gold standard to determine whether the patients had Helicobacter pylori infection.Results1.Basic characteristics of the subjects:241 patients were included in this study,including 127 males and 114 females.The youngest age was 27 years old,the maximum age was 80 years old,and the average age was（54.57±11.81）years old.117 patients who underwent ¹³C urea breath test were positive,and the infection rate of Helicobacter pylori was 48.5%.2.The results of ¹³C urea breath test showed that the incidence of hypertension and coronary heart disease in Helicobacter pylori positive patients was significantly higher than that in Helicobacter pylori negative patients（P<0.05）.3.The incidence of abdominal distension and belching in Helicobacter pylori positive patients was significantly higher than that in Helicobacter pylori negative patients（P<0.05）,but there was no significant difference in the incidence of acid heartburn,nausea and vomiting,abdominal pain,diarrhea and constipation between the two groups（P>0.05）.Compared with the patients with dyspepsia,the detection rate of 13C urea breath test in the abdominal distension and belching group was significantly higher than that in other groups,and the difference was statistically significant（P<0.05）.4.The incidences of atrophy,intestinal metaplasia,hyperplastic polyp,serpentine fold enlargement,xanthoma,white turbid mucus and RAC negative were significantly different between Helicobacter pylori infection and uninfected patients（P<0.05）,but there was no significant difference in the incidence of diffuse redness and chicken skin changes between the two groups（P>0.05）.Under gastroscopy,atrophy,intestinal metaplasia,hyperplastic polyp,serpentine fold enlargement,xanthoma,white turbid mucus and negative RAC were correlated with Helicobacter pylori infection,and the difference was statistically significant（P<0.001）.5.Compared with 13C urea breath test,among the gastric mucosal changes supporting Helicobacter pylori infection,the highest AUC and coincidence rates were atrophy（0.811～81.33%）,intestinal metaplasia（0.610～61.83%）,enlarged folds（0.617～62.24%）,white turbid mucus（0.626～63.49%）and higher sensitivity,specificity,PPV and NPV.Taking the gastric mucosal changes in accordance with at least one of the above four as the criteria for judging Helicobacter pylori infection under gastroscopy,the white light mode judged Helicobacter pylori infection with an AUC of 0.873,a total coincidence rate of 81.33%,a sensitivity of 85.59%,and a specificity of 77.69%,77.61%,and 86.32%.Among the gastric mucosal changes supporting Helicobacter pylori infection,the PPV（99.19%）and specificity（80.005%）of chicken skin changes were the highest,but the coincidence rate（52.70%）was lower.Among the gastric mucosal changes that did not support Helicobacter pylori infection,the PPV clearly visible by RAC was the highest（54.84%）and the coincidence rate was the lowest（30.71%）.ConclusionWhen observing the morphology of gastric mucosa under white light endoscopic,the classification of Kyoto gastritis has a certain auxiliary value in the direct diagnosis of Helicobacter pylori infection and can be used in the clinical diagnosis of Helicobacter pylori infection.