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Updated: Jun 13, 2026
Gastric Mucosa Quantitative Polymerase Chain Reaction Analysis for Detecting Helicobacter pylori and Antibiotic Resistance
Published on: March 7, 2025
Endoscopic identification of Helicobacter pylori gastritis in children
Nao Hidaka1, Yoshiko Nakayama, Akira Horiuchi
1Departments of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
Insights
The absence of the regular arrangement of collecting venules (RAC) pattern in children
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Diagnostic Endoscopy
Background:
- The diagnostic utility of endoscopic findings for Helicobacter pylori (Hp) infection in children is not well-established.
- Accurate diagnosis of Hp infection in pediatric patients is crucial for effective treatment and management.
Purpose of the Study:
- To evaluate the diagnostic value of specific endoscopic features, particularly the regular arrangement of collecting venules (RAC) pattern, for identifying Hp infection in children.
- To determine if endoscopic findings can guide the decision to perform gastric biopsies in pediatric Hp diagnosis.
Main Methods:
- Esophagogastroduodenoscopy (EGD) was performed on 87 children.
- Hp status was confirmed using histology, (13)C-urea breath test, and serum Hp IgG antibody.
- Endoscopic evaluation included scoring for antral nodularity and the RAC pattern in the gastric corpus.
Main Results:
- Helicobacter pylori infection was present in 29% of the evaluated children.
- Antral nodularity was observed in 84% of Hp-positive children.
- A negative RAC pattern demonstrated high diagnostic accuracy, with 100% sensitivity and 100% negative predictive value for Hp infection.
Conclusions:
- The absence of the RAC pattern is a strong indicator of Hp infection in children, even with normal-appearing gastric mucosa.
- Endoscopic assessment of the RAC pattern can aid in the decision-making process for gastric biopsies in pediatric Hp diagnosis.
Aim:
The role of endoscopic findings in deciding whether to biopsy the gastric mucosa of children remains unclear. The present study attempted, for the first time, to identify the value of endoscopic features for diagnosis of Helicobacter pylori (Hp) infection in children.
Methods:
Hp status of consecutive children receiving esophagogastroduodenoscopy (EGD) was established by combinations of histology, (13)C-urea breath test, and serum Hp immunoglobulin (Ig)G antibody. After routine EGD using a conventional endoscope, the presence of RAC (regular arrangement of collecting venules) was scored by close observation, which was carried out at two sites of lower corpus lesser curvature and upper corpus greater curvature. RAC-positive was defined as the presence of minute red points in a regular pattern. Antral nodularity was also scored as present/absent.
Results:
Eighty-seven consecutive children (38 boys, median age 13 years, range 9-15 years) were evaluated; 25 (29%) were Hp positive. Antral nodularity was seen in 21 (84%) all of whom were Hp positive. The RAC-negative pattern based on examination of the upper and lower corpus yielded a sensitivity, specificity, positive predictive value and negative predictive value for the presence of Hp infection of 100%, 90%, 81%, and 100%. Magnifying endoscopy confirmed that the RAC pattern corresponded to collecting venules in the gastric corpus.
Conclusions:
The absence of RAC pattern suggests that gastric mucosa biopsies should be taken despite otherwise normal-appearing gastric mucosa for the diagnosis of Hp infection in children.
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