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Mucosal patterns change after Helicobacter pylori eradication: Evaluation using blue laser imaging in patients with
Yoshiyuki Nishikawa1, Yoshio Ikeda2, Hidehiro Murakami3
1Department of Gastroenterology, Nishikawa Gastrointestinal Clinic, Matsuyama 790-0878, Ehime, Japan. yonishik@ehime.med.or.jp.
Background:
Mucosal patterns (MPs) observed on blue laser imaging in patients with atrophic gastritis can be classified as spotty, cracked, and mottled. Furthermore, we hypothesized that the spotty pattern may change to the cracked pattern after Helicobacter pylori (H. pylori) eradication.
Aim:
To further substantiate and comprehensively investigate MP changes after H. pylori eradication in a larger number of patients.
Methods:
We included 768 patients who were diagnosed with atrophic gastritis with evaluable MP using upper gastrointestinal endoscopy at the Nishikawa Gas-trointestinal Clinic, Japan. Among them, 325 patients were H. pylori-positive, and of them, 101 patients who underwent upper gastrointestinal endoscopy before and after H. pylori eradication were evaluated for post-eradication MP changes. The patients' MPs were interpreted by three experienced endoscopists who were blinded to their clinical features.
Results:
Among 76 patients with the spotty pattern before or after H. pylori eradication, the pattern disappeared or decreased in 67 patients [88.2%, 95% confidence interval (CI): 79.0%-93.6%), appeared or increased in 8 patients (10.5%, 95%CI: 5.4%-19.4%), and showed no change in 1 patient (1.3%, 95%CI: 0.2%-7.1%). In 90 patients with the cracked pattern before or after H. pylori eradication, the pattern disappeared or decreased in 7 patients (7.8%, 95%CI: 3.8%-15.2%), appeared or increased in 79 patients (87.8%, 95%CI: 79.4%-93.0%), and showed no change in 4 patients (4.4%, 95%CI: 1.7%-10.9%). In 70 patients with the mottled pattern before or after H. pylori eradication, the pattern disappeared or decreased in 28 patients (40.0%, 95%CI: 29.3%-51.7%), appeared or increased in 35 patients (50.0%, 95%CI: 38.6%-61.4%), and showed no change in 7 patients (10.0%, 95%CI: 4.9%-19.2%).
Conclusion:
After H. pylori eradication, MPs changed from spotty to cracked in most patients, which may help endoscopists easily and precisely evaluate H. pylori-related gastritis status.
Insights
After Helicobacter pylori eradication, mucosal patterns in atrophic gastritis predominantly shift from spotty to cracked. This transformation aids endoscopists in accurately assessing H. pylori-related gastritis.
Area of Science:
- Gastroenterology
- Endoscopy
- Microbiology
Background:
- Atrophic gastritis is characterized by distinct mucosal patterns (MPs) observable via blue laser imaging: spotty, cracked, and mottled.
- A hypothesis suggests that the spotty MP may evolve into a cracked MP following successful Helicobacter pylori eradication.
Purpose of the Study:
- To comprehensively investigate and confirm MP alterations after H. pylori eradication in a larger patient cohort.
- To provide further evidence for the dynamic changes in mucosal patterns post-H. pylori treatment.
Main Methods:
- A cohort of 768 patients with atrophic gastritis and evaluable MPs underwent upper gastrointestinal endoscopy.
- 101 H. pylori-positive patients with evaluable MPs before and after eradication therapy were analyzed for MP changes.
- MPs were independently assessed by three blinded, experienced endoscopists.
Main Results:
- Following H. pylori eradication, 88.2% of patients with the spotty pattern showed its disappearance or reduction.
- The cracked pattern increased or appeared in 87.8% of patients, while the mottled pattern showed a 50.0% increase or appearance.
- Significant shifts in MPs were observed, with the spotty pattern frequently resolving and the cracked pattern emerging post-eradication.
Conclusions:
- H. pylori eradication leads to a predominant transformation of mucosal patterns from spotty to cracked in patients with atrophic gastritis.
- These observed MP changes offer a valuable tool for endoscopists to more easily and precisely evaluate H. pylori-related gastritis status.
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