Histopathological features of gastric map-like redness under image-enhanced endoscopy

Map-like redness (MLR) is a characteristic feature of gastritis after Helicobacter pylori (H. pylori) eradication and independent risk factor of gastric cancer after H. pylori eradication. The present study investigated the endoscopic manifestations and histopathological features of MLR to further investigate the relationship between MLR and gastric cancer after Helicobacter pylori eradication.

We enrolled 56 consecutive MLR patients between January 2023 and July 2023. Endoscopic signs and histopathological characteristics were compared among the reddish area, transition zone, and background mucosa (areas R, T, and B, respectively).

The histopathological analysis showed significantly greater atrophy, gastric intestinal metaplasia (GIM), and dysplasia in area R compared to other areas (p < 0.05). Incomplete GIM predominated in area R, while complete GIM predominated in areas T and B. Area R had a higher microvascular density compared to areas T and B. Intervening parts width for area T was greater than that for area B, which was greater than that for area R (p < 0.05). Crypt opening sizes in area R were greater than those in area T, which were greater than those in area B (p < 0.05).

Gastric MLR, particularly the central reddish area, was associated with localized high-risk mucosal changes, including advanced atrophy, GIM, incomplete GIM, increased microvessel density, and dysplasia in some cases. MLR may serve as an endoscopic marker of high-risk mucosal changes after successful H. pylori eradication.