Endoscopic Prediction of Helicobacter pylori Infection: A High-accuracy Optic Evaluation

Helicobacter pylori (H. pylori) infection is one of the most prevalent chronic bacterial infections worldwide. Literature describes several endoscopic signs that might predict H. pylori status. However, random biopsies according to Sydney system are still widely used for its determination. We aimed to evaluate the diagnostic performance of endoscopic characteristics in predicting H. pylori infection.

This is a monocentric prospective study including all consecutive patients who underwent upper gastrointestinal endoscopy in one-year timeframe. In each procedure regular arrangement of collecting venules (RAC), fundic gland polyps (FGPs), linear streaks, hematin spots, diffuse redness and intestinal metaplasia were described. H. pylori infection was histologically investigated.

A total of 421 patients were enrolled (F: 222, 52.7%, median age 54.1). The presence of RAC both in greater and in lesser curvature and FGPs were significantly associated with lower prevalence of H. pylori infection, by contrast, diffuse redness was associated with a higher prevalence (p<0.0001). Considering the interaction effect by the optical evidence of intestinal metaplasia, RAC and FGPs maintained their significance with an OR of 0.05 (0.02-0.13) and 0.11 (0.03-0.53), respectively. All the characteristics showed a high negative predictive value (>90%). AUROC of the whole diagnostic model was 0.893 (95%CI: 0.854-0.932).

The proposed endoscopic assessment has a high predictive capability for H. pylori infection. Notably, the presence of RAC and FGPs emerges as important and reliable indicators of H. pylori-negative status. These findings may represent a first step toward avoiding unnecessary biopsies, promoting a more accurate endoscopic examination centered on meticulous assessment of gastric mucosa.