Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis.

BACKGROUND Magnifying narrow-band imaging (NBI) endoscopy clearly visualizes superficial gastric mucosal patterns and capillary patterns. OBJECTIVE To investigate gastric mucosal patterns by using magnifying NBI endoscopy and identify any relationship between those patterns and Helicobacter pylori-induced gastritis. DESIGN Gastric mucosal patterns seen with magnifying NBI in uninvolved gastric corpus were divided into the following categories: normal--small, round pits with regular subepithelial capillary networks; type 1-slightly enlarged, round pits with unclear or irregular subepithelial capillary networks; type 2--obviously enlarged, oval or prolonged pits with increased density of irregular vessels; and type 3-well--demarcated oval or tubulovillous pits with clearly visible coiled or wavy vessels. SETTING Department of Gastroenterology, Fujita Health University. PATIENTS This study involved 106 participants undergoing upper endoscopy. RESULTS H pylori infection-positive ratios of normal and types 1, 2, and 3 patterns were 7.5%, 92.9%, 94.5%, and 66.7%, respectively. Sensitivity and specificity for types 1 + 2 + 3 for detection of H pylori positivity and type 3 for detection of intestinal metaplasia were 95.2%, 82.2%, 73.3%, and 95.6%, respectively. Development of mucosal patterns from normal to types 1, 2, and 3 was correlated with all histological parameters (P < .0001), lower pepsinogen I/II ratios (P < .0001), and degree of endoscopic atrophy (P < .0001). Sensitivity and specificity of type 3 for the prediction of severe histological atrophy was also better than those of serum pepsinogen level and standard endoscopy. LIMITATIONS Only 1 endoscopist performed endoscopic procedures, and interobserver agreement could not be assessed. CONCLUSIONS Magnifying NBI endoscopy is useful for predicting H pylori infection and the histological severity of gastritis and is valuable for predicting gastric atrophy in the entire stomach.

[1]  K. Yao,et al.  High-resolution magnification endoscopy can reliably identify normal gastric mucosa, Helicobacter pylori-associated gastritis, and gastric atrophy , 2007, Endoscopy.

[2]  T. Takemoto,et al.  An Endoscopic Recognition of the Atrophic Border and its Significance in Chronic Gastritis , 1969 .

[3]  D. Graham,et al.  Relationship of Helicobacter pylori to serum pepsinogens in an asymptomatic Japanese population. , 1992, Gastroenterology.

[4]  Prateek Sharma,et al.  Correlation between narrow band imaging and nonneoplastic gastric pathology: a pilot feasibility trial. , 2008, Gastrointestinal endoscopy.

[5]  G. Friedman,et al.  Helicobacter pylori infection and the risk of gastric carcinoma. , 1991, The New England journal of medicine.

[6]  K. Hiroshima,et al.  High magnification bronchovideoscopy combined with narrow band imaging could detect capillary loops of angiogenic squamous dysplasia in heavy smokers at high risk for lung cancer , 2003, Thorax.

[7]  R. Lambert.  Mass Screening Programs in Japan: What Can We Learn in the West? , 1998, Endoscopy.

[8]  A. Costa-Pereira,et al.  Meta-analysis on the validity of pepsinogen test for gastric carcinoma, dysplasia or chronic atrophic gastritis screening , 2004, Journal of medical screening.

[9]  M. Blaser,et al.  Parasitism by the "slow" bacterium Helicobacter pylori leads to altered gastric homeostasis and neoplasia. , 1994, The Journal of clinical investigation.

[10]  Masahiro Yamaguchi,et al.  Appearance of enhanced tissue features in narrow-band endoscopic imaging. , 2004, Journal of biomedical optics.

[11]  K. Yagi,et al.  Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection , 2002, Journal of gastroenterology and hepatology.

[12]  Hisao Tajiri,et al.  Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett's adenocarcinoma. , 2007, Gastrointestinal endoscopy.

[13]  M F Dixon,et al.  Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. , 1996, The American journal of surgical pathology.

[14]  S. Leung,et al.  Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. , 2004, JAMA.

[15]  O. Hosokawa,et al.  Diagnosis of Gastric Cancer up to Three Years after Negative Upper Gastrointestinal Endoscopy , 1998, Endoscopy.

[16]  K. Ida,et al.  Endoscopical Findings of Fundic and Pyloric Gland Area Using Dye Scattering Method , 1973 .

[17]  K. Haruma,et al.  Effect of Helicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. , 1997, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[18]  I. Samloff,et al.  Serum pepsinogen I and serum gastrin in the screening of severe atrophic corpus gastritis. , 1991, Scandinavian journal of gastroenterology. Supplement.

[19]  D. Beall.  Classification and Grading of Gastritis: The Updated Sydney System , 1997 .

[20]  H. Tajiri,et al.  Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. , 2004, Endoscopy.

[21]  N. Sasaki,et al.  Helicobacter pylori infection and the development of gastric cancer. , 2001, The New England journal of medicine.

[22]  T. Takemoto,et al.  Magnifying Endoscopic Observation of the Gastric Mucosa, Particularly in Patients with Atrophic Gastritis , 1978, Endoscopy.

[23]  J. Virtamo,et al.  Spontaneous disappearance of Helicobacter pylori antibodies in patients with advanced atrophic corpus gastritis , 2003, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.

[24]  R. Hunt,et al.  Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. , 1998, Gastroenterology.

[25]  A. Bansal,et al.  The utility of a novel narrow band imaging endoscopy system in patients with Barrett's esophagus. , 2005, Gastrointestinal endoscopy.

[26]  O vanRensburg,et al.  Helicobacter pylori in peptic ulcer disease. , 2004, Delaware medical journal.