INTEROBSERVER AGREEMENT AND PREDICTIVE VALUE OF ENDOSCOPIC FINDINGS FOR HELICOBACTER-PYLORI AND GASTRITIS IN NORMAL VOLUNTEERS

Background: Endoscopic findings such as erythema are frequently labele d as gastritis. We sought to determine interobserver agreement for spe cific endoscopic features and assess the diagnostic value of features with good agreement for Helicobacter pylori and histologic gastritis. Methods: Fifty-two healthy subjects without ulcers, erosions, or hemor rhages had a full endoscopy recorded on video tape. Biopsy specimens w ere examined for H. pylori and gastritis. Two endoscopists independent ly reviewed the tapes for predefined features (erythema, area gastrica e, clefts, and nodularity) in the gastric body and antrum. Diagnostic value of endoscopic features with acceptable agreement (kappa > 0.40) was then determined for H. pylori and gastritis.Results: kappa was gre ater than 0.40 only for prominent body area gastricae (0.49), body nod ularity (0.65), and antral nodularity (0.68). For antral nodularity, s ensitivity was 32%, specificity was 96%, and positive predictive value was 90% for H. pylori. When both antral nodularity and body area gast ricae were both present, sensitivity was only 18% but specificity and positive predictive value were 100%. Conclusion: Interobserver agreeme nt is poor for some features such as erythema labeled as gastritis. An tral nodularity is a fairly reproducible finding and is very specific, though not sensitive, for H. pylori gastritis.