The role of endoscopic findings for the diagnosis of Helicobacter pylori infection: Evaluation in a country with high prevalence of atrophic gastritis

Background. This study examines endoscopic findings in the diagnosis of Hel icobacter py(ori H. pylori) in the Japanese population. Materials and Methods. The endoscopic findings (including gastric fold find ings and degree of atrophy by the Kimura-Takemoto classification system), h istologic severity of inflammation, and glandular atrophy were assessed acc ording to the Sydney system in 642 patients (419 men; 223 women; mean age 4 3.5 years, range 13-86). H. pylori infection was evaluated by Giemsa staini ng and serum IgG antibodies. Results. 391 of 642 patients (60.9%) were diagnosed as having endoscopic ga stritis. Of the 391 patients with endoscopic gastritis, 318 (82.6%) had his tologic gastritis and 310 (79.3%) had H. pylori infection. Of the 251 patie nts with endoscopically normal stomachs, 43 (17.1%) had histologic gastriti s and 32 (12.7%) had H. pylori infection. Atrophic gastritis was the most p revalent finding (56.3%) among those with endoscopic gastritis. The prevale nce of H. pylori infection in patients with atrophic gastritis (92.7%) and rugal hyperplastic gastritis (92.3%) was significantly higher than in those with other types of gastritis or with a normal stomach (12.7%). A markedly high prevalence of H. pylori infection was found in subjects with tortuosi ty, hyper-rugosity, and/or hyporugosity of the gastric folds. Conclusions. The accurate endoscopic assessment of gastritis according to t he Sydney system along with gastric fold findings and the endoscopically id entified extent of gastric atrophy are valuable indicators for determining H. pylori infection and histologic gastritis in the Japanese population.