Correlation Between Different Gastric Mucosa Manifestations And Helicobacter Pylori Infection Under White Light Gastroscopy

BackgroundHelicobacter pylori（HP）parasitizes the gastric mucosa and induces inflammation.In some cases,persistent infection can even lead to malignant gastric lesions.Therefore,the World Health Organization（WHO）classified it as a class I carcinogen in 1994.About half of the world’s population is infected by this bacteria,and its infection rate is significantly negatively correlated with economic development.It is reported that the infection rate in our country is about 56.22%.The"Kyoto Gastritis Consensus"in 2015 identified it as an infectious disease,and timely diagnosis and treatment of HP infection is of great significance for reducing the occurrence of chronic gastritis,gastric ulcer and preventing gastric cancer.Nowadays,the commonly used HP detection methods in clinic include ¹³carbon/¹⁴carbon-urea breath test(^13/14 C-UBT-urea breath test,^13/14 C-UBT),rapid urease test,stool antigen test and tissue biopsy,etc.However,due to the focal distribution of HP in the stomach,as well as the influence of proton pump inhibitors and antibiotics,the above detection methods may have certain distortions.Recent years,with the advancement of endoscopic technology,the study of mucosal manifestations of HP infection under endoscopy has gradually become a new hotspot.The earliest general classification of white light gastroscope diagnosis of HP infection can be traced back to the Sydney system introduced in the 1990s.Sydney The system comprehensively includes site,pathological tissue images,and endoscopic findings,and lists11 microscopic examination items such as edema,redness,fragility,exudate,and erosion,but it is difficult to be objective due to fragility and exudate manifestations.The shortcomings of evaluation,endoscopic manifestations,and pathological manifestations are confusing,which makes it difficult to be used in clinical practice.The"Kyoto Classification of Gastritis"published in 2014 more scientifically and comprehensively expounds the regular arrangement of collecting venules.RAC,atrophy,intestinal metaplasia,diffuse redness and other 19 kinds of gastric mucosal morphological manifestations and the correlation of HP infection,and launched a gastric cancer risk scoring system composed of atrophy,intestinal metaplasia,chicken skin gastritis and diffuse redness.The"Kyoto Classification of Gastritis"republished in 2018 added 4 gastric mucosal manifestations,including pseudo polyps,paving stone-like mucosa,black spots and frostbite,and also explained AIG,proton Graphics for PPI-associated gastropathy,eosinophilic gastritis and other diseases.However,the method of judging HP infection by white light gastroscope has not been promoted in our country,and the general endoscopists have limited understanding of it,and the current research is still mostly focused on various image-enhanced endoscopy techniques.It is complicated and expensive.Compared with ordinary white light gastroscope,the popularity is not high,and it cannot be fully used in clinical practice.Our project intends to investigate the understanding of the digestive specialists in Chongqing on the diagnosis of HP infection by white light gastroscope by means of an online questionnaire,at the same time,the clinical value of judging HP infection by the morphological manifestations of esophagus and gastric mucosa under white light gastroscope was also discussed.Objective1.To investigate the understanding and application of white light gastroscopy in the diagnosis of HP infection by digestive specialists in Chongqing.2.To investigate the clinical value of judging Helicobacter pylori infection through the morphology of the esophagus and gastric mucosa under white light gastroscope.Methods1.A questionnaire was designed to study the understanding and application of endoscopy in the diagnosis of HP infection by Chongqing digestive specialists by using We Chat questionnaire.2.The diffuse redness,spotted redness,mucosal swelling,enlarged folds,sticky mucus,white and flat elevated lesion,digestive tract ulcer,hyperplastic polyp,xanthoma,nodularity,atrophy,intestinal metaplasia,depressive erosion were more common in patients with HP infected,the difference is statistically significant（P<0.05）.Binary Logistic regression analysis showed diffuse redness（P<0.001,OR=75.974,95%CI:32.551～177.327）,spotted redness（P=0.002,OR=3.360,95%CI:1.536～7.349）,mucosal swelling（P<0.001,OR=3.150,95%CI:1.654～5.996）are independent risk factors suggesting HP infection.receiver operating characteristic curve analysis showed that diffuse redness,spotted redness,mucosal swelling,enlarged folds,sticky mucus,peptic ulcer,depressive erosion,the area under the curve predicting HP infection was greater than 0.5,and P<0.05,among which diffuse redness,spot redness,and mucosal swelling predict HP infection area under the curve are greater than 0.7,the judgment sensitivity corresponding to the three indicators are 0.735,0.512,and 0.445,and the specificities are 0.992,0.983,And 0.971,the positive predictive values were 0.978,0.931,and 0.874,and the negative predictive values were 0.890,0.814,and 0.792,respectively.Results1.The questionnaire showed that the vast majority of gastroenterologists had the intention to give gastroscopy and HP examination to patients with the above gastrointestinal symptoms as the main manifestation,and 83.80%of the physicians chose non-invasive breath test as the first choice for the detection of HP infection.The vast majority of gastroenterologists believed that it was necessary to learn the Kyoto Classification of Gastritis,and believed that it could assist in the diagnosis of HP infection in clinical practice.However,only 72（50.70%）had received relevant training,among which senior physicians The chances of obtaining training were significantly more than those of the last senior physicians（P<0.05）.2.The diffuse redness,spotted redness,mucosal swelling,enlarged folds,sticky mucus,white and flat elevated lesion,digestive tract ulcer,hyperplastic polyp,xanthoma,nodularity,atrophy,intestinal metaplasia,depressive erosion were more common in patients with Hp infected,the difference is statistically significant（P<0.05）.The old bleeding spots,red streak,fundic gland polyps,raised erosion,regular collecting vein（RAC）,RE and BE were more common in uninfected patients,and there was significant statistical difference（P<0.05）.Binary logistic regression analysis indicated that diffuse redness,spotted redness,mucosal swelling,sticky mucus and xanthoma were risk factors for HP infection,and the difference was statistically significant（P<0.05）.Raised erosion,RAC and RE are higher in HP-negative patients,and the difference is statistically significant（P<0.05）.The area under the ROC curve of diffuse redness,spotted redness,mucosal swelling,and RAC are all above0.7.When used as an independent indicator,it is more accurate to determine the status of HP infection.Conclusion1.Gastrointestinal physicians in Chongqing area still need to further learn to use white light gastroscope to diagnose HP infection,especially for the end-year physicians,they should take more relevant training and study.2.Observing the morphological manifestations of the esophagus and gastric mucosa through white light gastroscopy can more accurately judge the HP infection.Among them,the clinical value of diffuse redness,spotted redness,and mucosal swelling under the endoscopy is greater.