| Background and Objective: The high incidence of Helicobacter pylori infection can lead to a variety of gastrointestinal diseases and parenteral diseases,which seriously harm people’s health.Eradication of Helicobacter pylori can significantly reduce its harm,especially the occurrence of gastric cancer and the risk of death from gastric cancer.Therefore,many countries recommend that Helicobacter pylori infection should be eradicated.However,with the increasing problem of antibiotic resistance,the eradication rate of Helicobacter pylori decreased year by year.Helicobacter pylori culture and drug sensitivity test are the main means to understand the resistance of Helicobacter pylori,which can guide clinical drug selection,reduce secondary resistance and increase eradication rate.However,Helicobacter pylori culture is affected by various factors,especially the focus distribution of Helicobacter pylori in the stomach,which may lead to a low content of Helicobacter pylori in the tissues taken,resulting in a low positive rate,thus limiting its clinical application.The Kyoto classification of gastritis can be used to determine the Helicobacter pylori infection of gastric mucosa in real time under the direct vision of endoscopy with high accuracy,so it has been widely used in clinical practice by endoscopists since it was proposed.This study intends to analyze the relationship between the status of Helicobacter pylori infection determined by the Kyoto classification of gastritis and various endoscopic manifestations mentioned by the Kyoto gastritis classification and the results of Helicobacter pylori culture,in order to find the characteristic manifestations that can improve the positive rate of Helicobacter pylori culture,so as to guide clinical sampling.Research methods: The patients who underwent Helicobacter pylori culture and drug sensitivity test in endoscopy center of our hospital from January 2021 to September 2022 were selected.First,the positive rate and drug resistance of Helicobacter pylori culture in this area were analyzed.Subsequently,the endoscopic images of these patients were collected and reviewed to record the 19 endoscopic features mentioned in the Kyoto classification of gastritis,and the status of Helicobacter pylori infection under the endoscope was determined according to the Kyoto classification of gastritis.Then,the relationship between the endoscopic features,the status of Helicobacter pylori infection based on the Kyoto classification of gastritis and the results of Helicobacter pylori culture was analyzed.Results:1.A total of 968 patients were included in this study,of which 777 were positive for H.pylori culture,with a positive rate of 80.3%.There was no significant difference between genders and ages.2.Of the 777 positive strains,only 19(2.4%)were sensitive to all six antibiotics and the rest were resistant to at least one antibiotic.Among them,314 cases(40.4%)were resistant to only one antibiotic,227 cases(29.2%)were resistant to two antibiotics and 217 cases(27.9%)were resistant to three antibiotics.All strains were sensitive to amoxicillin,furazolidone and tetracycline,and the resistance rate of metronidazole was the highest in 737 cases(94.9%),followed by clarithromycin in 361 cases(46.5%)and levofloxacin in 321 cases(41.3%).There was no significant difference in drug resistance between different genders.Among different age groups,double and triple drug resistance rates increased significantly with the increase of age.3.The detection rates of 19 endoscopic features described in the Kyoto classification of gastritis are as follows: There were 589 cases(60.8%)of diffuse redness,387 cases(40.0%)of patchy redness,853 cases(88.1%)of mucosal swelling,0 cases of map-like redness,16 cases(1.7%)of xanthoma,74 cases(7.6%)of intestinal metaplasia,13 cases(1.3%)of hematin,38 cases(3.9%)of red streak,180 cases(18.6%)of depressed erosion,42 cases(4.3%)of polyp,0 cases of multiple white and flat elevated lesions,553 cases(57.1%)of spotty redness,710 cases(73.3%)of enlarged folds,803 cases(83.0%)of sticky mucus,84 cases(8.7%)of RAC,62 cases(6.4%)of nodularity,133 cases(13.7%)of raised erosion.There were 402 cases(41.5%)of atrophy,among which the atrophy was divided into six categories: C1~C3 and O1~O3 according to Kimura-Taketo classification.There were 46 cases(4.8%)of C1,139 cases(14.4%)of C2,118 cases(12.2%)of C3,54 cases(5.6%)of O1,32 cases(3.3%)of O2,and 13 cases(1.3%)of O3.The following features are more common in men: diffuse redness(71.7% vs.54.0%,P < 0.001),spotty redness(44.5% vs.37.1%,P=0.021),mucosal swelling(91.5% vs.86%,P=0.01),intestinal metaplasia(13.1% vs.4.2%),spotty redness(67.7% vs.50.4%),enlarged folds(82.7% vs.67.5%),raised erosion(17.9% vs.11.1%,P=0.006).Polyps(1.9% vs.5.9%,P=0.003)and nodularity(3.2% vs.8.4%,P=0.001)are more common in women.The following performance are changed with the age: There were 0 cases(0.0%)of xanthoma in youth,7 cases(1.4%)in middle age,9 cases(4.4%)in the elderly,P = 0.001).There were 10 cases of intestinal metaplasia in young adults(3.8%),42 cases in middle age(8.5%)and 22 cases in old age(10.7%),P=0.008.There were 31 cases of RAC in young people(11.7%),46 cases in middle age(9.3%),and 7 cases in old age(3.4%),P=0.003.There were 37 cases(13.9%)of nodularity in young people,21 cases(4.2%)in middle age and 4 cases(2.0%)in old people(P < 0.001).4.In the Hp culture positive group,the detection rate of the following 8 mucosal characteristics under endoscopy was higher than that in the Hp culture negative group: Diffuse redness(67.6%vs.33.5%,P < 0.001),patchy redness(44.5%vs.21.5%,P < 0.001),mucosal swelling(98.3%vs.46.6%,P < 0.001),spotty redness(63.4%vs.31.4%,P < 0.001),enlarged folds(81.2%vs.41.4%,P < 0.001),sticky mucus(92.9%vs.42.4%,P < 0.001),DU(16.5%vs.5.2%,P < 0.001),GU(10.8%vs.3.7%,P=0.002).The following three manifestations were less likely to occur in the Hp culture positive group than in the Hp culture negative group: red streak(1.8%vs.12.6%,P < 0.001),polyps(3.1%vs.9.4%,P < 0.001),and RAC(2.2%vs.35.1%,P < 0.001).Multivariate Logistic regression analysis showed that only mucosal swelling(P < 0.001)and intestinal metaplasia(P=0.006)were statistically significant,with OR values of 69.3(17.9-268.5)and 0.4(0.2~0.8),respectively.5.According to the Kyoto classification of gastritis,the status of Helicobacter pylori infection under endoscope was interpreted,and the enrolled patients were divided into 854 current infection group,84 non-infection group and 30 past infection group.The positive rate of Hp culture in each group was 89.8%,10.7% and 3.3%,respectively.Conclusions: 1.The resistance rate of Hp strains in this region to metronidazole is extremely high,and the resistance rate to clarithromycin and levofloxacin is also as high as 40%.Therefore,metronidazole,clarithromycin and levofloxacin are not recommended for Hp eradication treatment,but amoxicillin,furazolidone and tetracycline,whose resistance rate is 0 in this region,are recommended.When other antibiotics need to be selected for adverse drug reactions and other reasons,it is recommended to select appropriate antibiotics according to the results of Helicobacter pylori culture and drug sensitivity test.2.The positive rate of Hp culture in patients with mucosal swelling observed under endoscopy was higher than that in patients without the above signs.The positive rate of Hp culture in patients with intestinal metaplasia observed under endoscopy was lower than those without the above signs.3.The Kyoto classification of gastritis can determine the Hp infection status of patients in real time,which can help endoscopists to initially judge the positive rate of Hp culture.In particular,the positive rate of Hp culture is very low in patients who are judged to be Hp infection treated under endoscopy,so it is not recommended to conduct biopsy and examination for these patients,so as to reduce the medical burden of patients and medical risks brought by biopsy. |
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