Exploring the endoscopic microanatomy of Helicobacter pylori related gastritis: Insights from near focus endoscopy, narrow-band imaging, and acetic acid enhancement

Aims In Helicobacter pylori (Hp) related gastritis the endoscopic microanatomy has been structurally altered to the absence of venules, irregularity of subepithelial capillary network (SECN), and enlargment pits and crypts [1] [2] [3] [4]. The aim of this study is to compare the endoscopic microanatomy of the antral and body gastric mucosa in patients positive and negative for Hp, using narrow-band imaging (NBI), near focus (NF) magnification, and acetic acid (AA) enhancement.

Methods During 2023 and 2024, 91 patients consisted of 40 men and 51 women with a mean age of 41.7 years (range: 20-65 years) underwent proximal gastrointestinal endoscopy at Blue Medical Group hospital, Tuzla, Bosnia and Herzegovina. Regarding the results of the rapid urease test, patients were divided into a Hp positive group (56 patients) and a negative group (35 patients). The study excluded patients who had received anticoagulant therapy or drugs for chronic metabolic and systemic inflammation disease.

On the NF-NBI mode for the body mucosa, the regular/clear appearance of venules, honeycomb type of SECN, and gastric pits is consider as the S0 pattern; without the venules S1 pattern; with irregularity of the SECN S2 pattern. For the antral mucosa, coil type of SECN with poligonal type of marginal crypt epithelium (MCE) is consider as the S0 pattern, pebble type of SECN with curved type of MCE S1 pattern, enlarged/irregular type of SECN with loop type of MCE S2 pattern. On the AA-NF-NBI mode for the body mucosa, crypts as a dark spots are consider as the S0 pattern; crypts as a dark irregularity S1 pattern. For the antral mucosa, MCE as a dark lines is consider as the S0 pattern, MCE as a dark irregularity S1 pattern.

The differences between the negative and positive patterns were compared using the Fisher's exact test. P values<0.05 were considered significant.

Results Endoscopic microanatomy from the provided NF-NBI and AA-NF-NBI images were analysed by combining two experienced endoscopists (TB, EA).

On NF-NBI for the antrum, S0 pattern was significantly present in Hp negative patients (p<0.01). S1 and S2 patterns were significantly present in Hp positive patients (p<0.01).

On NF-NBI for the body, S0 pattern was significantly present in Hp negative patients (p<0.01). S1 and S2 patterns were significantly present in Hp positive patients (p<0.01).

On AA-NF-NBI for the antrum, S0 pattern was significantly present in Hp negative patients (p<0.01). S1 pattern was significantly present in Hp positive patients (p<0.01).

On AA-NF-NBI for the body, S0 pattern was significantly present in Hp negive patients (p<0.01). S1 pattern was significantly present in Hp positive patients (p<0.01).

Conclusions Using the NF-NBI and AA-NF-NBI modes for evaluating the venules, the regularity/irregularity of SECN, and the shape and size of the pits and crypts could determinate the presence/absence of Hp infection.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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