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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Mucosal patterns change after Helicobacter pylori eradication: Evaluation using blue laser imaging in patients with atrophic gastritis
Yoshiyuki Nishikawa, Yoshio Ikeda, Hidehiro Murakami, Shin-Ichiro Hori, Megumi Yoshimatsu, Naoki Nishikawa
Yoshiyuki Nishikawa, Department of Gastroenterology, Nishikawa Gastrointestinal Clinic, Matsuyama 790-0878, Ehime, Japan
Yoshio Ikeda, Endoscopy Center, Ehime University Hospital, Toon 791-0295, Ehime, Japan
Hidehiro Murakami, Department of Internal Medicine, Saiseikai Matsuyama Hospital, Matsuyama 791-8026, Ehime, Japan
Shin-Ichiro Hori, Department of Gastroenterology, Himeji Red Cross Hospital, Himeji 670-8540, Hyogo, Japan
Megumi Yoshimatsu, Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama 791-0280, Ehime, Japan
Naoki Nishikawa, Department of Gastroenterology, Matsuyama Shimin Hospital, Matsuyama 790-0067, Ehime, Japan
Author contributions: Nishikawa Y conceived and designed the study; Nishikawa Y, Ikeda Y, Murakami H, Hori S, and Yoshimatsu M analyzed and interpreted the data; Nishikawa Y and Nishikawa N drafted the manuscript; Nishikawa Y, Ikeda Y, Murakami H, Hori S, Yoshimatsu M, and Nishikawa N critically revised the manuscript for important intellectual content; Nishikawa Y gave final approval of the manuscript; all authors approved the final version of the article to be published.
Institutional review board statement: This study was approved by the Ethics Committee of Ehime University Hospital (No. 1605010; August 22, 2016).
Informed consent statement: This study was conducted retrospectively from data obtained for clinical purposes. The study was approved by the institutional review board at the Ethics Committee of Ehime University Hospital. Prior to receiving an endoscopic examination, all patients agreed that the data obtained in this study might be published in academic papers.
Conflict-of-interest statement: None of the authors have any financial relationships to disclose with relevance to this article.
Data sharing statement: Data presented in this study is available on request from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Yoshiyuki Nishikawa, MD, PhD, Director, Department of Gastro-enterology, Nishikawa Gastrointestinal Clinic, 2-72 Katsuyama-cho, Matsuyama 790-0878, Ehime, Japan. yonishik@ehime.med.or.jp
Received: February 8, 2023
Peer-review started: February 8, 2023
First decision: February 16, 2023
Revised: March 3, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 7, 2023
BACKGROUND
Mucosal patterns (MPs) observed on blue laser imaging in patients with atrophic gastritis can be classified as spotty, cracked, and mottled. Furthermore, we hypothesized that the spotty pattern may change to the cracked pattern after Helicobacter pylori (H. pylori) eradication.
AIM
To further substantiate and comprehensively investigate MP changes after H. pylori eradication in a larger number of patients.
METHODS
We included 768 patients who were diagnosed with atrophic gastritis with evaluable MP using upper gastrointestinal endoscopy at the Nishikawa Gas-trointestinal Clinic, Japan. Among them, 325 patients were H. pylori-positive, and of them, 101 patients who underwent upper gastrointestinal endoscopy before and after H. pylori eradication were evaluated for post-eradication MP changes. The patients’ MPs were interpreted by three experienced endoscopists who were blinded to their clinical features.
RESULTS
Among 76 patients with the spotty pattern before or after H. pylori eradication, the pattern disappeared or decreased in 67 patients [88.2%, 95% confidence interval (CI): 79.0%-93.6%), appeared or increased in 8 patients (10.5%, 95%CI: 5.4%-19.4%), and showed no change in 1 patient (1.3%, 95%CI: 0.2%-7.1%). In 90 patients with the cracked pattern before or after H. pylori eradication, the pattern disappeared or decreased in 7 patients (7.8%, 95%CI: 3.8%-15.2%), appeared or increased in 79 patients (87.8%, 95%CI: 79.4%-93.0%), and showed no change in 4 patients (4.4%, 95%CI: 1.7%-10.9%). In 70 patients with the mottled pattern before or after H. pylori eradication, the pattern disappeared or decreased in 28 patients (40.0%, 95%CI: 29.3%-51.7%), appeared or increased in 35 patients (50.0%, 95%CI: 38.6%-61.4%), and showed no change in 7 patients (10.0%, 95%CI: 4.9%-19.2%).
CONCLUSION
After H. pylori eradication, MPs changed from spotty to cracked in most patients, which may help endoscopists easily and precisely evaluate H. pylori-related gastritis status.
Core Tip: We investigated whether the mucosal patterns on blue laser imaging may change from spotty to cracked after Helicobacter pylori (H. pylori) eradication. The spotty pattern disappeared or decreased in 88.2% of patients, while the cracked pattern appeared or increased in 87.8% of patients. These suggest that the spotty pattern observed in H. pylori-positive patients is likely to disappear after eradication and may be replaced by the cracked pattern. These observations may help endoscopists easily and precisely evaluate H. pylori-related gastritis status.
