Endoscopic diagnosis of H. pylori infection

Helicobacter pylori (H. pylori) is one of the most common infections in the world, affecting from 10% to over 80% of the population depending on the region, with a prevalence of around 50% in the Spanish population.1H. pylori-induced gastritis is currently considered one of the most important risk factors for gastric and duodenal ulcer disease, gastric cancer (GC) and its precursor lesions (atrophy, metaplasia and dysplasia), and mucosa-associated lymphoid tissue (MALT) lymphoma.

In symptomatic patients, gastroscopy with biopsies is the preferred test for diagnosing H. pylori infection, as it allows us to characterise the gastric mucosal pattern and pathology examination will identify Gram-negative bacilli resistant to acid pH. Gastroscopy is also a chance to improve GC prevention by identifying premalignant lesions. In recent years, progress has been made in the real-time diagnosis (optical diagnosis) of GC precursor lesions, which are almost always associated with an underlying H. pylori infection. Using techniques such as chromoendoscopy or magnification, the arrangement of the gastric mucosa can be better visualised, thus enabling targeted biopsies in areas of suspected atrophy, intestinal metaplasia or dysplasia. These high-quality gastroscopies require expert endoscopists and a significantly longer mean examination time than other types of gastroscopy.

The diagnosis of H. pylori infection based on the changes in the mucosal arrangement observed during gastroscopy has a series of advantages, and has been the subject of numerous studies in Eastern countries. On the one hand, identifying endoscopic signs which determine that the mucosa is normal makes it possible to rule out patients who do not have H. pylori infection and are therefore at low risk of developing GC precursor lesions. In these patients, the endoscopic technique could be adapted in situ, not only reducing the total examination time but also avoiding the need for biopsies, with the reduction of additional costs. On the other, findings of suspicious mucosal changes suggestive of H. pylori infection would justify the use of advanced imaging techniques, along with application of comprehensive protocols for taking photographs and targeted and random biopsies.

The aim of this review is to describe the endoscopic signs related to H. pylori infection, so first of all we have to know what normal gastric mucosa looks like.

留言 (0)

沒有登入
gif