Objective
The endoscopic findings associated with H. pylori naïve status, current infection or past infection is an area of ongoing interest. Previous studies have investigated parameters with potential diagnostic value. The aim of this study was to perform meta-analysis of the available literature to validate the diagnostic accuracy of mucosal features proposed in the Kyoto classification.
Data Sources
The databases of Medline and Embase, clinicaltrials.gov and the Cochrane library were systematically searched for relevant studies from October 1999 to October 2019.
Methods
A bivariate random effects model was used to produce pooled diagnostic accuracy calculations for each of the studied endoscopic findings. Diagnostic odds ratios and sensitivity and specificity characteristics were calculated to identify significant predictors of H. pylori status.
Results
Meta-analysis included 4,380 patients in 15 studies. The most significant predictor of an H. pylori naïve status was a regular arrangement of collecting venules (RAC). (DOR 55.0, Sensitivity 78.3%, Specificity 93.8%) Predictors of active H. pylori infection were mucosal oedema (18.1, 63.7%, 91.1%) and diffuse redness (14.4, 66.5%, 89.0%). Map-like redness had high specificity for previous H. pylori eradication (99.0%), but poor specificity (13.0%).
Conclusions
The RAC, mucosal oedema, diffuse redness and map-like redness are important endoscopic findings for determining H. pylori status. This meta-analysis provides a tentative basis for developing future endoscopic classification systems.