Background
There is growing interest in the endoscopic recognition of H. pylori infection, and application to routine practice. We present a systematic review of the current literature regarding diagnosis of H. pylori during standard (non-magnified) endoscopy, including adjuncts such as image enhancement and computer-aided diagnosis.
Method
The Medline and Cochrane databases were searched for studies investigating the performance of non-magnified optical diagnosis for H. pylori, or those which characterised mucosal features associated with H. pylori infection. Studies were preferred with a validated reference test as the comparator, although were included if at least one validated reference test was used.
Results
20 suitable studies were identified and included for analysis. In total, 4,703 patients underwent investigation including white light endoscopy, narrow band imaging, i-scan, blue-laser imaging, and computer-aided diagnostic techniques. The endoscopic features of H. pylori infection observed using each modality are discussed and diagnostic accuracies reported. The Regular Arrangement of Collecting Venules (RAC) is an important predictor of the H. pylori naïve stomach. ‘Mosaic’ and ‘Mottled’ patterns have a positive association with H. pylori infection. The ‘Cracked’ pattern may be a predictor of an H. pylori negative stomach following eradication.
Conclusions
This review summarises the current progress made in endoscopic diagnosis of H. pylori infection. At present there is no single diagnostic approach that provides validated diagnostic accuracy. Further prospective studies are required, as is the development of a validated classification system. Early studies in Computer-Aided Diagnosis suggest potential for a high level of accuracy but real-time results are awaited.