Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
Journal website http://www.gastrores.org

Original Article

Volume 11, Number 2, April 2018, pages 112-123


Assessment of Gastric Acidity by Conventional Endoscopy With Serological Gastric Markers

Figures

Figure 1.
Figure 1. Representative mucosal findings of antrum. (A-1) Normal antrum-in angle and proximal antrum lesser curvature side, RAC could be seen (A-1-a), RAC in proximal antrum greater curvature side also could be seen in right sided image (A-1-b). (A-2) Normal antrum vessel structure might be seen in remote (A-2-a), but RAC could be found between vessels in close up image (right sided image (A-2-b)). (A-3) Antrum visible vessel (A_VV) (A-3-a)-there are not any RAC between vessels (right sided close up image (A-3-b)). (A-4) Antrum visible vessel break (A_VV_B)-visible mucosal differences in thickness and color between antrum and low body greater curvature side (A-4-a) and no RAC on right sided close up view (A-4-b). (A-5), (A-6) Two representative figures of antrum camouflage (A_CAM)-mosaic like mucosal change with peripheral white grooves (A-5-a, A-6-a), both right sided close up views clearly show peripheral white grooves, and some erythematous mucosal change could enhance detection of CAM (A-5-b, A-6-b). (A-7) Excluded form of similar A_CAM-mosaic like mucosal image similar to A-5 or A-6 (A-7-a), however in close up view no peripheral white grooves (A-7-b). (A-8) Antrum mucosal edema (A_ME)-soft swelling of mucosa with mosaic pattern accompanying dark peripheral grooves (A-8-a, A-8-b). (A-9) Antrum intestinal metaplasia-whitish plaques were scattered on the mucosal surface. (A-10) Antrum diffuse erythema (A_DE)-any dark or light red colors scattered diffusely on the mucosa.
Figure 2.
Figure 2. Representative mucosal findings of corpus. (C-1) Body xanthoma(B_XAN)-yellow white spot on the gastric mucosa. (C-2) Body visible vessel (B_VV)-graded as 3 when prominent and clear vessel marking in body lesser curvature side (C-2-c), and 2 when visible vessel mingled with irregular mucosa (C-2-b), 1 when only visible mucosal change in body LC side (C-2-a). (C-3) Body type A, B, and C (B_typeA, B_type B and B_type C)-A: mosaic-like appearance (C-3-a); B: diffuse homogenous redness (C-3-b); C: untypical (C-3-c). (C-4) Body spotty erythema (B_SE)-multilple red spots on the mucosa, graded as 1 when it could be seen only in body greater curvature (C-4-a) and 3 when clearly seen in fundus and body (C-4-c), and 2 when observed but neither 1 nor 3 (C-4-b). (C-5) Body rugal hyperplastic gastritis (B_RHG)-when gastric fold width was equal or over 5mm with the aid of opening width (7 mm) of biopsy forcep despite sufficient aeration. (C-6) Body exudate (B_EXU)-white mucinous fluid sticking to the mucosa. (C-7) Body regular arrangement of collecting venule (B_RAC). (C-7-a), (C-7-b) Body diffuse erythema (B_DE)-erythematous mucosal change graded as 1 when it could be identified by close-up observation of mucosa due to light red color (C-7-a) and 2 when easily identified at some distance due to dark red color (C-7-b).

Tables

Table 1. Endoscopic Parameters
 
Endoscopic featureBiology of featureScalesNote
Body xanthoma (B_XAN)Suggestive of H. pylori-associated gastritis with surrounding more atrophic mucosaGrade 0: do not exist; Grade 1: existYellow white spot on the gastric mucosa
Body visible vessel (B_VV)Atrophy of body mucosaGrade 0: do not exist; Grade 1: only visible mucosal change in body lesser curvature; Grade 2: visible vessels mingled with irregular mucosa; Grade 3: when prominent, and clear vessels marking in body lesser curvature side
Body type A (B_type A)Highly accurate mucosal pattern of H. pylori infection. Higher degree of atrophy (B > A,C) and IM (A,B) than normal RAC patternGrade 0: do not exist; Grade 1: existMosaic-like appearance
Body type B (B_type B)Diffuse homogenous redness
Body type C (B_type C)Untypical-irregular redness with groove
Body spotty erythema (B_SE)Suggestive of H. pylori-associated gastritisGrade 0: do not exist; Grade 1: when it could be seen only in body greater curvature; Grade 3: when clearly seen in fundus and body; Grade 2: when observed but neither 1 or 3
Body rugal hyperplasia (B_RHG)Suggestive of H. pylori-associated gastritisGrade 0: do not exist; Grade 1: existGastric fold width was equal or over 5mm with the aid of opening width (7 mm) of biopsy forcep despite sufficient air inflation of stomach
Body regular arrangement of collecting venule (B_RAC)Usually H. pylori free gastric mucosa.Grade 0: do not exist; Grade 1: exist
Body exudate (B_EXU)Suggestive of H. pylori-associated gastritisGrade 0: do not exist; Grade 1: existWhite mucinous sticky fluid on the gastric mucosa
Body diffuse erythema (B_DE)Suggestive of H. pylori-associated gastritisGrade 0: do not exist; Grade 1: when it could be identified by close-up observation of mucosa due to light red color; Grade 2: when easily identified at some distance due to dark red color
Endoscopic atrophic border (EAB)Degree of atrophy extentClosed type 1 - 3 (C 1 – 3) (cardia saved from atrophic front); open type 1 - 3 (O 1 - 3) (cardia involved with atrophy)As suggested by Kimura and Takemoto[13]
Antrum visible vessel break (A_VV_B)Atrophy of antral mucosa with features suggestive of more inflammatory change in body sideGrade 0: do not exist; Grade 1: existVisible differences in mucosal thickness and color between antrum and low body greater curvature side
Antrum visible vessel (A_VV)Atrophy of antral mucosaGrade 0: do not exist; Grade 1: exist
Antrum camouflage (A_CAM)Suggestive of H. pylori-associated gastritisGrade 0: do not exist; Grade 1: existMosaic like mucosal change with peripheral white grooves, some erythematous mucosal change could enhance detection
Antrum mucosal edema (A_ME)Suggestive of H. pylori-associated gastritisGrade 0: do not exist; Grade 1: existSoft swelling of mucosa with mosaic pattern but accompanied with dark peripheral grooves
Antrum intestinal metaplasia (A_IM)Metaplastic antral mucosaGrade 0: do not exist; Grade 1: existWhen whitish plaques were scattered on the mucosal surface
Antrum diffuse erythema (A_DE)Suggestive of H. pylori-associated gastritisGrade 0: do not exist; Grade 1: exist

 

Table 2. Characteristics of Subjects
 
TotalClosed typeOpen type
Number19615145
Age (years ± SD)50.6 ± 9.049.8 ± 9.053.5 ± 8.8
Sex (male : female)144 : 52112 : 3932 : 13
Hyperacidity(number)78726
Hypoacidity (number)733736
Normoacidity (number)45423

 

Table 3. Demographic and Serological Data of Hypoacid, Normoacid and Hyperacid
 
TotalHypoacidNormoacidHyperacidP-value (hypoacid vs. normoacid vs. hyperacid)
Pep_I: pepsinogen I; Pep_II: pepsinogen II.
Number196734578
Age (years ± SD)50.6 ± 9.053.4 ± 8.549.9 ± 9.348.4 ± 8.70.002
Sex (male : female)144 : 5250 : 2330 : 1564 : 140.085
Pep_I65.1 ± 25.660.9 ± 24.664.1 ± 23.169.5 ± 27.50.116
Pep_II22.2 ± 10.828.6 ± 11.621.4 ± 8.016.6 ± 7.90.001
Gastrin73.0 ± 37.794.3 ± 49.964.1 ± 22.858.3 ± 16.50.001
I/II ratio3.2 ± 1.22.1 ± 0.43.0 ± 0.24.4 ± 0.90.001

 

Table 4. Scores of Endoscopic Appearances of Hypoacid, Normoacid and Hyperacid
 
TotalHypoacidNormoacidHyperacidP-value (hypoacid vs. normoacid vs. hyperacid)
B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema.
Number196734578
B_XAN0.06 ± 0.230.11 ± 0.320.04 ± 0.210.01 ± 0.110.033
B_VV1.31 ± 0.871.66 ± 0.871.22 ± 0.821.04 ± 0.780.001
B_type A0.34 ± 0.480.15 ± 0.360.33 ± 0.480.53 ± 0.500.001
B_type B0.45 ± 0.500.78 ± 0.480.40 ± 0.500.17 ± 0.380.001
B_type C0.10 ± 0.300.03 ± 0.160.20 ± 0.410.12 ± 0.320.009
B_SE0.63 ± 0.980.59 ± 0.920.87 ± 1.160.53 ± 0.890.160
B_RHG0.17 ± 0.380.30 ± 0.460.11 ± 0.320.08 ± 0.270.001
B_RAC0.11 ± 0.310.04 ± 0.200.07 ± 0.250.19 ± 0.400.006
B_EXU0.47 ± 0.500.71 ± 0.460.40 ± 0.500.29 ± 0.460.001
B_DE0.97 ± 0.971.16 ± 0.971.02 ± 0.970.77 ± 0.950.041
EAB3.04 ± 1.023.66 ± 1.032.78 ± 0.742.60 ± 0.870.001
A_VV_B0.21 ± 0.410.25 ± 0.430.18 ± 0.390.21 ± 0.410.658
A_VV0.33 ± 0.470.49 ± 0.500.31 ± 0.470.18 ± 0.390.001
A_CAM0.38 ± 0.490.30 ± 0.460.33 ± 0.480.49 ± 0.500.047
A_ME0.20 ± 0.400.21 ± 0.410.20 ± 0.410.21 ± 0.410.997
A_IM0.18 ± 0.380.25 ± 0.430.11 ± 0.320.15 ± 0.360.135
A_DE0.47 ± 0.500.42 ± 0.500.58 ± 0.500.46 ± 0.500.262

 

Table 5. Risk Factors for Hyperacid in Univariable Analysis
 
Number(hyper)Overall 196 (78)Closed type 151 (72)Open type 45 (6)
OR95% CIP-valueOR95% CIP-valueOR95% CIP-value
A: There were not any cases; B: indefinite; B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema. CI: confidence interval; OR: odds ratio.
Age0.9540.923 - 0.9870.0060.9560.920 - 0.9930.0191.0080.912 - 1.1140.877
Sex2.1711.083 - 4.3520.0291.9180.904 - 4.0680.0903.728×108B0.999
B_XAN0.1400.018 - 1.1190.0640.2080.024 - 1.8290.1570.000B0.999
B_VV0.5230.363 - 0.7520.0000.7330.485 - 1.1080.1410.2640.062 - 1.1190.071
B_type A3.9212.105 - 7.3040.0003.2971.660 - 6.5500.0015.5000.890 - 33.9940.067
B_type B0.1150.057 - 0.2320.0000.1430.066 - 0.3130.0000.1290.020 - 0.8350.032
B_type C1.2690.500 - 3.2200.6160.8830.343 - 2.2730.797A
B_SE0.8320.614 - 1.1280.2350.8670.626 - 1.2000.3900.000B0.998
B_RHG0.2810.110 - 0.7170.0080.3320.123 - 0.8950.0290.000B0.999
B_RAC4.4441.642 - 12.0310.0034.1311.280 - 13.3300.0189.2501.010 - 84.7320.049
B_EXU0.2870.156 - 0.5280.0000.4440.227 - 0.8710.0180.1090.017 - 0.7200.021
B_DE0.6930.513 - 0.9360.0170.6010.427 - 0.8460.0031.1110.466 - 2.6520.812
A_VV_B0.9130.453 - 1.8410.8000.9600.439 - 2.0980.9180.6670.069 - 6.4700.727
A_VV0.2980.150 - 0.5900.0010.3680.166 - 0.8140.0140.6250.111 - 3.5090.593
A_CAM2.0801.153 - 3.7530.0152.3031.178 - 4.5020.0151.7860.317 - 10.0610.511
A_ME1.0110.497 - 2.0540.9760.9500.427 - 2.1170.9011.9370.300 - 12.5320.487
A_IM0.7510.349 - 1.6140.4632.0570.762 - 5.5540.1550.000B0.998
A_DE0.9170.517 - 1.6270.7680.8630.455 - 1.6390.6532.1050.345 - 12.8610.420
EAB0.4360.303 - 0.6270.000

 

Table 6. Risk Factors for Hyperacid in Multivariable Analysis
 
Number (hypo)Overall 196 (78)Closed type 151 (72)Open type 45 (6)
OR95% CIP-valueOR95% CIP-valueOR95% CIP-value
B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema; CI: confidence interval; OR: odds ratio.
Age0.9510.970 - 0.9950.028
Sex2.3891.076 - 5.3010.032
B_XAN
B_VV
B_type A
B_type B0.1540.074 - 0.3220.0000.1640.072 - 0.3720.000
B_type C
B_SE
B_RHG
B_RAC
B_EXU0.1090.017 - 0.7200.021
B_DE0.6540.444 - 0.9660.033
A_VV_B
A_VV
A_CAM2.5271.169 - 5.4630.018
A_ME
A_IM
A_DE
EAB0.5360.357 - 0.8050.003

 

Table 7. Risk Factors for Hypoacid in Univariable Analysis
 
Number (hypo)Overall 196 (73)Closed type 151 (37)Open type 45 (36)
OR95% CIP-valueOR95% CIP-valueOR95% CIP-value
A: there were not any cases; B: indefinite; B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema; CI: confidence interval; OR: odds ratio.
Age1.0611.024 - 1.0990.0011.0881.036 - 1.1440.0010.9370.854 - 1.0280.170
Sex0.6710.352 - 1.2790.2250.7700.338 - 1.7540.5330.2500.028 - 2.2370.215
B_XAN4.9231.263 - 19.1970.0226.7881.190 - 38.7200.0311.0000.098 - 10.2190.000
B_VV2.2151.521 - 3.2250.0001.2110.757 - 1.9370.4253.2931.070 - 12.0720.039
B_type A0.2120.102 - 0.4420.0000.2310.089 - 0.5960.0020.2020.040 - 1.0180.053
B_type B10.5735.314 - 21.0340.00010.0254.215 - 23.8390.0005.1791.097 - 24.4570.038
B_type C0.1640.037 - 0.7300.0180.3050.067 - 1.3810.123A
B_SE0.9370.693 - 1.2650.6700.8660.584 - 1.2840.4741.5660.578 - 4.2440.377
B_RHG4.3921.982 - 9.7350.0004.4951.778 - 11.3630.0015.592×108B0.999
B_RAC0.2500.071 - 0.8810.0310.1700.022 - 1.3300.0910.2060.025 - 1.7190.144
B_EXU4.9522.637 - 9.3020.0003.0521.421 - 6.5560.0046.2501.287 - 30.3490.023
B_DE1.3821.022 - 1.8690.0362.0261.324 - 3.0990.0010.7730.367 - 1.6270.498
A_VV_B1.3500.674 - 2.7030.3971.2720.528 - 3.0640.5922.6670.292 - 24.3450.385
A_VV3.3011.770 - 6.1550.0002.4081.075 - 5.3950.0331.2570.287 - 5.4990.761
A_CAM0.5700.308 - 1.0530.0730.4260.185 - 0.9850.0460.7070.161 - 3.1050.646
A_ME1.0140.495 - 2.0780.9701.1540.464 - 2.8670.7580.4830.096 - 2.4230.376
A_IM2.0410.975 - 4.2710.0580.3260.072 - 1.4840.1477.27×108B0.998
A_DE0.7260.405 - 1.3010.2820.5420.251 - 1.1680.1180.8000.184 - 3.4730.766
EAB3.3462.204 - 5.0820.000

 

Table 8. Risk Factors for Hypoacid in Multivariable Analysis
 
Number (hypo)Overall 196 (73)Closed type 151 (37)Open type 45 (36)
OR95% CIP-valueOR95% CIP-valueOR95% CIP-value
B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema; CI: confidence interval; OR: odds ratio.
Age1.06610.170 - 1.1180.0081.1341.056 - 1.2170.001
Sex
B_XAN127.6035.867 - 2775.0340.002
B_VV
B_type A
B_type B6.3912.953 - 13.8310.00012.5173.944 - 39.7220.000
B_type C
B_SE
B_RHG3.4171.289 - 9.0560.0135.2051.319 - 20.5430.019
B_RAC
B_EXU10.6711.324 - 86.0180.026
B_DE2.6671.423 - 4.9970.002
A_VV_B
A_VV
A_CAM
A_ME
A_IM
A_DE0.1610.047 - 0.5540.004
EAB2.7561.717 - 4.4240.000

 

Table 9. Serological and Demographic Meaning of Antrum Camouflage
 
TotalCAMNon-CAMP-value (CAM vs. non-CAM)
Pep_I: pepsinogen I; Pep_II: pepsinogen II.
Number15175121
Age (years ± SD)49.8 ± 9.050.5 ± 7.950.7 ± 9.70.873
Sex (male : female)112 : 3954 : 2190 : 310.536
Pep_I68.4 ± 24.661.3 ± 22.467.4 ± 27.30.103
Pep_II21.7 ± 10.419.8 ± 9.523.7 ± 11.30.015
Gastrin68.2 ± 32.470.0 ± 35.874.9 ± 38.80.382
I/II ratio3.5 ± 1.13.4 ± 1.23.1 ± 1.20.067