Endoscopic findings

Esophagogastroduodenoscopy (EGD) was performed with the Evis Lucera Elite system (Olympus Corporation, Tokyo, Japan) and a GIF‐H290Z scope (Olympus Corporation). The grading of gastric mucosal atrophy by endoscopic findings was based on the Kimura–Takemoto classification ⁵ : no atrophy (C‐0); closed‐type (C‐1 to C‐3), in which an endoscopic atrophic border is in the lesser curvature of the gastric body and does not extend beyond the cardia; and open type (O‐1 to O‐3), in which an endoscopic atrophic border extends beyond the cardia and progresses into the greater curvature.

Endoscopic findings, which suggest active gastritis, such as diffuse redness, mucosal swelling, sticky mucus, and enlarged fold, are reported to have high diagnostic odds ratio and are helpful in the diagnosis of current H. pylori infection. ⁶ , ⁷ Therefore, in determining H. pylori infection status, we used these findings (Fig. 2).

Endoscopic findings that suggest active gastritis. (a) Spotty redness: multiple tiny reddish spots in the fundic gland region. Spotty redness is usually observed in the upper region of the stomach. (b) Diffuse redness: uniform redness involving the entire mucosa of the fundic gland region. (c) Disappearance of the regular arrangement of collecting venules: starfish‐like red spots in a regular arrangement visible through the mucosal surface in the fundic gland region have disappeared due to H. pylori‐induced inflammation. (d) Enlarged/tortuous folds. (e) mucosal swelling. (f) sticky mucus.