Helicobacter pylori (H. pylori) infection is one of the most prevalent chronic bacterial infections worldwide [1]. The literature describes several endoscopic signs may predict H. pylori status [2-3]. However, random biopsies according to Sydney system are still widely used for its determination. Aim is to evaluate the diagnostic performance of endoscopic characteristics in predicting H. pylori infection.

This was a monocentric prospective study including all consecutive patients who underwent upper-GI endoscopy in one-year timeframe. Every procedure was performed by trained endoscopists in order to describe regular arrangement collecting venules (RAC), fundic gland polyps (FGPs), linear streaks, hematin spots and diffuse redness. H. pylori infection was histologically investigated.

A total of 421 patients were enrolled, according to inclusion criteria (F: 222, 52.7%, median age 54.1 y.o.). The presence of RAC both in greater curvature and in lesser curvature, FGPs and diffuse redness were significantly associated with higher prevalence of H. pylori infection (p<0.0001). Considering the interaction effect by the optical evidence of intestinal metaplasia, RAC and FGPs maintained their significance with an OR of 0.05 (0.02-0.13) and 0.11 (0.03-0.53), respectively. All the characteristics described showed a high negative predictive value (>90%). Lastly, according to a probabilistic model, a ROC curve was built with AUROC 0.893 (95% CI: 0.854–0.932).

The proposed endoscopic assessment has a high predictive capability for H. pylori infection, whereas the presence of RAC and FGPs are the most important and reliable indicators of H. pylori status. Our findings may represent a first step toward avoiding unnecessary random biopsies, promoting a more accurate endoscopic examination focused on the careful assessment of the gastric mucosa.