The Kyoto classification was introduced to standardize the endoscopic description of chronic gastritis associated with Helicobacter pylori (H. pylori). The diagnostic value of elementary endoscopic lesions has not been evaluated in our setting, where the prevalence of infection is high.

The aim of our study was to assess the diagnostic performance of each elementary endoscopic lesion for predicting H. pylori status.

This was a single-center, cross-sectional study conducted over a six-month period. Included patients were H. pylori–treatment naïve and had not received recent antibiotics or proton pump inhibitors. Endoscopic evaluation focused on eight elementary lesions. H. pylori status was determined by histological examination. Diagnostic performance for each lesion was assessed by sensitivity (Se), secificity (Sp), positive predictive value (PPV), and negative predictive value (NPV).

Among the 300 included patients, 228 (76.0%) were H. pylori positive (mean age 40.2 ± 13.3 years; 54.4% women). The most frequent lesions were diffuse redness (94.3%), nodularity (50.4%), and atrophy (46.9%). Diagnostic performance was as follows:

 Diffuse redness: Se = 94.3%, Sp = 8.3%, PPV = 76.5%, NPV = 31.6%

 Nodularity: Se = 50.4%, Sp = 86.1%, PPV = 92.0%, NPV = 35.4%

 Atrophy: Se = 46.9%, Sp = 43.1%, PPV = 72.3%, NPV = 20.4%

 Fold hypertrophy: Se = 24.6%, Sp = 83.3%, PPV = 82.4%, NPV = 25.9%

 Adherent mucus: Se = 30.3%, Sp = 75.0%, PPV = 79.3%, NPV = 25.4%

 Spotty erythema: Se = 9.2%, Sp = 94.4%, PPV = 84.0%, NPV = 24.7%

 RAC absence/presence: Se = 32.5%, Sp = 29.2%, PPV = 59.2%, NPV = 12.0%

 Fundic gland polyp: Se = 3.1%, Sp = 94.4%, PPV = 63.6%, NPV = 23.5%

Nodularity is the most specific lesion and the strongest predictor of H. pylori infection (PPV = 92.0%). Conversely, the absence of diffuse redness—owing to its high sensitivity (Se =94.3%)—is a good indicator for ruling out infection. Fundic gland polyp is highly specific for excluding H. pylori infection (Sp = 94.4%), but its very low prevalence (3.1%) limits its practical value.