Prediction of Helicobacter pylori Infection by Endoscopic Severity of Erythematous Gastritis in Asymptomatic Adults

Background/Aims: Helicobacter pylori (H. pylori) infection is correlated with erythematous gastritis, which is one of the endoscopic findings of the Sydney classification system. The present study evaluated the association between the endoscopic severity of erythematous gastritis and H. pylori infection.Methods: We prospectively enrolled asymptomatic adults who were diagnosed with erythematous gastritis during screening esophagogastroduodenoscopy. A rapid urease test was performed in all participants to diagnose H. pylori infection. The severity of erythematous gastritis was determined based on the Sydney classification system. The primary endpoint was the H. pylori infection rate according to the severity of erythematous gastritis (mild to moderate vs. severe).Results: In total, 131 patients with erythematous gastritis were included. The rate of H. pylori infection was 45.8% across all patients. Of the 131 included patients, 45 had mild gastritis, 43 had moderate gastritis, and 43 had severe gastritis. The H. pylori infection rate was significantly different between patients with mild to moderate erythematous gastritis and those with severe erythematous gastritis (20.5% vs. 97.7%, respectively; p = 0.000). After adjustment for potential confounding variables, the severity of erythematous gastritis was associated with the H. pylori infection rate. The kappa value was 0.563, and interobserver variation was 14.43%.Conclusions: H. pylori infection is observed to a moderate degree in patients with erythematous gastritis. The severity of erythematous gastritis is associated with the H. pylori infection rate.