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      Diagnóstico de infección por Helicobacter pylori en cuerpo gástrico con magnificación endoscópica y "Flexible Spectral Imaging Colour Enhancement" (FICE) Translated title: Diagnosis of Helicobacter pylori infection in gastric body with endoscopic magnification and Flexible Spectral Imaging Colour Enhancement (FICE)

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          Abstract

          La endoscopia estándar no diagnostica infección por Helicobacter pylori. Con magnificación y "Flexible Spectral Imaging Colour Enhancement" (FICE) se observan patrones de mucosa gástrica que sugieren su presencia. Objetivo: Diagnosticar infección por Helicobacter pylori con magnificación endoscópica y "Flexible Spectral Imaging Colour Enhancement" (FICE). Pacientes: Previo consentimiento se incluyeron a los individuos con indicación electiva de endoscopia digestiva superior. Materiales y Métodos: Se realizó endoscopia digestiva superior con equipo Fujinon Inc. EG 590 ZW, y procesador EPX 4400. En ambas caras del cuerpo gástrico se realizó consecutivamente: a) alta resolución, b) magnificación, c) alta resolución, d)FICE, e)magnificación y f) biopsia en el antro y del patrón mas prevalente en cada cara del cuerpo evaluadas sin información del paciente. Todo el procedimiento se grabó, se fotografió y se guardó en JPEG en programa Power Point. Resultados: Se evaluaron 60 áreas en 30 pacientes: 10 hombres y 20 mujeres con edades de 20-82 años y promedio 49,60 años. Solo magnificación y FICE identificaron los patrones de mucosa en cuerpo gástrico. En 37,03% se diagnosticó Helicobacter pylori con histología, 53,33% y 61,11% en patrón Z2 y Z3 respectivamente. Conclusión: La magnificación y FICE permiten identificar los patrones de mucosa gástrica que sugieren infección por Helicobacter pylori.

          Translated abstract

          Helicobacter pylori infection is not diagnosed with standard endoscopy. With high resolution and magnification patterns of gastric mucosa suggesting its presence are observed. Objective: Diagnose Helicobacter pylori infection with endoscopic magnification and "Flexible Spectral Imaging Colour Enhancement" (FICE). Patients: Individuals scheduled to undergo routine upper gastrointestinal endoscopy were enrolled. Materials and methods: Upper gastrointestinal endoscopy was performed with Fujinon Inc. 590 EG ZW and EPX 4400 processor. Endoscopy was practiced on both sides of the gastric body consecutively with: a) high-resolution, b) magnification, c) high-resolution, d) FICE, e) magnification and g) biopsy of the antrum and the pattern more prevalent on each side of the body evaluated without patient information. The entire procedure was recorded, was photographed and was saved in JPEG in program Power Point. Results: 60 Areas in 30 patients were evaluated: 10 men and 20 women with ages of 20-82 years and average 49.60. Only magnification and FICE identified patterns of mucosa in gastric body. Helicobacter pylori was diagnosed in 37.03% with histology and in pattern Z2 and Z3 in 53.33% and 61.11% respectively. Conclusion: The endoscopic magnification and Flexible Spectral Imaging Colour Enhancement (FICE) identify patterns of gastric mucosa suggesting Helicobacter pylori infection.

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          Most cited references13

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          Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis.

          Magnifying narrow-band imaging (NBI) endoscopy clearly visualizes superficial gastric mucosal patterns and capillary patterns. To investigate gastric mucosal patterns by using magnifying NBI endoscopy and identify any relationship between those patterns and Helicobacter pylori-induced gastritis. Gastric mucosal patterns seen with magnifying NBI in uninvolved gastric corpus were divided into the following categories: normal--small, round pits with regular subepithelial capillary networks; type 1-slightly enlarged, round pits with unclear or irregular subepithelial capillary networks; type 2--obviously enlarged, oval or prolonged pits with increased density of irregular vessels; and type 3-well--demarcated oval or tubulovillous pits with clearly visible coiled or wavy vessels. Department of Gastroenterology, Fujita Health University. This study involved 106 participants undergoing upper endoscopy. H pylori infection-positive ratios of normal and types 1, 2, and 3 patterns were 7.5%, 92.9%, 94.5%, and 66.7%, respectively. Sensitivity and specificity for types 1 + 2 + 3 for detection of H pylori positivity and type 3 for detection of intestinal metaplasia were 95.2%, 82.2%, 73.3%, and 95.6%, respectively. Development of mucosal patterns from normal to types 1, 2, and 3 was correlated with all histological parameters (P < .0001), lower pepsinogen I/II ratios (P < .0001), and degree of endoscopic atrophy (P < .0001). Sensitivity and specificity of type 3 for the prediction of severe histological atrophy was also better than those of serum pepsinogen level and standard endoscopy. Only 1 endoscopist performed endoscopic procedures, and interobserver agreement could not be assessed. Magnifying NBI endoscopy is useful for predicting H pylori infection and the histological severity of gastritis and is valuable for predicting gastric atrophy in the entire stomach.
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            Relationship between histopathologic gastritis and mucosal microvascularity: observations with magnifying endoscopy.

            The purpose of this study was to determine the usefulness of magnifying endoscopy for the diagnosis of Helicobacter pylori-induced histopathologic gastritis. A total of 92 patients scheduled to undergo routine endoscopic examination were enrolled. After routine endoscopic examination, 3 sites in the stomach were studied by magnified observation. Visualized collecting venulae were classified into the following 3 patterns: regular, irregular, and obscured. The sites observed by magnifying endoscopy were assessed histopathologically with an Updated Sydney System; 4 morphologic parameters (activity, inflammation, atrophy, metaplasia) were assessed and graded from 0 to 3. The regular pattern cases were negative for H pylori infection at all sites observed by magnifying endoscopy (antrum greater curve, 0/11; body greater curve, 0/24; body lesser curve, 0/23). The scores for all 4 morphologic parameters were significantly lower in the regular pattern group than the irregular and obscured groups (p < 0.01). The value of the atrophy parameter in the irregular group was significantly higher than that in the obscured group (p < 0.05 for a single test of hypothesis; correction for multiple testing of data removed significance). Visibility of collecting venulae in the gastric mucosa is influenced by H pylori-induced histopathologic gastritis. Magnifying endoscopy is useful for the diagnosis of histopathologic gastritis.
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              Unique features of Helicobacter pylori disease in children.

              In a six-year period, 41 children had endoscopically documented duodenal ulcer disease or primary H. pylori antral gastritis without duodenal ulcer. Of 37 children with H. pylori gastritis, group 1 comprised 23 patients with duodenal ulcer disease and group 2 had 14 patients without ulcers (primary H. pylori gastritis). Group 3 comprised four children with duodenal ulcer disease and H. pylori-negative antral biopsies. During the study period, all primary chronic ulcer disease was duodenal; no primary chronic gastric ulcer was present. Two distinct types of duodenal ulcer disease were identified; the majority (85%) was always associated with significant active H. pylori antral gastritis (group 1). The minority (15%) had virtually absent gastritis and no H. pylori (group 3). Native Indian children were represented in group 1 quite out of proportion to the referral population and had the most severe disease. While it is established that a higher prevalence of asymptomatic H. pylori infection exists in non-Caucasians, this appears to be the first demonstration of a higher prevalence of symptomatic ulcer disease in non-Caucasian children or adults. Caucasian children tended to have primary H. pylori gastritis (group 2) or duodenal ulcer without H. pylori (group 3). Antral nodularity was found to be an important specific endoscopic sign, unique to those children with H. pylori disease. It has not been described in adult H. pylori disease. Non-Caucasian children, especially Native Indians, in British Columbia have more prevalent and more severe H. pylori disease than Caucasians. Endoscopy with gastric antral biopsies is necessary to distinguish different types of duodenal ulcer disease and to diagnose primary H. pylori gastritis.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                gen
                Gen
                Gen
                Sociedad Venezolana de Gastroentereología (Caracas )
                0016-3503
                June 2013
                : 67
                : 2
                : 71-75
                Affiliations
                [1 ] Universidad Central de Venezuela Venezuela
                [2 ] Universidad Central de Venezuela Venezuela
                [3 ] Universidad Central de Venezuela Venezuela
                Article
                S0016-35032013000200005
                057b2e5e-8d3b-45a3-b4c7-808b4d5f2955

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0016-3503&lng=en

                Helicobacter pylori,Endoscopic Gastritis,FICE,Virtual Chromoendoscopy,Endoscopic Gastric Magnification,Cromoscopia Virtual,Magnificación Endoscópica de Estómago,Gastritis endoscópica

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