Diagnostic value of endoscopic signs of gastritis: with special emphasis to nodular antritis

Background: Antral nodularity in children is described to have a high correlation with active H. pylori infection. Data on antral nodulariry in adults are sparse. Patients/methods: A cross-sectional study was done in order to determine sensitivity (sens), specificity (spec), positive (PPV) and negative (NPV) predictive value of macroscopic signs of gastritis (nodularity, erosions, intramucosal haemorrhage, redness). Antral biopsy specimens for HE, Gram's stain and culture were taken irrespective of endoscopic diagnosis. The macroscopic aspect of the antrum was noted explicitely. Results: In 305 consecutive patients antral biopsy specimens were taken. In 218 (71.4%) the macroscopic appearance of the antrum was normal, 65 (29.8%) of them were positive for PI. pylori. The remaining 87 patients (28.6%), 58 (67%) of them H. pylori positive, showed antral abnormalities. The presence of an macroscopically abnormal gastric antrum and presence of antral nodularity had a sens of 39.8%, a spec of 83.6%, a PPV of 72.4%, a NPV of 56.4% and a sens of 19.6%, a spec of 98.6%, a PPV: 93.9% and a NPV: 53.3% respectively with respect to histological gastritis. Conclusions: Endoscopic signs of gastritis have low sensitivity but relatively high specificity. Antral nodularity is the only sign with a high positive predictive value for H. pylori infection. (C) 1999 Elsevier Science B.V. All rights reserved.