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. 2021 Aug 22;2(1):e15.
doi: 10.1002/deo2.15. eCollection 2022 Apr.

Endoscopic findings of cardiac lymphoid hyperplasia and Helicobacter pylori infection status

Kyoichi Adachi  1 , Norihisa Ishimura  2 , Takumi Notsu  1 , Kanako Kishi  1 , Tomoko Mishiro  1 , Kazunari Sota  1 , Nahoko Nagano  3 , Shunji Ishihara  2
Affiliations

Endoscopic findings of cardiac lymphoid hyperplasia and Helicobacter pylori infection status

Kyoichi Adachi et al. DEN Open. .

Abstract

Objective: Lymphoid hyperplasia is endoscopically observed as multiple small whitish round nodules or spots. This retrospective study was performed to examine the prevalence of that finding in patients with Barrett's epithelium and its relationship with the status of H. pylori infection.

Methods: The study subjects were 3353 patients (males 2186, females 1167; mean age 55.2 ± 9.4 years) in whom the status of H. pylori infection had been determined. The presence of Barrett's epithelium ≥ 5 mm in length was endoscopically determined, and then endoscopic observations with blue laser imaging were used to investigate the presence of lymphoid hyperplasia in those areas.

Results: Barrett's epithelium was diagnosed in 1884 (56.2%) of the subjects, and endoscopic findings of lymphoid hyperplasia were observed in 402 (21.3%) of those with Barrett's epithelium. Lymphoid hyperplasia in Barrett's epithelium was not present in any without a current or prior H. pylori infection, while the prevalence of lymphoid hyperplasia in H. pylori-positive and post-eradicated subjects was 48.4% and 30.4%, respectively (p < 0.001). Multiple logistic regression analysis revealed that female gender, younger age, and higher degree of gastric mucosal atrophy were significant factors related to lymphoid hyperplasia positivity. In addition, the duration after H. pylori eradication was negatively correlated with its prevalence.

Conclusion: Endoscopic findings of cardiac lymphoid hyperplasia were well correlated with H. pylori infection, although prevalence decreased over time following bacterial eradication.

Keywords: Barrett's esophagus; Helicobacter pylori; blue laser imaging; endoscopy; lymphoid hyperplasia.

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Conflict of interest statement

The authors have no conflict of interest to declare in regard to this study.

Figures

FIGURE 1
FIGURE 1
Endoscopic findings of cardiac portion in subjects positive for H. pylori infection ((a) white light image, (b) blue laser imaging [BLI], (c) linked color imaging [LCI], (d) BLI image 2 years after eradication for H. pylori]. Multiple small whitish round nodules, an endoscopic finding indicating lymphoid hyperplasia, were easily recognized with BLI. In addition, the distal ends of palisade vessels were observed in the area of lymphoid hyperplasia as well as on the oral side of gastric folds with endoscopy using LCI, suggesting that endoscopic findings showing lymphoid hyperplasia can be confirmed in an area of Barrett's epithelium. Endoscopic findings of lymphoid hyperplasia has been diminished after successful eradication for H. pylori
FIGURE 2
FIGURE 2
Histology results of biopsied samples obtained from cardiac portion in patients with multiple small whitish round nodules shown by endoscopy. Lymphocyte aggregation was observed deep in the area of mucosa
FIGURE 3
FIGURE 3
Flow of subject selection for this study
FIGURE 4
FIGURE 4
H. pylori‐positive and post‐eradicated subjects with endoscopic findings of lymphoid hyperplasia in Barrett's epithelium. The timing of H. pylori eradication could not be clarified in six subjects, and those were excluded from the analysis of duration after H. pylori eradication
See this image and copyright information in PMC

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