1 | INTRODUCTION
Helicobacter pylori (H. pylori) is a gram-negative bacterium affecting
up to 50% of the population worldwide and is the most common cause of
chronic gastritis, peptic ulcer, and gastric cancer(1-3). Eradication of
chronic H. pylori infection significantly reduces gastric cancer
risk(4-6). A systematic review including ten randomized controlled
trials provided evidence that H. pylori eradication therapy reduces
gastric cancer incidence in healthy individuals and patients with
gastric neoplasia(7). The strong association between H. pylori and
gastric cancer risk highlights the importance of adequate detection and
eradication of H. pylori in clinical practice.
Conventional examinations for the
diagnosis of H. pylori infection include noninvasive and gastroscopic
biopsy-based tests. These examinations, however, cannot evaluate
endoscopic findings associated with H. pylori infection (8-13).
Recently, many investigators have attempted to characterize endoscopic
features indicative of H. pylori infection. Several endoscopic features
in the Kyoto classification of gastritis, such as the regular
arrangement of collecting venules (RAC), diffuse redness, or atrophy,
have been proposed to evaluate the status of H. pylori infection and the
potential risk of developing gastric cancer(14).
RAC is an endoscopic feature defined as numerous red dots regularly
distributed over the entire gastric body(15, 16). The presence of RAC at
the level of the distal part of the lesser gastric curvature has been
regarded as a characteristic endoscopic feature of the H.
pylori-negative normal stomach. However, data on the diagnostic accuracy
of RAC as an endoscopic marker for the diagnosis of H. pylori infection
are conflicting, with reported sensitivity ranging from 86% to 100%
and specificity ranging from 7% to
98%(17-31). Variations in the
sensitivity and specificity of RAC for H. pylori infection in these
studies highlight the need for a comprehensive evaluation of the
diagnostic performance of RAC before broader application. Therefore,
this study was conducted to determine the diagnostic accuracy and
clinical utility of RAC for the diagnosis of H. pylori infection.