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Journal List > Korean J Gastroenterol > v.58(5) > 1006874

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Na, Chung, Park, Kim, Kwon, Hahm, Choi, Jeong, Ha, and Kim: The Usefulness of the Regular Arrangement of Collecting Venules Pattern for the Determination of Helicobacter pylori Infection
Original Article

Korean J Gastroenterol 2011;58(5):252-257.

Published online: 4 October 2011

DOI: https://doi.org/10.4166/kjg.2011.58.5.252

The Usefulness of the Regular Arrangement of Collecting Venules Pattern for the Determination of Helicobacter pylori Infection

Sunyoung Na, Jun-Won Chung, Hyun Joo Park1, Yoon Jae Kim, Kwang An Kwon, Ki Baik Hahm, Duck Joo Choi, Seok Hoo Jeong, Minsu Ha, Geum-Ha Kim2

Department of Internal Medicine, Gachon University Gil Hospital, Gachon Graduate School of Medicine, Incheon, Korea

1Vievis Namuh Hospital, Seoul, Korea

2Nasaret International Hospital, Incheon, Korea

Correspondence to: Jun-Won Chung, Department of Internal Medicine, Gachon University Gil Hospital, Gachon Graduate School of Medicine, 1198, Guwol-dong, Namdong-gu, Incheon 405-706, Korea. Tel: +82-32-460-2622, Fax: +82-32-460-3431, E-mail: drgreen@gilhospital.com

Received 13 June 2011       Accepted 9 August 2011

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

In the Helicobacter pylori (H. Pylori)-negative normal stomach, collecting venules are visible over all the gastric body as numerous minute points evaluated with standard endoscopy. This finding was termed regular arrangement of collecting venules (RAC), and its absence suggests H. pylori gastritis. The aim of this study was to evaluate the correlation between the RAC and rapid urease test.

Methods

Two hundred sixty three consecutive adults undergoing upper digestive endoscopy and rapid urease test were included. The lesser curvature of the lower corpus was evaluated for the RAC pattern using a standard endoscope and different hemoglobin index. Two biopsies from the lesser curvature of the antrum and the greater curvature of the body were collected for rapid urease test.

Results

H. pylori were detected in 51.3% (135/263) patients. Of the 57 patients with H. pylori-negative normal stomachs 53 patients (93%) had RAC. As a determinant of the normal stomach without H. pylori infection, the presence of RAC had 41.4% sensitivity, 97.0% specificity, 93.0% positive predictive value and 63.6% negative predictive value.

Conclusions

RAC-positive finding by standard endoscopy showed high positive predictive value and specificity of H. pylori-negative normal stomach. RAC-positive finding by standard endoscopy could be an useful finding to predict H. pylori negativity.

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Keywords: Venules, Helicobacter pylori

References

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kjg-58-252f1.tif
Fig. 1.
Typical image of a regular arrangement of collecting venule (RAC) positive case. (A) Typical close observation view of a RAC-positive case. Numerous minute red points of almost similar size were seen at regular intervals all over the monitor view at the lesser curvature of the lower corpus. (B) Endoscopic image of gastric mucosa switching hemoglobin index in RAC-positive case.
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kjg-58-252f2.tif
Fig. 2.
Typical image of a regular arrangement of collecting venule (RAC) negative case. (A) Typical close observation view of a RAC-negative case. The red points were irregularly presented or absent. (B) Endoscopic image of gastric mucosa switching hemoglobin index in RAC-negative case.
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Table 1.
Baseline Characteristics of the 263 Patients
  RAC-positive patients (n=57) RAC-negative patients (n=206)
Demographics    
   Age (yr, mean±SD) 44.8±15.1 52.1±12.7
   Sex (male/female) 27/30 105/101
Helicobacter pylori-positive 4 (7) 131 (63.6)
   patients, n (%)    
Endoscopic findings, n (%)    
   Duodenal ulcer 10 (17.5) 35 (17.0)
   Gastric ulcer 5 (8.8) 30 (14.6)
   Gastritis 22 (38.6) 86 (41.7)
    Atrophic gastritis 3 (5.3) 35 (17.0)
    Erosive gastritis 6 (10.5) 17 (8.3)
    Superficial gastritis 13 (22.8) 33 (16.0)
   GERD 8 (14.0) 14 (6.8)

RAC, regular arrangement of collecting venule; GERD, gastroesophageal reflux disease.

Table 2.
Correlation between RAC and Rapid Urease Test
Variables Rapid urease test, n Total, n
Negative Positive
RAC-positive 53 4 57
RAC-negative 75 131 206
Total 128 135 263

RAC, regular arrangement of collecting venule.

Table 3.
Comparison of Sensitivity, Specificity, PPV, NPV, and Accuracy of RAC Classified by the Presence or Absence of Atrophic Gastritis
  All patients (n=263) Atrophic gastritis (＋)(n=38) Atrophic gastritis (－)(n=225) p-value
Sensitivity 41.4 (53/128) 23.1 (3/13) 43.5 (50/115) 0.24
Specificity 97.0 (131/135) 100 (25/25) 96.4 (106/110) 1.00
PPV 93.0 (53/57) 100 (3/3) 92.6 (50/54) 1.00
NPV 63.6 (131/206) 71.4 (25/35) 62.0 (106/171) 0.34
Accuracy 70.0 (184/263) 73.7 (28/38) 69.3 (156/225) 0.70

PPV, positive predictive value; NPV, negative predictive value; RAC, regular arrangement of collecting venule.

Values are presented as % (n).

Table 4.
Comparison of Sensitivity, Specificity, PPV, NPV, and Accuracy of RAC according to Age
Age (yr) Sensitivity Specificity PPV NPV Accuracy
＜30 (n=25) 85.7 (12/14) 100 (11/11) 100 (12/12) 84.6 (11/13) 92.0 (23/25)
30–39 (n=31) 64.3 (9/14) 100 (17/17) 100 (9/9) 77.3 (17/22) 83.9 (26/31)
40–49 (n=59) 41.4 (12/29) 96.7 (29/30) 92.3 (12/13) 63.0 (29/46) 69.5 (41/59)
50–59 (n=77) 24.3 (9/37) 95 (38/40) 81.8 (9/11) 57.6 (38/66) 61.0 (47/77)
60–69 (n=54) 35.7 (10/28) 100 (26/26) 100 (10/10) 59.1 (26/44) 66.7 (36/54)
≥70 (n=17) 16.7 (1/6) 90.9 (10/11) 50 (1/2) 66.7 (10/15) 64.7 (11/17)
p-value <0.001 0.36 0.10 0.09 0.01

PPV, positive predictive value; NPV, negative predictive value; RAC, regular arrangement of collecting venule. Values are presented as % (n).

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