Background and Aim Gastric acidic abnormalities are related to various types of diseases in Helicobacter pylori (H.pylori) infection status. However, no studies have shown correlations between many tiny endoscopic findings and the acid secretion level simultaneously. In the present study, we investigated predictive tiny endoscopic findings of hyperchlorhydria and hypochlorhydria. Methods A total of 223 subjects without organic diseases who underwent esophagogastroduodenoscopy and endoscopic gastrin test (EGT) for estimating gastrin-stimulated gastric acid secretory response between 1999 and 2012 at our institution were retrospectively analyzed. Two blinded expert endoscopists reviewed the images independently and recorded the endoscopic findings. Results According to the EGT values, the enrolled subjects were categorized into hyperchlorhydria, normal acid secretion, and hypochlorhydria groups. In all subjects, hematin (odds ratio [95% confidence interval]=3.32 [1.40-7.84]) and antral erosion(2.88 [1.24-6.70]) were the predictive endoscopic findings for hyperchlorhydria, and swelling of areae gastricae (14.4 [5.74-36.1]) and open-type atrophy (15.1 [7.35-31.1]) were those for hypochlorhydria. In addition, the predictive endoscopic findings for hyperchlorhydria differed according to the H.pylori infection status, hematin in H.pylori-positive subjects and antral erosion in H.pylori-negative subjects, in contrast to those for hypochlorhydria, which were the same irrespective of the H.pylori infection status. Conclusions We could predict the acid secretion status based on the endoscopic findings regardless of H.pylori infection status, which would be of some help for evaluating the risk for acid-related diseases.
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