To investigate the differences of mucosal manifestations between Helicobacter pylori (Hp)-positive and Hp-negative patients, so as to provide reference for clinical work.

A retrospective analysis of the 14C-urea breath test (+ ) and 14C-urea breath test (-) admitted to the Department of Gastroenterology, the Second Hospital of Tianjin Medical University during the period from December 2017 to March 2019, and the subjects who underwent gastroscopy at the same time. A total of 1792 cases were observed under endoscopy, and the gastric mucosal manifestations were recorded and analyzed for Hp(+ )and Hp(-)endoscopic mucosal differences.

(1)In the analysis of the differences of mucosal manifestations under gastroscopy in different Hp infection states, single factor analysis showed that, peptic ulcer, spotted redness, patchy redness, linear erythema, mucosal hemorrhage, nodular changes, mucosal edema, mucosal atrophy, wrinkle enlargement and hyperplastic polyps in Hp-positive and Hp-negative endoscopic mucosa showed a statistically significant difference (P< 0.05), and the above showed high incidences in Hp-positive patients. The incidence of reflux esophagitis (RE), regular collecting vein (RAC) and fundic gland polyps in Hp-negative patients were higher than that in Hp-positive patients, and there was significant statistical difference (P<0.05). Mucosal erosion was not statistically significant in Hp-positive and Hp-negative patients (P>0.05), but the incidence of protruding erosion of gastric antrum in Hp-positive patients was significantly higher than that in Hp-negative patients, the difference was statistically significant (P<0.05). Multivariate Logistic regression analysis showed that RE, RAC and fundus glandular polyps were more in Hp-negative patients than that in Hp-positive patients with statistically significant differences (P<0.05). Peptic ulcer, spotted redness, nodular changes, mucosal edema, mucosal atrophy, linear erythema, patchy redness and protruding erosion of gastric antrum had high incidences in Hp-positive patients, with statistically significant differences (P<0.05). (2) In the analysis of the diagnostic value of mucosal manifestations under different gastroscopes for predicting Hp infection, the AUC, sensitivity, specificity, positive predictive value and negative predictive value of RAC for predicting Hp negative were 0.750, 65.6%, 84.5%, 77.8% and 74.7% respectively, and the specificity and positive predictive value of fundus glandular polyps for predicting Hp negative were 99.8% and 96.4% respectively. The specificity of Hp negative diagnosis in RE patients was 94.7%; the sensitivity of spotted redness as a predictor of Hp positive was 80%, the specificity was 74.9%, AUC was 0.774, and the positive predictive value was 79.3%; the specificity of nodular changes in predicting Hp positive was 99.9%, and the positive predictive value was 92.3%. The specificity of peptic ulcer, hyperplastic polyps, mucosal atrophy and linear erythema were 90.8%, 98.2%, 86.3% and 85.1% respectively. The positive predictive values were 78.3%, 71.4%, 80.4% and 75% respectively.

(1) RE, RAC and fundic gland polyps are Hp negative and independent mucosal signs under gastroscope; peptic ulcer, spotted redness, nodular changes, mucosal edema, mucosal atrophy, linear erythema, patchy redness and protruding erosion of gastric antrum are Hp positive and independent mucosal signs under gastroscope; (2) RAC and spotted redness of mucosa predicting Hp infection in accordance with 14C-urea breath test results , the combination rate is high. Nodular changes, mucosal atrophy, peptic ulcer, antral protuberant erosions and linear erythema are of great value in the prediction of Hp infection; mucosal edema, wrinkle enlargement, hyperplastic polyps , mucosal hemorrhage and patchy redness are not recommended as independent indicators for Hp positive diagnosis; fundic gland polyps are of great value in the prediction of Hp negative; RE as a single indicator for Hp negative diagnosis is not recommended.