Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Original Article

Volume 11, Number 2, April 2018, pages 112-123

Assessment of Gastric Acidity by Conventional Endoscopy With Serological Gastric Markers

Figure 1. Representative mucosal findings of antrum. (A-1) Normal antrum-in angle and proximal antrum lesser curvature side, RAC could be seen (A-1-a), RAC in proximal antrum greater curvature side also could be seen in right sided image (A-1-b). (A-2) Normal antrum vessel structure might be seen in remote (A-2-a), but RAC could be found between vessels in close up image (right sided image (A-2-b)). (A-3) Antrum visible vessel (A_VV) (A-3-a)-there are not any RAC between vessels (right sided close up image (A-3-b)). (A-4) Antrum visible vessel break (A_VV_B)-visible mucosal differences in thickness and color between antrum and low body greater curvature side (A-4-a) and no RAC on right sided close up view (A-4-b). (A-5), (A-6) Two representative figures of antrum camouflage (A_CAM)-mosaic like mucosal change with peripheral white grooves (A-5-a, A-6-a), both right sided close up views clearly show peripheral white grooves, and some erythematous mucosal change could enhance detection of CAM (A-5-b, A-6-b). (A-7) Excluded form of similar A_CAM-mosaic like mucosal image similar to A-5 or A-6 (A-7-a), however in close up view no peripheral white grooves (A-7-b). (A-8) Antrum mucosal edema (A_ME)-soft swelling of mucosa with mosaic pattern accompanying dark peripheral grooves (A-8-a, A-8-b). (A-9) Antrum intestinal metaplasia-whitish plaques were scattered on the mucosal surface. (A-10) Antrum diffuse erythema (A_DE)-any dark or light red colors scattered diffusely on the mucosa.

Figure 2. Representative mucosal findings of corpus. (C-1) Body xanthoma(B_XAN)-yellow white spot on the gastric mucosa. (C-2) Body visible vessel (B_VV)-graded as 3 when prominent and clear vessel marking in body lesser curvature side (C-2-c), and 2 when visible vessel mingled with irregular mucosa (C-2-b), 1 when only visible mucosal change in body LC side (C-2-a). (C-3) Body type A, B, and C (B_typeA, B_type B and B_type C)-A: mosaic-like appearance (C-3-a); B: diffuse homogenous redness (C-3-b); C: untypical (C-3-c). (C-4) Body spotty erythema (B_SE)-multilple red spots on the mucosa, graded as 1 when it could be seen only in body greater curvature (C-4-a) and 3 when clearly seen in fundus and body (C-4-c), and 2 when observed but neither 1 nor 3 (C-4-b). (C-5) Body rugal hyperplastic gastritis (B_RHG)-when gastric fold width was equal or over 5mm with the aid of opening width (7 mm) of biopsy forcep despite sufficient aeration. (C-6) Body exudate (B_EXU)-white mucinous fluid sticking to the mucosa. (C-7) Body regular arrangement of collecting venule (B_RAC). (C-7-a), (C-7-b) Body diffuse erythema (B_DE)-erythematous mucosal change graded as 1 when it could be identified by close-up observation of mucosa due to light red color (C-7-a) and 2 when easily identified at some distance due to dark red color (C-7-b).

**Table 1.** Endoscopic Parameters
Endoscopic feature	Biology of feature	Scales	Note
Body xanthoma (B_XAN)	Suggestive of H. pylori-associated gastritis with surrounding more atrophic mucosa	Grade 0: do not exist; Grade 1: exist	Yellow white spot on the gastric mucosa
Body visible vessel (B_VV)	Atrophy of body mucosa	Grade 0: do not exist; Grade 1: only visible mucosal change in body lesser curvature; Grade 2: visible vessels mingled with irregular mucosa; Grade 3: when prominent, and clear vessels marking in body lesser curvature side
Body type A (B_type A)	Highly accurate mucosal pattern of H. pylori infection. Higher degree of atrophy (B > A,C) and IM (A,B) than normal RAC pattern	Grade 0: do not exist; Grade 1: exist	Mosaic-like appearance
Body type B (B_type B)			Diffuse homogenous redness
Body type C (B_type C)			Untypical-irregular redness with groove
Body spotty erythema (B_SE)	Suggestive of H. pylori-associated gastritis	Grade 0: do not exist; Grade 1: when it could be seen only in body greater curvature; Grade 3: when clearly seen in fundus and body; Grade 2: when observed but neither 1 or 3
Body rugal hyperplasia (B_RHG)	Suggestive of H. pylori-associated gastritis	Grade 0: do not exist; Grade 1: exist	Gastric fold width was equal or over 5mm with the aid of opening width (7 mm) of biopsy forcep despite sufficient air inflation of stomach
Body regular arrangement of collecting venule (B_RAC)	Usually H. pylori free gastric mucosa.	Grade 0: do not exist; Grade 1: exist
Body exudate (B_EXU)	Suggestive of H. pylori-associated gastritis	Grade 0: do not exist; Grade 1: exist	White mucinous sticky fluid on the gastric mucosa
Body diffuse erythema (B_DE)	Suggestive of H. pylori-associated gastritis	Grade 0: do not exist; Grade 1: when it could be identified by close-up observation of mucosa due to light red color; Grade 2: when easily identified at some distance due to dark red color
Endoscopic atrophic border (EAB)	Degree of atrophy extent	Closed type 1 - 3 (C 1 – 3) (cardia saved from atrophic front); open type 1 - 3 (O 1 - 3) (cardia involved with atrophy)	As suggested by Kimura and Takemoto[13]
Antrum visible vessel break (A_VV_B)	Atrophy of antral mucosa with features suggestive of more inflammatory change in body side	Grade 0: do not exist; Grade 1: exist	Visible differences in mucosal thickness and color between antrum and low body greater curvature side
Antrum visible vessel (A_VV)	Atrophy of antral mucosa	Grade 0: do not exist; Grade 1: exist
Antrum camouflage (A_CAM)	Suggestive of H. pylori-associated gastritis	Grade 0: do not exist; Grade 1: exist	Mosaic like mucosal change with peripheral white grooves, some erythematous mucosal change could enhance detection
Antrum mucosal edema (A_ME)	Suggestive of H. pylori-associated gastritis	Grade 0: do not exist; Grade 1: exist	Soft swelling of mucosa with mosaic pattern but accompanied with dark peripheral grooves
Antrum intestinal metaplasia (A_IM)	Metaplastic antral mucosa	Grade 0: do not exist; Grade 1: exist	When whitish plaques were scattered on the mucosal surface
Antrum diffuse erythema (A_DE)	Suggestive of H. pylori-associated gastritis	Grade 0: do not exist; Grade 1: exist

Table 1. Endoscopic Parameters

Endoscopic feature

Biology of feature

Scales

Note

Body xanthoma (B_XAN)

Suggestive of H. pylori-associated gastritis with surrounding more atrophic mucosa

Grade 0: do not exist; Grade 1: exist

Yellow white spot on the gastric mucosa

Body visible vessel (B_VV)

Atrophy of body mucosa

Grade 0: do not exist; Grade 1: only visible mucosal change in body lesser curvature; Grade 2: visible vessels mingled with irregular mucosa; Grade 3: when prominent, and clear vessels marking in body lesser curvature side

Body type A (B_type A)

Highly accurate mucosal pattern of H. pylori infection. Higher degree of atrophy (B > A,C) and IM (A,B) than normal RAC pattern

Grade 0: do not exist; Grade 1: exist

Mosaic-like appearance

Body type B (B_type B)

Diffuse homogenous redness

Body type C (B_type C)

Untypical-irregular redness with groove

Body spotty erythema (B_SE)

Suggestive of H. pylori-associated gastritis

Grade 0: do not exist; Grade 1: when it could be seen only in body greater curvature; Grade 3: when clearly seen in fundus and body; Grade 2: when observed but neither 1 or 3

Body rugal hyperplasia (B_RHG)

Suggestive of H. pylori-associated gastritis

Grade 0: do not exist; Grade 1: exist

Gastric fold width was equal or over 5mm with the aid of opening width (7 mm) of biopsy forcep despite sufficient air inflation of stomach

Body regular arrangement of collecting venule (B_RAC)

Usually H. pylori free gastric mucosa.

Grade 0: do not exist; Grade 1: exist

Body exudate (B_EXU)

Suggestive of H. pylori-associated gastritis

Grade 0: do not exist; Grade 1: exist

White mucinous sticky fluid on the gastric mucosa

Body diffuse erythema (B_DE)

Suggestive of H. pylori-associated gastritis

Grade 0: do not exist; Grade 1: when it could be identified by close-up observation of mucosa due to light red color; Grade 2: when easily identified at some distance due to dark red color

Endoscopic atrophic border (EAB)

Degree of atrophy extent

Closed type 1 - 3 (C 1 – 3) (cardia saved from atrophic front); open type 1 - 3 (O 1 - 3) (cardia involved with atrophy)

As suggested by Kimura and Takemoto[13]

Antrum visible vessel break (A_VV_B)

Atrophy of antral mucosa with features suggestive of more inflammatory change in body side

Grade 0: do not exist; Grade 1: exist

Visible differences in mucosal thickness and color between antrum and low body greater curvature side

Antrum visible vessel (A_VV)

Atrophy of antral mucosa

Grade 0: do not exist; Grade 1: exist

Antrum camouflage (A_CAM)

Suggestive of H. pylori-associated gastritis

Grade 0: do not exist; Grade 1: exist

Mosaic like mucosal change with peripheral white grooves, some erythematous mucosal change could enhance detection

Antrum mucosal edema (A_ME)

Suggestive of H. pylori-associated gastritis

Grade 0: do not exist; Grade 1: exist

Soft swelling of mucosa with mosaic pattern but accompanied with dark peripheral grooves

Antrum intestinal metaplasia (A_IM)

Metaplastic antral mucosa

Grade 0: do not exist; Grade 1: exist

When whitish plaques were scattered on the mucosal surface

Antrum diffuse erythema (A_DE)

Suggestive of H. pylori-associated gastritis

Grade 0: do not exist; Grade 1: exist

**Table 2.** Characteristics of Subjects
	Total	Closed type	Open type
Number	196	151	45
Age (years ± SD)	50.6 ± 9.0	49.8 ± 9.0	53.5 ± 8.8
Sex (male : female)	144 : 52	112 : 39	32 : 13
Hyperacidity(number)	78	72	6
Hypoacidity (number)	73	37	36
Normoacidity (number)	45	42	3

Table 2. Characteristics of Subjects

Total

Closed type

Open type

Number

196

151

Age (years ± SD)

50.6 ± 9.0

49.8 ± 9.0

53.5 ± 8.8

Sex (male : female)

144 : 52

112 : 39

32 : 13

Hyperacidity(number)

Hypoacidity (number)

Normoacidity (number)

**Table 3.** Demographic and Serological Data of Hypoacid, Normoacid and Hyperacid
	Total	Hypoacid	Normoacid	Hyperacid	P-value (hypoacid vs. normoacid vs. hyperacid)
Pep_I: pepsinogen I; Pep_II: pepsinogen II.
Number	196	73	45	78
Age (years ± SD)	50.6 ± 9.0	53.4 ± 8.5	49.9 ± 9.3	48.4 ± 8.7	0.002
Sex (male : female)	144 : 52	50 : 23	30 : 15	64 : 14	0.085
Pep_I	65.1 ± 25.6	60.9 ± 24.6	64.1 ± 23.1	69.5 ± 27.5	0.116
Pep_II	22.2 ± 10.8	28.6 ± 11.6	21.4 ± 8.0	16.6 ± 7.9	0.001
Gastrin	73.0 ± 37.7	94.3 ± 49.9	64.1 ± 22.8	58.3 ± 16.5	0.001
I/II ratio	3.2 ± 1.2	2.1 ± 0.4	3.0 ± 0.2	4.4 ± 0.9	0.001

Table 3. Demographic and Serological Data of Hypoacid, Normoacid and Hyperacid

Total

Hypoacid

Normoacid

Hyperacid

P-value (hypoacid vs. normoacid vs. hyperacid)

Pep_I: pepsinogen I; Pep_II: pepsinogen II.

Number

196

Age (years ± SD)

50.6 ± 9.0

53.4 ± 8.5

49.9 ± 9.3

48.4 ± 8.7

0.002

Sex (male : female)

144 : 52

50 : 23

30 : 15

64 : 14

0.085

Pep_I

65.1 ± 25.6

60.9 ± 24.6

64.1 ± 23.1

69.5 ± 27.5

0.116

Pep_II

22.2 ± 10.8

28.6 ± 11.6

21.4 ± 8.0

16.6 ± 7.9

0.001

Gastrin

73.0 ± 37.7

94.3 ± 49.9

64.1 ± 22.8

58.3 ± 16.5

0.001

I/II ratio

3.2 ± 1.2

2.1 ± 0.4

3.0 ± 0.2

4.4 ± 0.9

0.001

**Table 4.** Scores of Endoscopic Appearances of Hypoacid, Normoacid and Hyperacid
	Total	Hypoacid	Normoacid	Hyperacid	P-value (hypoacid vs. normoacid vs. hyperacid)
B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema.
Number	196	73	45	78
B_XAN	0.06 ± 0.23	0.11 ± 0.32	0.04 ± 0.21	0.01 ± 0.11	0.033
B_VV	1.31 ± 0.87	1.66 ± 0.87	1.22 ± 0.82	1.04 ± 0.78	0.001
B_type A	0.34 ± 0.48	0.15 ± 0.36	0.33 ± 0.48	0.53 ± 0.50	0.001
B_type B	0.45 ± 0.50	0.78 ± 0.48	0.40 ± 0.50	0.17 ± 0.38	0.001
B_type C	0.10 ± 0.30	0.03 ± 0.16	0.20 ± 0.41	0.12 ± 0.32	0.009
B_SE	0.63 ± 0.98	0.59 ± 0.92	0.87 ± 1.16	0.53 ± 0.89	0.160
B_RHG	0.17 ± 0.38	0.30 ± 0.46	0.11 ± 0.32	0.08 ± 0.27	0.001
B_RAC	0.11 ± 0.31	0.04 ± 0.20	0.07 ± 0.25	0.19 ± 0.40	0.006
B_EXU	0.47 ± 0.50	0.71 ± 0.46	0.40 ± 0.50	0.29 ± 0.46	0.001
B_DE	0.97 ± 0.97	1.16 ± 0.97	1.02 ± 0.97	0.77 ± 0.95	0.041
EAB	3.04 ± 1.02	3.66 ± 1.03	2.78 ± 0.74	2.60 ± 0.87	0.001
A_VV_B	0.21 ± 0.41	0.25 ± 0.43	0.18 ± 0.39	0.21 ± 0.41	0.658
A_VV	0.33 ± 0.47	0.49 ± 0.50	0.31 ± 0.47	0.18 ± 0.39	0.001
A_CAM	0.38 ± 0.49	0.30 ± 0.46	0.33 ± 0.48	0.49 ± 0.50	0.047
A_ME	0.20 ± 0.40	0.21 ± 0.41	0.20 ± 0.41	0.21 ± 0.41	0.997
A_IM	0.18 ± 0.38	0.25 ± 0.43	0.11 ± 0.32	0.15 ± 0.36	0.135
A_DE	0.47 ± 0.50	0.42 ± 0.50	0.58 ± 0.50	0.46 ± 0.50	0.262

Table 4. Scores of Endoscopic Appearances of Hypoacid, Normoacid and Hyperacid

Total

Hypoacid

Normoacid

Hyperacid

P-value (hypoacid vs. normoacid vs. hyperacid)

B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema.

Number

196

B_XAN

0.06 ± 0.23

0.11 ± 0.32

0.04 ± 0.21

0.01 ± 0.11

0.033

B_VV

1.31 ± 0.87

1.66 ± 0.87

1.22 ± 0.82

1.04 ± 0.78

0.001

B_type A

0.34 ± 0.48

0.15 ± 0.36

0.33 ± 0.48

0.53 ± 0.50

0.001

B_type B

0.45 ± 0.50

0.78 ± 0.48

0.40 ± 0.50

0.17 ± 0.38

0.001

B_type C

0.10 ± 0.30

0.03 ± 0.16

0.20 ± 0.41

0.12 ± 0.32

0.009

B_SE

0.63 ± 0.98

0.59 ± 0.92

0.87 ± 1.16

0.53 ± 0.89

0.160

B_RHG

0.17 ± 0.38

0.30 ± 0.46

0.11 ± 0.32

0.08 ± 0.27

0.001

B_RAC

0.11 ± 0.31

0.04 ± 0.20

0.07 ± 0.25

0.19 ± 0.40

0.006

B_EXU

0.47 ± 0.50

0.71 ± 0.46

0.40 ± 0.50

0.29 ± 0.46

0.001

B_DE

0.97 ± 0.97

1.16 ± 0.97

1.02 ± 0.97

0.77 ± 0.95

0.041

EAB

3.04 ± 1.02

3.66 ± 1.03

2.78 ± 0.74

2.60 ± 0.87

0.001

A_VV_B

0.21 ± 0.41

0.25 ± 0.43

0.18 ± 0.39

0.21 ± 0.41

0.658

A_VV

0.33 ± 0.47

0.49 ± 0.50

0.31 ± 0.47

0.18 ± 0.39

0.001

A_CAM

0.38 ± 0.49

0.30 ± 0.46

0.33 ± 0.48

0.49 ± 0.50

0.047

A_ME

0.20 ± 0.40

0.21 ± 0.41

0.20 ± 0.41

0.21 ± 0.41

0.997

A_IM

0.18 ± 0.38

0.25 ± 0.43

0.11 ± 0.32

0.15 ± 0.36

0.135

A_DE

0.47 ± 0.50

0.42 ± 0.50

0.58 ± 0.50

0.46 ± 0.50

0.262

**Table 5.** Risk Factors for Hyperacid in Univariable Analysis
Number(hyper)	Overall 196 (78)	Closed type 151 (72)	Open type 45 (6)
A: There were not any cases; B: indefinite; B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema. CI: confidence interval; OR: odds ratio.
Age	0.954	0.923 - 0.987	0.006	0.956	0.920 - 0.993	0.019	1.008	0.912 - 1.114	0.877
Sex	2.171	1.083 - 4.352	0.029	1.918	0.904 - 4.068	0.090	3.728×10⁸	B	0.999
B_XAN	0.140	0.018 - 1.119	0.064	0.208	0.024 - 1.829	0.157	0.000	B	0.999
B_VV	0.523	0.363 - 0.752	0.000	0.733	0.485 - 1.108	0.141	0.264	0.062 - 1.119	0.071
B_type A	3.921	2.105 - 7.304	0.000	3.297	1.660 - 6.550	0.001	5.500	0.890 - 33.994	0.067
B_type B	0.115	0.057 - 0.232	0.000	0.143	0.066 - 0.313	0.000	0.129	0.020 - 0.835	0.032
B_type C	1.269	0.500 - 3.220	0.616	0.883	0.343 - 2.273	0.797		A
B_SE	0.832	0.614 - 1.128	0.235	0.867	0.626 - 1.200	0.390	0.000	B	0.998
B_RHG	0.281	0.110 - 0.717	0.008	0.332	0.123 - 0.895	0.029	0.000	B	0.999
B_RAC	4.444	1.642 - 12.031	0.003	4.131	1.280 - 13.330	0.018	9.250	1.010 - 84.732	0.049
B_EXU	0.287	0.156 - 0.528	0.000	0.444	0.227 - 0.871	0.018	0.109	0.017 - 0.720	0.021
B_DE	0.693	0.513 - 0.936	0.017	0.601	0.427 - 0.846	0.003	1.111	0.466 - 2.652	0.812
A_VV_B	0.913	0.453 - 1.841	0.800	0.960	0.439 - 2.098	0.918	0.667	0.069 - 6.470	0.727
A_VV	0.298	0.150 - 0.590	0.001	0.368	0.166 - 0.814	0.014	0.625	0.111 - 3.509	0.593
A_CAM	2.080	1.153 - 3.753	0.015	2.303	1.178 - 4.502	0.015	1.786	0.317 - 10.061	0.511
A_ME	1.011	0.497 - 2.054	0.976	0.950	0.427 - 2.117	0.901	1.937	0.300 - 12.532	0.487
A_IM	0.751	0.349 - 1.614	0.463	2.057	0.762 - 5.554	0.155	0.000	B	0.998
A_DE	0.917	0.517 - 1.627	0.768	0.863	0.455 - 1.639	0.653	2.105	0.345 - 12.861	0.420
EAB	0.436	0.303 - 0.627	0.000

Table 5. Risk Factors for Hyperacid in Univariable Analysis

Number(hyper)

Overall 196 (78)

Closed type 151 (72)

Open type 45 (6)

95% CI

P-value

95% CI

P-value

95% CI

P-value

A: There were not any cases; B: indefinite; B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema. CI: confidence interval; OR: odds ratio.

Age

0.954

0.923 - 0.987

0.006

0.956

0.920 - 0.993

0.019

1.008

0.912 - 1.114

0.877

Sex

2.171

1.083 - 4.352

0.029

1.918

0.904 - 4.068

0.090

3.728×10⁸

0.999

B_XAN

0.140

0.018 - 1.119

0.064

0.208

0.024 - 1.829

0.157

0.000

0.999

B_VV

0.523

0.363 - 0.752

0.000

0.733

0.485 - 1.108

0.141

0.264

0.062 - 1.119

0.071

B_type A

3.921

2.105 - 7.304

0.000

3.297

1.660 - 6.550

0.001

5.500

0.890 - 33.994

0.067

B_type B

0.115

0.057 - 0.232

0.000

0.143

0.066 - 0.313

0.000

0.129

0.020 - 0.835

0.032

B_type C

1.269

0.500 - 3.220

0.616

0.883

0.343 - 2.273

0.797

B_SE

0.832

0.614 - 1.128

0.235

0.867

0.626 - 1.200

0.390

0.000

0.998

B_RHG

0.281

0.110 - 0.717

0.008

0.332

0.123 - 0.895

0.029

0.000

0.999

B_RAC

4.444

1.642 - 12.031

0.003

4.131

1.280 - 13.330

0.018

9.250

1.010 - 84.732

0.049

B_EXU

0.287

0.156 - 0.528

0.000

0.444

0.227 - 0.871

0.018

0.109

0.017 - 0.720

0.021

B_DE

0.693

0.513 - 0.936

0.017

0.601

0.427 - 0.846

0.003

1.111

0.466 - 2.652

0.812

A_VV_B

0.913

0.453 - 1.841

0.800

0.960

0.439 - 2.098

0.918

0.667

0.069 - 6.470

0.727

A_VV

0.298

0.150 - 0.590

0.001

0.368

0.166 - 0.814

0.014

0.625

0.111 - 3.509

0.593

A_CAM

2.080

1.153 - 3.753

0.015

2.303

1.178 - 4.502

0.015

1.786

0.317 - 10.061

0.511

A_ME

1.011

0.497 - 2.054

0.976

0.950

0.427 - 2.117

0.901

1.937

0.300 - 12.532

0.487

A_IM

0.751

0.349 - 1.614

0.463

2.057

0.762 - 5.554

0.155

0.000

0.998

A_DE

0.917

0.517 - 1.627

0.768

0.863

0.455 - 1.639

0.653

2.105

0.345 - 12.861

0.420

EAB

0.436

0.303 - 0.627

0.000

Table 6. Risk Factors for Hyperacid in Multivariable Analysis

Number (hypo)

Overall 196 (78)

Closed type 151 (72)

Open type 45 (6)

95% CI

P-value

95% CI

P-value

95% CI

P-value

Age

0.951

0.970 - 0.995

0.028

Sex

2.389

1.076 - 5.301

0.032

B_XAN

B_VV

B_type A

B_type B

0.154

0.074 - 0.322

0.000

0.164

0.072 - 0.372

0.000

B_type C

B_SE

B_RHG

B_RAC

B_EXU

0.109

0.017 - 0.720

0.021

B_DE

0.654

0.444 - 0.966

0.033

A_VV_B

A_VV

A_CAM

2.527

1.169 - 5.463

0.018

A_ME

A_IM

A_DE

EAB

0.536

0.357 - 0.805

0.003

**Table 7.** Risk Factors for Hypoacid in Univariable Analysis
Number (hypo)	Overall 196 (73)	Closed type 151 (37)	Open type 45 (36)
A: there were not any cases; B: indefinite; B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema; CI: confidence interval; OR: odds ratio.
Age	1.061	1.024 - 1.099	0.001	1.088	1.036 - 1.144	0.001	0.937	0.854 - 1.028	0.170
Sex	0.671	0.352 - 1.279	0.225	0.770	0.338 - 1.754	0.533	0.250	0.028 - 2.237	0.215
B_XAN	4.923	1.263 - 19.197	0.022	6.788	1.190 - 38.720	0.031	1.000	0.098 - 10.219	0.000
B_VV	2.215	1.521 - 3.225	0.000	1.211	0.757 - 1.937	0.425	3.293	1.070 - 12.072	0.039
B_type A	0.212	0.102 - 0.442	0.000	0.231	0.089 - 0.596	0.002	0.202	0.040 - 1.018	0.053
B_type B	10.573	5.314 - 21.034	0.000	10.025	4.215 - 23.839	0.000	5.179	1.097 - 24.457	0.038
B_type C	0.164	0.037 - 0.730	0.018	0.305	0.067 - 1.381	0.123		A
B_SE	0.937	0.693 - 1.265	0.670	0.866	0.584 - 1.284	0.474	1.566	0.578 - 4.244	0.377
B_RHG	4.392	1.982 - 9.735	0.000	4.495	1.778 - 11.363	0.001	5.592×10⁸	B	0.999
B_RAC	0.250	0.071 - 0.881	0.031	0.170	0.022 - 1.330	0.091	0.206	0.025 - 1.719	0.144
B_EXU	4.952	2.637 - 9.302	0.000	3.052	1.421 - 6.556	0.004	6.250	1.287 - 30.349	0.023
B_DE	1.382	1.022 - 1.869	0.036	2.026	1.324 - 3.099	0.001	0.773	0.367 - 1.627	0.498
A_VV_B	1.350	0.674 - 2.703	0.397	1.272	0.528 - 3.064	0.592	2.667	0.292 - 24.345	0.385
A_VV	3.301	1.770 - 6.155	0.000	2.408	1.075 - 5.395	0.033	1.257	0.287 - 5.499	0.761
A_CAM	0.570	0.308 - 1.053	0.073	0.426	0.185 - 0.985	0.046	0.707	0.161 - 3.105	0.646
A_ME	1.014	0.495 - 2.078	0.970	1.154	0.464 - 2.867	0.758	0.483	0.096 - 2.423	0.376
A_IM	2.041	0.975 - 4.271	0.058	0.326	0.072 - 1.484	0.147	7.27×10⁸	B	0.998
A_DE	0.726	0.405 - 1.301	0.282	0.542	0.251 - 1.168	0.118	0.800	0.184 - 3.473	0.766
EAB	3.346	2.204 - 5.082	0.000

Table 7. Risk Factors for Hypoacid in Univariable Analysis

Number (hypo)

Overall 196 (73)

Closed type 151 (37)

Open type 45 (36)

95% CI

P-value

95% CI

P-value

95% CI

P-value

A: there were not any cases; B: indefinite; B_XAN: body xanthoma; B_VV: body visible vessel; B_type A: body type A; B_type B: body type B; B_type C: body type C; B_SE: body spotty erythema; B_RHG: body rugal hyperplasia; B_RAC: body regular arrangement of collecting venule; B_EXU: body exudate; B_DE: body diffuse erythema; EAB: endoscopic atrophic border; A_VV_B: antrum visible vessel break; A_VV: antrum visible vessel; A_CAM: antrum camouflage; A_ME: antrum mucosal edema; A_IM: antrum intestinal metaplasia; A_DE: antrum diffuse erythema; CI: confidence interval; OR: odds ratio.

Age

1.061

1.024 - 1.099

0.001

1.088

1.036 - 1.144

0.001

0.937

0.854 - 1.028

0.170

Sex

0.671

0.352 - 1.279

0.225

0.770

0.338 - 1.754

0.533

0.250

0.028 - 2.237

0.215

B_XAN

4.923

1.263 - 19.197

0.022

6.788

1.190 - 38.720

0.031

1.000

0.098 - 10.219

0.000

B_VV

2.215

1.521 - 3.225

0.000

1.211

0.757 - 1.937

0.425

3.293

1.070 - 12.072

0.039

B_type A

0.212

0.102 - 0.442

0.000

0.231

0.089 - 0.596

0.002

0.202

0.040 - 1.018

0.053

B_type B

10.573

5.314 - 21.034

0.000

10.025

4.215 - 23.839

0.000

5.179

1.097 - 24.457

0.038

B_type C

0.164

0.037 - 0.730

0.018

0.305

0.067 - 1.381

0.123

B_SE

0.937

0.693 - 1.265

0.670

0.866

0.584 - 1.284

0.474

1.566

0.578 - 4.244

0.377

B_RHG

4.392

1.982 - 9.735

0.000

4.495

1.778 - 11.363

0.001

5.592×10⁸

0.999

B_RAC

0.250

0.071 - 0.881

0.031

0.170

0.022 - 1.330

0.091

0.206

0.025 - 1.719

0.144

B_EXU

4.952

2.637 - 9.302

0.000

3.052

1.421 - 6.556

0.004

6.250

1.287 - 30.349

0.023

B_DE

1.382

1.022 - 1.869

0.036

2.026

1.324 - 3.099

0.001

0.773

0.367 - 1.627

0.498

A_VV_B

1.350

0.674 - 2.703

0.397

1.272

0.528 - 3.064

0.592

2.667

0.292 - 24.345

0.385

A_VV

3.301

1.770 - 6.155

0.000

2.408

1.075 - 5.395

0.033

1.257

0.287 - 5.499

0.761

A_CAM

0.570

0.308 - 1.053

0.073

0.426

0.185 - 0.985

0.046

0.707

0.161 - 3.105

0.646

A_ME

1.014

0.495 - 2.078

0.970

1.154

0.464 - 2.867

0.758

0.483

0.096 - 2.423

0.376

A_IM

2.041

0.975 - 4.271

0.058

0.326

0.072 - 1.484

0.147

7.27×10⁸

0.998

A_DE

0.726

0.405 - 1.301

0.282

0.542

0.251 - 1.168

0.118

0.800

0.184 - 3.473

0.766

EAB

3.346

2.204 - 5.082

0.000

Table 8. Risk Factors for Hypoacid in Multivariable Analysis

Number (hypo)

Overall 196 (73)

Closed type 151 (37)

Open type 45 (36)

95% CI

P-value

95% CI

P-value

95% CI

P-value

Age

1.066

10.170 - 1.118

0.008

1.134

1.056 - 1.217

0.001

Sex

B_XAN

127.603

5.867 - 2775.034

0.002

B_VV

B_type A

B_type B

6.391

2.953 - 13.831

0.000

12.517

3.944 - 39.722

0.000

B_type C

B_SE

B_RHG

3.417

1.289 - 9.056

0.013

5.205

1.319 - 20.543

0.019

B_RAC

B_EXU

10.671

1.324 - 86.018

0.026

B_DE

2.667

1.423 - 4.997

0.002

A_VV_B

A_VV

A_CAM

A_ME

A_IM

A_DE

0.161

0.047 - 0.554

0.004

EAB

2.756

1.717 - 4.424

0.000

**Table 9.** Serological and Demographic Meaning of Antrum Camouflage
	Total	CAM	Non-CAM	P-value (CAM vs. non-CAM)
Pep_I: pepsinogen I; Pep_II: pepsinogen II.
Number	151	75	121
Age (years ± SD)	49.8 ± 9.0	50.5 ± 7.9	50.7 ± 9.7	0.873
Sex (male : female)	112 : 39	54 : 21	90 : 31	0.536
Pep_I	68.4 ± 24.6	61.3 ± 22.4	67.4 ± 27.3	0.103
Pep_II	21.7 ± 10.4	19.8 ± 9.5	23.7 ± 11.3	0.015
Gastrin	68.2 ± 32.4	70.0 ± 35.8	74.9 ± 38.8	0.382
I/II ratio	3.5 ± 1.1	3.4 ± 1.2	3.1 ± 1.2	0.067

Table 9. Serological and Demographic Meaning of Antrum Camouflage

Total

CAM

Non-CAM

P-value (CAM vs. non-CAM)

Pep_I: pepsinogen I; Pep_II: pepsinogen II.

Number

151

121

Age (years ± SD)

49.8 ± 9.0

50.5 ± 7.9

50.7 ± 9.7

0.873

Sex (male : female)

112 : 39

54 : 21

90 : 31

0.536

Pep_I

68.4 ± 24.6

61.3 ± 22.4

67.4 ± 27.3

0.103

Pep_II

21.7 ± 10.4

19.8 ± 9.5

23.7 ± 11.3

0.015

Gastrin

68.2 ± 32.4

70.0 ± 35.8

74.9 ± 38.8

0.382

I/II ratio

3.5 ± 1.1

3.4 ± 1.2

3.1 ± 1.2

0.067