ObjectiveTo investigate the correlation between morphology of esophageal and gastric mucosal and Helicobacter pylori (HP) infection under white light gastroscope.MethodsA retrospective analysis was performed on data of 1 339 patients who underwent 13C-urea breath test and white light gastroscopy at the same time in the Southwest Hospital of Army Medical University from September 2018 to August 2019. Chi-square test or Fisher exact probability method was used to analyze the difference on detection rates of 22 indexes of gastroscopic mucosal manifestation between the HP infection group (n=422) and the non-infection group (n=917). Then the indexes with difference were further analyzed by binary logistic regression. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve and the sensitivity, specificity, positive predictive value and negative predictive value of prediction of HP infection was calculated.ResultsThe diffuse redness, spotted redness, mucosal swelling, enlarged folds, sticky mucus, digestive tract ulcer, nodularity, hyperplastic polyp, xanthoma, atrophy, intestinal metaplasia, and depressive erosion were more common in patients with HP infection (all P＜0.05). Binary logistic regression analysis showed that diffuse redness (P<0.001, OR=75.974, 95%CI: 32.551-177.327), spotted redness (P=0.002, OR=3.360, 95%CI: 1.536-7.349), mucosal swelling (P<0.001, OR=3.150, 95%CI: 1.654-5.996) were independent risk factors for HP infection. ROC curve analysis showed that the area under ROC curve of diffuse redness, spotted redness, mucosal swelling, enlarged folds, sticky mucus, peptic ulcer, and depressive erosion predicting HP infection were all greater than 0.5 (P<0.05), among which, the area under curve of diffuse redness, spotted redness and mucosal swelling predicting HP infection were greater than 0.7. The sensitivities corresponding to the three indicators were 0.735, 0.512, and 0.445, the specificities were 0.992, 0.983, and 0.971, the positive predictive values were 0.978, 0.931, and 0.874, and the negative predictive values were 0.890, 0.814, and 0.792, respectively.ConclusionMorphological manifestations of esophageal and gastric mucosa, especially diffuse redness, spotted redness, and mucosal swelling, are excellent indicators for HP infection under white light gastroscopy.