The simplified Kyoto classification score is consistent with the ABC method of classification as a grading system for endoscopic gastritis

Nishizawa, Toshihiro; Toyoshima, Osamu; Kondo, Rieko; Sekiba, Kazuma; Tsuji, Yosuke; Ebinuma, Hirotoshi; Suzuki, Hidekazu; Tanikawa, Chizu; Matsuda, Koichi; Koike, Kazuhiko

doi:10.3164/jcbn.20-41

Cited by 11 publications

(14 citation statements)

References 33 publications

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“…Dr. Haruma [24]suggested that serum PG I levels in AIG usually decrease to <25 ng/mL, and AIG is most likely to be diagnosed when its level is <10 ng/mL. Serum PG is also measured during the ABC method, a gastric risk stratification program based on the H. pylori antibody [25-27]. The ABC method focuses on grouping into 4 classifications, causing the PG I value to be ignored.…”

Section: Discussionmentioning

confidence: 99%

Clue of Diagnosis for Autoimmune Gastritis

Nishizawa

Yoshida

Watanabe³

et al. 2021

Digestion

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Background: The diagnostic clues for autoimmune gastritis (AIG) can be classified into 2 categories: endoscopic findings and pathological diagnosis. We believe that research on the AIG detection rate by endoscopists could provide a better understanding of the diagnosis of AIG. This study aimed to clarify the ratio of the endoscopic and the pathological diagnoses of AIG. Methods: We retrospectively reviewed consecutive patients who underwent esophagogastroduodenoscopy (EGD). During their first EGD, the gastric mucosa with C2 atrophy or more was biopsied for pathological evaluation based on the updated Sydney system. A gastric biopsy was also performed after Helicobacter pylori eradication, obtaining specimens from at least 2 sites, the greater curvature of the corpus and the antrum. We enrolled patients who were positive for the anti-parietal cell antibody and were diagnosed with AIG, histologically and/or endoscopically. The detection rates of AIG were compared between endoscopic diagnosis and pathological diagnosis. Results: A total of 10,822 patients underwent EGD during the study period. Finally, 41 patients with AIG were enrolled, leading to an AIG prevalence of 0.38% in this study. As for the clue leading to AIG detection, 31.7% (13/41) were diagnosed through endoscopy (proximal-predominant atrophy), and 68.3% (28/41) were diagnosed pathologically. The AIG detection rate by endoscopists in the posteradication group was significantly lower than in the H. pylori-negative group (p < 0.05). Conclusion: Endoscopists frequently overlooked AIG, especially in posteradication cases. Pathological assessment using the updated Sydney system after H. pylori eradication might be a promising strategy to detect AIG better.

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Section: Discussionmentioning

confidence: 99%

Clue of Diagnosis for Autoimmune Gastritis

Nishizawa

Yoshida

Watanabe³

et al. 2021

Digestion

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“…( 24 , 25 ) The PSCA SNP was also shown to be associated with pathological and serological (i.e., pepsinogen I/II ratio) atrophic gastritis, which partially supports our findings. ( 22 , 31 – 33 )…”

Section: Discussionmentioning

confidence: 99%

“…The Kyoto classification of gastritis, which is scored from 0 to 8, is based on the sum of scores of the following five endoscopic findings: atrophy, intestinal metaplasia (IM), enlarged folds, nodularity, and diffuse redness. ( 22 ) A high score represents increased risk for gastric cancer and H. pylori infection. ( 14 – 18 ) Gastric atrophy was classified according to the extent of mucosal atrophy, as described by Kimura and Takemoto.…”

Section: Methodsmentioning

confidence: 99%

A single nucleotide polymorphism in Prostate Stem Cell Antigen is associated with endoscopic grading in Kyoto classification of gastritis

Toyoshima¹,

Nishizawa

Sekiba

et al. 2021

J. Clin. Biochem. Nutr.

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The risk allele of a single nucleotide polymorphism (SNP) rs2294008 in the Prostate stem cell antigen ( PSCA ) gene is strongly associated with gastric cancer. Although the Kyoto classification score is believed to be an indicator of gastric cancer risk, it lacks supporting genetic evidence. We investigated the effect of this risk allele of PSCA SNP on the Kyoto score. Participants without a history of gastric cancer or Helicobacter pylori ( H. pylori ) eradication underwent esophagogastroduodenoscopy, H. pylori evaluation, and SNP genotyping. The Kyoto score is the sum of scores obtained from endoscopy-based atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness. The Kyoto score is novel in the light of scoring for gastritis. A total of 323 patients were enrolled (number of individuals with genotype CC: 52; CT: 140; TT: 131, average age: 50.1 years, male: 50.8%). The patient baseline characteristics including age, sex, body mass index, smoking, drinking, family history of gastric cancer, and H. pylori status had no association with PSCA SNP. The Kyoto score was higher in T (CT or TT genotype; risk allele) carriers than in CC carriers. Atrophy, enlarged folds, and diffuse redness scores were higher in T allele carriers (risk allele) than in CC genotype individuals. In multivariate analysis, the Kyoto score was independently associated with PSCA SNP (OR: 1.30, p = 0.012). Thus, the Kyoto score was associated with a genetic predisposition.

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“…The Kyoto score for endoscopic gastritis, which ranges from 0 to 8, is based on the total scores of the following five endoscopic findings: atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness. A high score represents an increased risk of gastric cancer[ 20 - 23 ] and H. pylori infection[ 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…The Kyoto classification adopted and scored atrophy, intestinal metaplasia, enlarged folds, nodularity, diffuse redness, and the regular arrangement of collecting venules (RAC) as endoscopic findings of gastritis. Among them, the Kyoto score, which is the sum of the scores of these factors, has been vigorously reported to be associated with gastric cancer[ 21 , 22 ], gastric cancer risk[ 20 , 23 ], and H. pylori infections[ 24 ]. Evaluating the risk of gastric cancer on the basis of endoscopic findings is an important alternative to biopsy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of endoscopic gastritis based on Kyoto classification between diffuse and intestinal gastric cancer

Toyoshima¹,

Nishizawa²,

Yoshida³

et al. 2021

WJGE

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BACKGROUND Gastric cancers can be categorized into diffuse- and intestinal-type cancers based on the Lauren histopathological classification. These two subtypes show distinct differences in metastasis frequency, treatment application, and prognosis. Therefore, accurately assessing the Lauren classification before treatment is crucial. However, studies on the gastritis endoscopy-based Kyoto classification have recently shown that endoscopic diagnosis has improved. AIM To investigate patient characteristics including endoscopic gastritis associated with diffuse- and intestinal-type gastric cancers in Helicobacter pylori ( H. pylori )-infected patients. METHODS Patients who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic were enrolled. The Kyoto classification included atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness. The effects of age, sex, and Kyoto classification score on gastric cancer according to the Lauren classification were analyzed. We developed the Lauren predictive background score based on the coefficients of a logistic regression model using variables independently associated with the Lauren classification. Area under the receiver operative characteristic curve and diagnostic accuracy of this score were examined. RESULTS A total of 499 H. pylori -infected patients (49.6% males; average age: 54.9 years) were enrolled; 132 patients with gastric cancer (39 diffuse- and 93 intestinal-type cancers) and 367 cancer-free controls were eligible. Gastric cancer was independently associated with age ≥ 65 years, high atrophy score, high intestinal metaplasia score, and low nodularity score when compared to the control. Factors independently associated with intestinal-type cancer were age ≥ 65 years (coefficient: 1.98), male sex (coefficient: 1.02), high intestinal metaplasia score (coefficient: 0.68), and low enlarged folds score (coefficient: -1.31) when compared to diffuse-type cancer. The Lauren predictive background score was defined as the sum of +2 (age ≥ 65 years), +1 (male sex), +1 (endoscopic intestinal metaplasia), and -1 (endoscopic enlarged folds) points. Area under the receiver operative characteristic curve of the Lauren predictive background score was 0.828 for predicting intestinal-type cancer. With a cut-off value of +2, the sensitivity, specificity, and accuracy of the Lauren predictive background score were 81.7%, 71.8%, and 78.8%, respectively. CONCLUSION Patient backgrounds, such as age, sex, endoscopic intestinal metaplasia, and endoscopic enlarged folds are useful for predicting the Lauren type of gastric cancer.

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The simplified Kyoto classification score is consistent with the ABC method of classification as a grading system for endoscopic gastritis

Cited by 11 publications

References 33 publications

Clue of Diagnosis for Autoimmune Gastritis

Clue of Diagnosis for Autoimmune Gastritis

A single nucleotide polymorphism in <i>Prostate Stem Cell Antigen</i> is associated with endoscopic grading in Kyoto classification of gastritis

Comparison of endoscopic gastritis based on Kyoto classification between diffuse and intestinal gastric cancer

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