The role of the Kyoto classification in the endoscopic diagnosis of gastritis associated with Helicobacter pylori infection

Close metadata

Recommended articles:

Results of using endoscopic stenting of the gastric outlet and duodenum with metal self-expanding stents. Endoscopic Surgery. 2024;(3):11-20

Morphological and molecular genetic features of gastric cancer. P.A. Herzen Journal of Oncology. 2024;(3):79-84

Double-tract reconstruction after gastrectomy for gastric cancer in patients with concomitant cardiovascular diseases. Pirogov Russian Journal of Surgery. 2024;(6):58-69

Exploring the feasibility of peroral endoscopic myotomy for stage IV esophageal achalasia patients. Russian Journal of Evidence-Based Gastroenterology. 2024;(2):5-13

The impact of endoscopy in upper gastrointestinal tract cancer screening programs. Russian Journal of Evidence-Based Gastroenterology. 2024;(2):79-88

Conversion surgery for gastric cancer with limited peritoneal carcinomatosis. P.A. Herzen Journal of Oncology. 2024;(4):5-10

Algorithm of autoimmune gastritis diagnosis and treatment. Russian Journal of Preventive Medicine. 2024;(9):101-110

Features of the inflammatory process in the gastric mucosa with bacterial and viral co-infection. Russian Journal of Evidence-Based Gastroenterology. 2024;(3):13-19

Peroral endoscopic myotomy for the treatment of epiphrenic diverticulum.(Case series). Russian Journal of Evidence-Based Gastroenterology. 2024;(3):111-117

Chronic gastritis is one of the most common disorders that can be detected during routine upper gastrointestinal endoscopy. Mostly, it is associated with Helicobacter pylori (H. pylori) infection. H. pylori infection is a predisposing factor in developing varios clinical conditions such as gastric adenocarcinomas, mucosa-associated lymphoid tissue lymphomas, gastric ulcers, duodenal ulcers and its complications. Advanced endoscopy system supports visualization of gastric mucosa in the finest details. Furthermore, endoscopists with the help of vast majority of up-to-date scientific researches could easily detect gastritis, determine the presence or absence of H. pylori infection, and assess the risk of gastric cancer. The Japan Gastroenterological Endoscopy Society approved the Kyoto Classification in 2013. The new grading system is used to organize endoscopic findings related to H. pylori-associated gastritis. It is helpful for determining H. pylori infection and evaluating gastric cancer risk. Atrophy, intestinal metaplasia, enlarged folds, and nodularity of the gastric antrum mucosa indicate an increased risk of gastric cancer. It could be ranged from 0 to 8. A Kyoto classification score of 0 indicates no history of H. pylori infection. A Kyoto classification score of 2 or more illustrates H. pylori-associated gastritis. A Kyoto classification score of 4 or more may suggests a high risk of gastric cancer.

Keywords:

gastric cancer

Helicobacter pylori

endoscopy

Kyoto classification

atrophy

intestinal metaplasia

enlarged folds

nodularity

diffuse redness

regular arrangement of collecting venules

Authors:

Korzheva I.Yu.

Russian Medical Academy of Postgraduate Education;
Botkin City Clinical Hospital

ORCID: 0000-0002-5984-5660

Laktyun’kina E.N.

Russian Medical Academy of Postgraduate Education;
Veresaev City Clinical Hospital

ORCID: 0000-0002-5920-5380

Kozyr’ L.V.

City Clinical Hospital No. 17

ORCID: 0009-0002-5254-5873

Fomina M.S.

Eramishantsev City Clinical Hospital

ORCID: 0009-0006-3165-3786

Received:

27.11.2023

Accepted:

29.01.2024

List of references:

Maev IV, Andreev DN, Samsonov AA, Dicheva DT, Partsvania-Vinogradova EV. Diagnosis and treatment of gastritis associated with Helicobacter pylori infection (on materials of the Kyoto consensus, 2015). Farmateka. 2016;6:24-33. (In Russ.). https://pharmateca.ru/ru/archive/article/32883
Kotilea K, Bontems P, Touati E. Epidemiology, diagnosis and risk factors of Helicobacter pylori infection. Helicobacter Pylori Hum Dis Adv Microbiol Infect Dis Public Health Vol 11. Published online 2019;17-33. https://doi.org/10.1007/5584_2019_357
Bordin D, Morozov S, Plavnik R, et al. Helicobacter pylori infection prevalence in ambulatory settings in 2017—2019 In Russia: The data of real‐world national multicenter trial. Helicobacter. 2022;27(5):e12924. https://doi.org/10.1111/hel.12924
Haruma K, Kato M, Inoue K, Murakami K, Kamada T. Kyoto classification of gastritis. Tokyo Nihon Med Cent. Published online 2017. https://doi.org/10.3748/wjg.v28.i43.6078
Glover B, Teare J, Ashrafian H, Patel N. The endoscopic predictors of Helicobacter pylori status: a meta-analysis of diagnostic performance. Ther Adv Gastrointest Endosc. 2020;13:263177452095084. https://doi.org/10.1177/2631774520950840
Toyoshima O, Nishizawa T, Yoshida S, Sakaguchi Y, Nakai Y, Watanabe H, Suzuki H, Tanikawa C, Matsuda K, Koike K. Endoscopy-based Kyoto classification score of gastritis related to pathological topography of neutrophil activity. World J Gastroenterol. 2020;26(34):5146. https://doi.org/10.3748/wjg.v26.i34.5146
Katake Y, Ichikawa K, Fujio C, Tomita S, Imura J, Fujimori T. Irregular arrangement of collecting venules (IRAC) provides a critical endoscopic insight in Helicobacter pylori-induced gastritis: A secondary publication. Biomed Rep. 2013;1(1):23-27. https://doi.org/10.3892/br.2012.8
Nishikawa I, Kato J, Terasoma S, Matsutani H, Tamaki H, Tamaki T, Kuwashima F, Nakata H, Tomeki T, Matsunaka H, Ibata Y, Yamashita Y, Maekita T, Higashi K, Ichinose M. Nodular gastritis in association with gastric cancer development before and after Helicobacter pylori eradication. JGH Open. 2018;2(3):80-86. https://doi.org/10.1002/jgh3.12049
T. Kamada, A. Tanaka, Yoshiyuki Yamanaka, N. Manabe, H. Kusunoki, M. Miyamoto, Shinji Tanaka, J. Hata, K. Chayama, K. Haruma. Nodular gastritis with Helicobacter pylori infection is strongly associated with diffuse-type gastric cancer in young patients. Dig Endosc. 2007;19(4):180-184. https://doi.org/10.1111/j.1443-1661.2007.00750.x
Hirahashi M, Yao T, Matsumoto T, Nishiyama K, Oya M, Iida M, Tsuneyoshi M. Intramucosal gastric adenocarcinoma of poorly differentiated type in the young is characterized by Helicobacter pylori infection and antral lymphoid hyperplasia. Mod Pathol. 2007;20(1):29-34. https://doi.org/10.1038/modpathol.3800714
Cho JH, Jeon SR, Jin SY, Park S. Standard vs magnifying narrow-band imaging endoscopy for diagnosis of Helicobacter pylori infection and gastric precancerous conditions. World J Gastroenterol. 2021;27(18):2238-2250. https://doi.org/10.3748/wjg.v27.i18.2238
Kono S. Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan. World J Gastroenterol. 2015;21(46):13113. https://doi.org/10.3748/wjg.v21.i46.13113
Lee JY, Kim N, Lee HS, Oh JC, Kwon YH, Choi YJ, Yoon KC, Hwang JJ, Lee HJ, Lee A, Jeong Y, Jo HJ, Yoon H, Shin CM, Park YS, Lee DH. Correlations Among Endoscopic, Histologic and Serologic Diagnoses for the Assessment of Atrophic Gastritis. J Cancer Prev. 2014;19(1):47-55. https://doi.org/10.15430/jcp.2014.19.1.47
Dohi O, Majima A, Naito Y, Yoshida T, Ishida T, Azuma Y, Kitae H, Matsumura S, Mizuno N, Yoshida N, Kamada K, Itoh Y. Can image‐enhanced endoscopy improve the diagnosis of Kyoto classification of gastritis in the clinical setting? Dig Endosc. 2020;32(2):191-203. https://doi.org/10.1111/den.13540
Yan T, Wong PK, Choi IC, Vong CM, Yu HH. Intelligent diagnosis of gastric intestinal metaplasia based on convolutional neural network and limited number of endoscopic images. Comput Biol Med. 2020;126:104026. https://doi.org/10.1016/j.compbiomed.2020.104026
Huang RJ, Choi AY, Truong CD, Yeh MM, Hwang JH. Diagnosis and Management of Gastric Intestinal Metaplasia: Current Status and Future Directions. Gut Liver. 2019;13(6):596-603. https://doi.org/10.5009/gnl19181
Esposito G, Pimentel-Nunes P, Angeletti S, Castro R, Libânio D, Galli G, Lahner E, Di Giulio E, Annibale B, Dinis-Ribeiro M. Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study. Endoscopy. 2019;51(06):515-521. https://doi.org/10.1055/a-0808-3186
Yoshii S, Mabe K, Watano K, Ohno M, Matsumoto M, Ono S, Kudo T, Nojima M, Kato M, Sakamoto N. Validity of endoscopic features for the diagnosis of Helicobacter pylori infection status based on the Kyoto classification of gastritis. Dig Endosc. 2020;32(1):74-83. https://doi.org/10.1111/den.13486
Nagata N, Shimbo T, Akiyama J, Nakashima R, Kim HH, Yoshida T, Hoshimoto K, Uemura N. Predictability of gastric intestinal metaplasia by mottled patchy erythema seen on endoscopy. Gastroenterol Res. 2011;4(5):203. https://doi.org/10.4021/gr357w
Watanabe K, Nagata N, Nakashima R, Furuhata E, Shimbo T, Kobayakawa M, Sakurai T, Imbe K, Niikura R, Yokoi C, Akiyama J, Uemura N. Predictive findings for Helicobacter pylori-uninfected,-infected and-eradicated gastric mucosa: validation study. World J Gastroenterol WJG. 2013;19(27):4374. https://doi.org/10.3748/wjg.v19.i27.4374
Zhao J, Xu S, Gao Y, Lei Y, Zou B, Zhou M, Chang D, Dong L, Qin B. Accuracy of Endoscopic Diagnosis of Helicobacter pylori Based on the Kyoto Classification of Gastritis: A Multicenter Study. Front Oncol. 2020;10:599218. https://doi.org/10.3389/fonc.2020.599218
Toyoshima O, Nishizawa T, Koike K. Endoscopic Kyoto classification of Helicobacter pylori infection and gastric cancer risk diagnosis. World J Gastroenterol. 2020;26(5):466. https://doi.org/10.3748/wjg.v26.i5.466
Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;1(03):87-97. https://doi.org/10.1055/s-0028-1098086
Take S, Mizuno M, Ishiki K, Yoshida T, Ohara N, Yokota K, Oguma K, Okada H, Yamamoto K. The long-term risk of gastric cancer after the successful eradication of Helicobacter pylori. J Gastroenterol. 2011;46(3):318-324. https://doi.org/10.1007/s00535-010-0347-9
Shichijo S, Hirata Y, Niikura R, Hayakawa Y, Yamada A, Ushiku T, Fukayama M, Koike K. Histologic intestinal metaplasia and endoscopic atrophy are predictors of gastric cancer development after Helicobacter pylori eradication. Gastrointest Endosc. 2016;84(4):618-624. https://doi.org/10.1016/j.gie.2016.03.791
Kaji K, Hashiba A, Uotani C, Yamaguchi Y, Ueno T, Ohno K, Takabatake I, Wakabayashi T, Doyama H, Ninomiya I, Kiriyama M, Ohyama S, Yoneshima M, Koyama N, Takeda Y, Yasuda K. Correction: grading of atrophic gastritis is useful for risk stratification in endoscopic screening for gastric Cancer. Off J Am Coll Gastroenterol ACG. 2019;114(5):836. https://doi.org/10.14309/ajg.0000000000000206
Nishibayashi H, Kanayama S, Kiyohara T, Yamamoto K, Miyazaki Y, Yasunaga Y, Shinomura Y, Takeshita T, Takeuchi T, Morimoto K, Matsuzawa Y. Helicobacter pylori-induced enlarged-fold gastritis is associated with increased mutagenicity of gastric juice, increased oxidative DNA damage, and an increased risk of gastric carcinoma. J Gastroenterol Hepatol. 2003;18(12):1384-1391. https://doi.org/10.1046/j.1440-1746.2003.03192.x
Lee JWJ, Zhu F, Srivastava S, Tsao SK, Khor C, Ho KY, Fock KM, Lim WC, Ang TL, Chow WC, So JBY, Koh CJ, Chua SJ, Wong ASY, Rao J, Lim LG, Ling KL, Chia CK, Ooi CJ, Rajnakova A, Yap WM, Salto-Tellez M, Ho B, Soong R, Chia KS, Teo YY, Teh M, Yeoh KG. Severity of gastric intestinal metaplasia predicts the risk of gastric cancer: a prospective multicentre cohort study (GCEP). Gut. 2022;71(5):854-863. https://doi.org/10.1136/gutjnl-2021-324057
Kawamura M, Uedo N, Koike T, Kanesaka T, Hatta W, Ogata Y, Oikawa T, Iwai W, Yokosawa S, Honda J, Asonuma S, Okata H, Ohyauchi M, Ito H, Abe Y, Ara N, Kayaba S, Shinkai H, Shimokawa T. Kyoto classification risk scoring system and endoscopic grading of gastric intestinal metaplasia for gastric cancer: Multicenter observation study in Japan. Dig Endosc. 2022;34(3):508-516. https://doi.org/10.1111/den.14114
Marcos P, Brito-Gonçalves G, Libânio D, Pita I, Castro R, Sá I, Dinis-Ribeiro M, Pimentel-Nunes P. Endoscopic grading of gastric intestinal metaplasia on risk assessment for early gastric neoplasia: can we replace histology assessment also in the West? Gut. 2020;69(10):1762-1768. https://doi.org/10.1136/gutjnl-2019-320091
Miura K, Oshima T, Tamura A, Hara K, Okugawa T, Fukushima M, Tomita T, Fukui H, Miwa H. Gastric Xanthoma Is Related to the Rapid Growth of Gastric Cancer. J Clin Med. 2021;10(23):5704. https://doi.org/10.3390/jcm10235704
Shibukawa N, Ouchi S, Wakamatsu S, Wakahara Y, Kaneko A. Gastric xanthoma is a predictive marker for metachronous and synchronous gastric cancer. World J Gastrointest Oncol. 2017;9(8):327. https://doi.org/10.4251/wjgo.v9.i8.327
Moribata K, Iguchi JK, Nakachi K, Maeda Y, Shingaki N, Niwa T, Deguchi H, Inoue I, Maekita T, Tamai H, Ichinose M. Endoscopic features associated with development of metachronous gastric cancer in patients who underwent endoscopic resection followed by Helicobacter pylori eradication. Dig Endosc. 2016;28(4):434-442. https://doi.org/10.1111/den.12581
Tahara T, Shibata T, Nakamura M, Yoshioka D, Okubo M, Arisawa T, Hirata I. Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis. Gastrointest Endosc. 2009;70(2):246-253. https://doi.org/10.1016/j.gie.2008.11.046
Chatrangsun B, Vilaichone RK. Endoscopic Diagnosis for H. pylori Infection: White Light Imaging (WLI) vs. Image-Enhanced Endoscopy (IEE). Asian Pac J Cancer Prev. 2021;22(9):3031-3038. https://doi.org/10.31557/apjcp.2021.22.9.3031

Close metadata