Gastroduodenal endoscopy was performed, and the findings were independently scored according to the Kyoto classification of gastritis and the Kimura-Takemoto classification by two endoscopists (9 (
link),15 ). The Kimura-Takemoto gastric atrophy classification scores atrophy as six grades: Closed (C)-I, C-II, C-III, and Open (O)-I, O-II, and O-III (15 ). In this classification, C-I, C-II, and C-III denote closed-type atrophic patterns, with a margin between the non-atrophic fundic mucosa and atrophic mucosa located in the lesser curvature of the stomach; and O-I, O-II, and O-III denote open-type atrophic patterns, whose margin does not cross the lesser curvature. According to the Kyoto classification of gastritis, patients are classified into three groups based on endoscopic findings:
H. pylori-negative patients (no gastritis), current
H. pylori-positive patients (active gastritis), and previous
H. pylori-infected patients (inactive gastritis). The total score involves five parameters of gastritis, including atrophy (Kimura-Takemoto classification CI = Kyoto A0, CII & C-III = Kyoto A1, and OI-OIII = Kyoto A2), intestinal metaplasia (none: IM0, within antrum: IM1, and up to corpus: IM2), hypertrophy of gastric folds (negative: H0, positive: H1), nodularity (negative: N0, positive: N1), and diffuse redness (negative: DR0, mild: DR1, severe: DR2). These scores were independently calculated for all subjects by two expert endoscopists after endoscopy (
Table 1). During endoscopy, more than 40 pictures were taken by an expert endoscopist. When the two endoscopists differed on the score assigned, they arrived at a consensus by reviewing the pictures. The status of intestinal metaplasia was diagnosed using image-enhanced endoscopy, such as narrow band imaging, but not pathological evaluations.
Sugimoto M., Ban H., Ichikawa H., Sahara S., Otsuka T., Inatomi O., Bamba S., Furuta T, & Andoh A. (2017). Efficacy of the Kyoto Classification of Gastritis in Identifying Patients at High Risk for Gastric Cancer. Internal Medicine, 56(6), 579-586.