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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopy-based Kyoto classification score of gastritis related to pathological topography of neutrophil activity
Osamu Toyoshima, Toshihiro Nishizawa, Shuntaro Yoshida, Yoshiki Sakaguchi, Yousuke Nakai, Hidenobu Watanabe, Hidekazu Suzuki, Chizu Tanikawa, Koichi Matsuda, Kazuhiko Koike
Osamu Toyoshima, Toshihiro Nishizawa, Shuntaro Yoshida, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
Osamu Toyoshima, Shuntaro Yoshida, Yoshiki Sakaguchi, Yousuke Nakai, Kazuhiko Koike, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Toshihiro Nishizawa, Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Chiba 286-8520, Japan
Shuntaro Yoshida, Yousuke Nakai, Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
Hidenobu Watanabe, Department of Pathology, Pathology and Cytology Laboratory Japan, Tokyo 166-0003, Japan
Hidekazu Suzuki, Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Kanagawa 259-1193, Japan
Chizu Tanikawa, Koichi Matsuda, Laboratory of Molecular Medicine, Human Genome Center, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
Koichi Matsuda, Department of Computational Biology and Medical Sciences, Laboratory of Clinical Genome Sequencing, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo 108-8639, Japan
Author contributions: Toyoshima O, Nishizawa T, Yoshida S and Matsuda K designed the study; Toyoshima O and Yoshida S recruited patients; Toyoshima O analyzed data and wrote the manuscript; Nishizawa T edited the manuscript; Yoshida S, Sakaguchi Y, Nakai Y, Tanikawa C, Matsuda K, Suzuki H and Koike K revised the manuscript; Watanabe H performed histological diagnoses; Matsuda K, Suzuki H and Koike K approved the final article.
Supported by Ministry of Education, Culture, Sports, Science and Technology of Japan, No. 25134707 and No. 16H01566 (to Matsuda K), and No. 15K14377 (to Tanikawa C); funding from the Tailor-Made Medical Treatment with the BBJ Project from Japan Agency for Medical Research and Development, AMED (from April 2015); and the Ministry of Education, Culture, Sports, Science, and Technology of Japan (from April 2003 to March 2015).
Institutional review board statement: This study was approved by the institutional review board at the Institute of Medical Science, University of Tokyo on September 21, 2013 (approval No. 25-34-0921).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study are published on the home page of Toyoshima Endoscopy Clinic.
Conflict-of-interest statement: All other authors have nothing to disclose.
Data sharing statement: Not available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Osamu Toyoshima, MD, Doctor, Department of Gastroenterology, Toyoshima Endoscopy Clinic, 6-17-5 Seijo, Setagaya-ku, Tokyo 157-0066, Japan. t@ichou.com
Received: May 24, 2020
Peer-review started: May 24, 2020
First decision: June 12, 2020
Revised: June 20, 2020
Accepted: August 26, 2020
Article in press: August 26, 2020
Published online: September 14, 2020
ARTICLE HIGHLIGHTS
Research background
The pathological topographic distribution of neutrophil activity in the gastric mucosa correlates to gastric cancer development. Endoscopy-based Kyoto classification of gastritis has also been reported to be associated with gastric cancer risk.
Research motivation
The consistency of the Kyoto classification score with the topographic distribution of neutrophil activity was not clear.
Research objectives
To investigate the association between endoscopic findings of gastritis based on the Kyoto classification and pathological topography of neutrophil activity.
Research methods
This study consisted of participants who underwent esophagogastroduodenoscopy at the Toyoshima Endoscopy Clinic from December 2013 to January 2016. We obtained two-points biopsy samples from the greater curvature of corpus and antrum. Based on the pathological topographic distribution of neutrophil activity, the subjects were divided into four categories: Inactive stomach, antrum-predominant gastritis, pangastritis, and corpus-predominant gastritis. We tested the association between the Kyoto classification score, including Atrophy, Intestinal metaplasia, Enlarged folds, Nodularity, and Diffuse redness score, and the four categories of topographic distribution of neutrophil activity.
Research results
We enrolled 327 patients. The Kyoto scores were significantly higher in the order of inactive stomach, antrum-predominant gastritis, pangastritis, and corpus-predominant gastritis (3.05, 4.57, 5.21, and 5.96, respectively). Especially, Atrophy score and Intestinal metaplasia score were correlated with the topographic distribution of neutrophil activity. On multivariate analysis, the Kyoto score, age, and serum Helicobacter pylori antibody were independently associated with the topographical distribution of neutrophil activity.
Research conclusions
Endoscopic findings of gastritis based on the Kyoto classification were associated with the pathological topographic distribution of neutrophil activity and showed the stepwise increase in the order of inactive stomach, antrum-predominant gastritis, pangastritis, and corpus-predominant gastritis.
Research perspectives
Our study supports the hypothesis that endoscopic findings based on the Kyoto score are useful for the assessment of gastric cancer risk. However, further studies are warranted to clarify the association between the Kyoto classification of gastritis and gastric cancer risk.
