Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan

Table 1 Patient demographic and clinical characteristics n (%)

Clinical parameters	United Kingdom (n = 126)	Japan (n = 126)	Total (n = 252)	P value (United Kingdom vs Japan)
Sex
Male	63 (50.0)	44 (35.0)	107 (42.5)	0.019
Female	63 (50.0)	82 (65.0)	145 (57.5)
Age (yr)
≥ 50	63 (50.0)	65 (51.6)	128 (50.8)	0.801
< 50	63 (50.0)	61 (48.4)	124 (49.2)
Helicobacter pylori IgG
Positive	47 (37.3)	56 (44.4)	103 (40.9)	0.733
Negative	79 (62.7)	70 (55.6)	149 (59.1)
Serologic features (ng/mL), mean ± SD
Pepsinogen I	51.9 ± 40.0	50.7 ± 26.8	51.3 ± 33.8	0.780
Pepsinogen II	13.0 ± 8.9	13.7 ± 9.7	13.4 ± 9.3	0.552
Pepsinogen I/II ratio	4.4 ± 1.8	4.6 ± 2.2	4.5 ± 2.0	0.364
Histological atrophy
None	56 (44.4)	38 (30.2)	94 (37.3)	< 0.001
Antrum	49 (38.8)	19 (15.0)	68 (27.0)
Angulus	19 (15.0)	20 (15.8)	39 (15.5)
Lesser curvature of middle body	2 (1.6)	25 (19.8)	27 (10.7)
Greater curvature of middle body	0 (0)	24 (19.0)	24 (9.5)
Endoscopic atrophy
No atrophy	56 (44.4)	27 (21.4)	83 (32.9)	< 0.001
Antral (C-1)	40 (31.8)	33 (26.2)	73 (29.0)
Antral predominant (C-2)	24 (19.0)	20 (15.8)	44 (17.5)
Corpus predominant (C-3-O-2)	6 (4.8)	43 (34.2)	49 (19.4)
Pan-atrophy (O-3)	0 (0)	3 (2.4)	3 (1.2)

Table 2 Cross-tabulation of endoscopic and histological atrophy

Endoscopic atrophy	Histological atrophy					Total	Weightedκvalue
	None	Antrum	Angulus	Middle body LC	Middle body GC
No atrophy	79	4				83	0.76
Antrum (C-1)	13	51	9			73
Antrum predominant (C-2)	2	12	21	5	4	44
Corpus predominant (C-3-O-2)		1	9	22	17	49
Pan-atrophy(O-3)					3	3
Total	94	68	39	27	24	252
Misdiagnosis	15	17	18	5	21	76 (30.2%)

GC: Greater curvature; LC: Lesser curvature.

Table 3 Univariate analysis of factors significantly associated with reduced concordance between endoscopic and histological atrophy n (%)

	Concordant group (n = 180)	Discordant group (n = 72)	OR	95%CI	P values
Populations
United Kingdom	107 (84.9)	19 (15.1)	1	Referent	< 0.001
Japan	69 (54.8)	57 (45.2)	0.22	0.12-0.39
Helicobacter pylori IgG
Negative	113 (78.5)	31 (21.5)	1	Referent	0.001
Positive	60 (58.3)	43 (41.7)	0.38	0.22-0.67
Age (yr)
< 50	102 (82.3)	22 (17.7)	1	Referent	< 0.001
≥ 50	74 (57.8)	54 (42.2)	0.30	0.17-0.53
Sex
Male	80 (74.8)	27 (25.2)	1	Referent	0.143
Female	96 (66.2)	49 (33.8)	0.66	0.38-1.15
Pepsinogen I/II ratio
> 3.0	141 (73.8)	50 (26.2)	1	Referent	0.015
≤ 3.0	35 (57.4)	26 (42.6)	0.48	0.26-0.87
Endoscopic atrophy
No atrophy	79 (95.2)	4 (4.8)	1	Referent	< 0.001
Others	97 (57.4)	72 (42.6)	0.07	0.02-0.20

Table 4 Multivariate analysis of factors significantly associated with reduced concordance between endoscopic and histological atrophy

	Adjusted OR	95%CI	P value
Populations
United Kingdom	1	Referent	< 0.001
Japan	0.22	0.11-0.43
Helicobacter pylori IgG
Negative	1	Referent	0.268
Positive	0.6	0.31-1.38
Age (yr)
< 50	1	Referent	0.008
≥ 50	0.32	0.16-0.66
Pepsinogen I/II ratio
> 3.0	1	Referent	0.328
≤ 3.0	1.50	0.67-3.35
Endoscopic atrophy
No atrophy	1	Referent	< 0.001
Others	0.10	0.03-0.36

Greater atrophy: Antral predominant, corpus predominant and pan-atrophy.

Table 5 Cross-tabulation of endoscopic and histological atrophy according to populations

Endoscopic atrophy	Histological atrophy					Total	Weightedκvalue
	None	Antrum	Angulus	Middle body LC	Middle body GC
United Kingdom
No atrophy	54	2				56	0.81
Antrum	1	37	2			40
Antrum predominant	1	9	14			24
Corpus predominant		1	3	2		6
Pan-atrophy						0
Total	56	49	19	2	0	126
Japan
No atrophy	25	2				27	0.68
Antrum	12	14	7			33
Antrum predominant	1	3	7	5	4	20
Corpus predominant			6	20	17	43
Pan-atrophy					3	3
Total	38	19	20	25	24	126

GC: Greater curvature; LC: Lesser curvature.

Table 6 Cross-tabulation of endoscopic and histological atrophy according to age

Endoscopic atrophy	Histological atrophy					Total	Weightedκvalue
	None	Antrum	Angulus	Middle body LC	Middle body GC
Age < 50 yr
No atrophy	61	2				63	0.81
Antrum	5	28	3			36
Antrum predominant	1	3	6	3	1	14
Corpus predominant			1	7	3	11
Pan-atrophy						0
Total	67	33	10	10	4	124
Age ≥ 50 yr
No atrophy	18	2				20	0.67
Antrum	8	23	6			37
Antrum predominant	1	9	15	2	3	30
Corpus predominant		1	8	15	14	38
Pan-atrophy					3	3
Total	27	35	29	17	20	128

GC: Greater curvature; LC: Lesser curvature.

Table 7 Cancer risk oriented atrophy grade

Endoscopic atrophy	Histological atrophy			Total	Weightedκvalue
	Normal	Limited	Extended
Normal	79	4		83	0.81
Limited (C-1-2)	15	93	9	117
Extended (C-3-O-3)		10	42	52
Total	94	107	51	252

Limited: Atrophy limited antrum and angulus; Extended: Atrophy with corps-predominant or pan-atrophy.

Table 8 Characteristics of underdiagnosed patients at high-risk of gastric cancer

No.	United Kingdom/Japan	Sex	Age	Helicobacter pylori antibody	Pepsinogen I (ng/mL)	Pepsinogen II (ng/mL)	Pepsinogen I/II ratio	Endoscopic atrophy
1	Japan	F	24	Negative	45.1	21.3	2.1	Antral predominant
2	Japan	F	42	Negative	126.0	41.4	3.0	Antral predominant
3	Japan	F	49	Negative	44.8	40.9	1.1	Antral predominant
4	Japan	F	55	Negative	65.4	34.3	1.9	Antral predominant
5	Japan	F	58	Negative	71.4	34.3	2.1	Antral predominant
6	Japan	F	66	Negative	46.9	17.4	2.7	Antral predominant
7	Japan	F	67	Negative	26.7	12.2	2.2	Antral predominant
8	Japan	M	35	Positive	56.0	23.8	2.4	Antral predominant
9	Japan	M	65	Negative	82.4	19.6	4.2	Antral predominant

M: Male; F: Female.