Consistency between the endoscopic Kyoto classification and pathological updated Sydney system for gastritis: A cross-sectional study

Abstract

Background: Two methods are used to evaluate gastritis: the updated Sydney system (USS) with pathology and Kyoto classification, a new endoscopy-based diagnostic criterion for which evidence is accumulating. However, the consistency of their results is unclear. This study investigated the consistency of their results.

Methods: Patients who underwent esophagogastroduodenoscopy and were evaluated for Helicobacter pylori infection for the first time were eligible. The association between corpus and antral USS scores (neutrophil activity, chronic inflammation, atrophy, and intestinal metaplasia) and Kyoto classification scores (atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness) was assessed.

Results: Seven-hundred-seventeen patients (mean age, 49.2 years; female sex, 57.9%; 450 H. pylori-positive and 267 H. pylori-negative patients) were enrolled. All endoscopic gastritis cases in the Kyoto classification were associated with high corpus and antral USS scores for neutrophil activity and chronic inflammation. A subanalysis was performed for H. pylori-positive patients. Regarding atrophy and intestinal metaplasia, endoscopic findings were associated with USS scores. Enlarged folds, nodularity, and diffuse redness were associated with high corpus USS scores for neutrophil activity and chronic inflammation, but with low antral USS scores for atrophy and intestinal metaplasia. The Kyoto classification scores were also associated with the pathological topographic distribution of neutrophil activity and intestinal metaplasia.

Conclusions: Among H. pylori-positive individuals, endoscopic and pathological diagnoses were consistent with atrophy and intestinal metaplasia. Enlarged folds, nodularity, and diffuse redness were associated with pathological inflammation (neutrophil activity and chronic inflammation) of the corpus; however, they were inversely associated with pathological atrophy and intestinal metaplasia. The endoscopy-based Kyoto classification of gastritis partially reflects pathology.

Keywords: Endoscopy; Gastritis; Helicobacter pylori; Kyoto classification; Pathology; Updated Sydney system.

Figure 1

Representative endoscopic findings based on the Kyoto classification (normal findings and atrophy). (a–c) Normal findings. Atrophy 0, intestinal metaplasia 0, enlarged folds 0, nodularity 0, and diffuse redness 0. (d–f) Atrophy 1. Atrophy is limited to the antrum and lesser curvature of the corpus. (g–i) Atrophy 2. Atrophy spreads from the antrum into the lesser curvature and greater curvature of the corpus. (a, d, g) Greater curvature of the corpus. (b, e, h) Lesser curvature of the corpus. (c, f, i) The antrum.

Figure 2

Representative endoscopic findings based on the Kyoto classification (intestinal metaplasia, enlarged folds, nodularity, and diffuse redness). (a–c) Intestinal metaplasia 1. Intestinal metaplasia is limited to the antrum. (d–f) Intestinal metaplasia 2. Intestinal metaplasia extends to the corpus. (g) Enlarged folds 1. (h) Nodularity 1. (i) Diffuse redness 1. (j) Diffuse redness 2. (a, d, g, i, j) Greater curvature of the corpus. (b, e) Lesser curvature of the corpus. (c, f, h) The antrum.