Shichijo Satoki, Hirata Yoshihiro, Niikura Ryota, Hayakawa Yoku, Yamada Atsuo, Koike Kazuhiko
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Gastroenterol Hepatol. 2017 Sep;32(9):1581-1586. doi: 10.1111/jgh.13764.
Histological gastritis is associated with gastric cancer, but its diagnosis requires biopsy. Many classifications of endoscopic gastritis are available, but not all are useful for risk stratification of gastric cancer. The Kyoto Classification of Gastritis was proposed at the 85th Congress of the Japan Gastroenterological Endoscopy Society. This cross-sectional study evaluated the usefulness of the Kyoto Classification of Gastritis for risk stratification of gastric cancer.
From August 2013 to September 2014, esophagogastroduodenoscopy was performed and the gastric findings evaluated according to the Kyoto Classification of Gastritis in a total of 4062 patients. The following five endoscopic findings were selected based on previous reports: atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness.
A total of 3392 patients (1746 [51%] men and 1646 [49%] women) were analyzed. Among them, 107 gastric cancers were diagnosed. Atrophy was found in 2585 (78%) and intestinal metaplasia in 924 (27%). Enlarged folds, nodularity, and diffuse redness were found in 197 (5.8%), 22 (0.6%), and 573 (17%), respectively. In univariate analyses, the severity of atrophy, intestinal metaplasia, diffuse redness, age, and male sex were associated with gastric cancer. In a multivariate analysis, atrophy and male sex were found to be independent risk factors. Younger age and severe atrophy were determined to be associated with diffuse-type gastric cancer.
Endoscopic detection of atrophy was associated with the risk of gastric cancer. Thus, patients with severe atrophy should be examined carefully and may require intensive follow-up.
组织学胃炎与胃癌相关，但其诊断需要活检。目前有多种内镜下胃炎分类方法，但并非所有分类都有助于胃癌的风险分层。日本胃肠内镜学会第85届大会提出了京都胃炎分类法。本横断面研究评估了京都胃炎分类法在胃癌风险分层中的应用价值。
2013年8月至2014年9月，对4062例患者进行了食管胃十二指肠镜检查，并根据京都胃炎分类法评估胃部检查结果。根据既往报告选择了以下五项内镜检查结果：萎缩、肠化生、皱襞粗大、结节状和弥漫性发红。
共分析了3392例患者（男性1746例[51%]，女性1646例[49%]）。其中，诊断出107例胃癌。发现2585例（78%）有萎缩，924例（27%）有肠化生。分别有197例（5.8%）、22例（0.6%）和573例（17%）出现皱襞粗大、结节状和弥漫性发红。单因素分析显示，萎缩程度、肠化生、弥漫性发红、年龄和男性与胃癌相关。多因素分析发现，萎缩和男性是独立的危险因素。年龄较轻和严重萎缩与弥漫型胃癌相关。
内镜检查发现萎缩与胃癌风险相关。因此，严重萎缩的患者应仔细检查，可能需要加强随访。
