Kim Gwang Ha
Korean J Helicobacter Up Gastrointest Res. 2023 Jun;23(2):89-98. doi: 10.7704/kjhugr.2023.0013. Epub 2023 Jun 2.
Recent advances in endoscopic technology, including high-definition and image-enhanced endoscopy such as narrow-band imaging have facilitated close observation and detailed imaging of the gastric mucosa. Currently, endoscopy is performed in Korea primarily for evaluation of premalignant conditions and gastric cancer detection. Recent research has established the Kyoto classification of gastritis, a novel grading system for endoscopic gastritis, which enables prediction of infection. The Kyoto classification score is calculated based on the sum of scores for five main items (of 19 endoscopic findings indicative of infection) such as atrophy, intestinal metaplasia, enlarged gastric folds, nodularity, and diffuse redness with/without regular arrangement of collecting venules (RAC). Of these five endoscopic findings, atrophy, intestinal metaplasia, enlarged gastric folds, and nodularity are associated with an increased risk and RAC with a decreased risk of gastric cancer. Previous studies have reported that a Kyoto classification score ≥2 indicates current or past infection. An increase in the Kyoto classification score is associated with a high risk of gastric cancer; specifically, a Kyoto classification score ≥4 indicates a high risk of gastric cancer. However, eradication is followed by disappearance of enlarged gastric folds, nodularity, and diffuse redness; therefore, this grading system cannot accurately reflect the gastric cancer risk in patients with previous infection. Limited studies have discussed the Kyoto classification of gastritis in Korea. Therefore, further large-scale multicenter studies are warranted for validation of the Kyoto classification to predict infection and gastric cancer risk.
内镜技术的最新进展，包括高清内镜和图像增强内镜（如窄带成像），有助于对胃黏膜进行密切观察和详细成像。目前，韩国主要通过内镜检查来评估癌前病变和检测胃癌。最近的研究建立了胃炎的京都分类法，这是一种用于内镜下胃炎的新型分级系统，能够预测幽门螺杆菌感染。京都分类评分是根据五个主要项目（19项内镜检查结果提示幽门螺杆菌感染）的得分总和计算得出的，这五个主要项目包括萎缩、肠化生、胃皱襞粗大、结节状改变以及伴有/不伴有集合小静脉规则排列（RAC）的弥漫性发红。在这五项内镜检查结果中，萎缩、肠化生、胃皱襞粗大和结节状改变与胃癌风险增加相关，而RAC与胃癌风险降低相关。先前的研究报告称，京都分类评分≥2表明当前或既往存在幽门螺杆菌感染。京都分类评分的增加与胃癌高风险相关；具体而言，京都分类评分≥4表明胃癌高风险。然而，幽门螺杆菌根除后，胃皱襞粗大、结节状改变和弥漫性发红会消失；因此，该分级系统无法准确反映既往感染幽门螺杆菌患者的胃癌风险。韩国对胃炎京都分类法的研究有限。因此，有必要开展进一步的大规模多中心研究，以验证京都分类法对幽门螺杆菌感染和胃癌风险的预测作用。
