Relationship between endoscopic gastric atrophy according to Kimura - Takemoto classification and histopathological characteristics in H. Pylori infected patients

Abstract

Background: Endoscopic gastric atrophy according to Kimura-Takemoto classification has been shown to be closely related to histopathological atrophy. Gastric atrophy and intestinal metaplasia are considered precancerous gastric lesions that need to be assessed and monitored for early detection of dysplasia and cancer, especially in H. pylori infected patients. The aim of this study was to evaluate the associations between these endoscopic atrophy according to Kimura - Takemoto classification and pathologic characteristics. Methods: A cross-sectional study was conducted in 72 dyspepsia patients at Hue University of Medicine and Pharmacy Hospital, assigned endoscopic assessment and testing H. pylori positive. Assessing endoscopic gastric atrophy according to Kimura-Takemoto classification and compared with histopathological precancerous lesions (atrophy, intestinal metaplasia, dysplasia) according to the modified Sydney system. Results: The mean age was 55.6 ± 13.13, male/female ratio was 1.4/1.0. The rate of endoscopic gastric atrophy at stage C1 was 37.5%, C2: 40.3%, C3: 9.7%, O1: 11.1% and O3: 1.4%. On histo-pathology, the rate of gastric atrophy in antrum was 81.9%, in both antrum and body: 16.7%. The rate of intestinal metaplasia in antrum, body, both antrum and body was 36.1%, 2.5% and 11.1%, respectively. The rate of low-grade dysplasia 12.5% (9/72), high-grade dysplasia 6.9% (5/72) and 2 cases of early gastric cancer. Endoscopic gastric atrophy stages C2 and C3 had a higher rate of atrophy on histopathology than stage C1 (91.7% vs 63%) and stages O had a higher rate of intestinal metaplasia than stages C (77.8% vs 30.2%) with p < 0.05. Conclusion: The degree of endoscopic gastric atrophy was related to the degree of histopathologic atrophy and intestinal metaplasia, the more severe the stage of endoscopic gastric atrophy, the higher the frequency of atrophy and metaplasia on histopathology. Evaluation of endoscopic gastric atrophy according to Kimura-Takemoto classification is a relatively simple strategy for monitoring for each patient with H. pylori chronic gastritis to detect dysplasia and early cancer. Key words: Atrophic gastritis, H. pylori, Kimura-Takemoto classification