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Endoscopic diagnosis of gastric mucosal activity and inflammation

Authors

  • Sachiyo Nomura,

    Corresponding author
    • Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo
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  • Shuichi Terao,

    1. Division of Gastroenterology, Kyoto Min-iren Chuo Hospital, Kyoto
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  • Kyoichi Adachi,

    1. Department of Clinical Nursing, Shimane University, Faculty of Medicine, Izumo
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  • Takahiro Kato,

    1. Department of Gastroenterology, Murakami Memorial Hospital, Asahi University, Gifu
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  • Kazunori Ida,

    1. Department of Gastroenterology, Murakami Memorial Hospital, Asahi University, Gifu
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  • Hidenobu Watanabe,

    1. Niigata University, Niigata, Japan
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  • Takuro Shimbo,

    1. Department of Clinical Research and Informatics, International Clinical Research Center, Research Institute, International Medical Center of Japan
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  • the Research Group for Establishment of Endoscopic Diagnosis of Chronic Gastritis

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    • The Research Group for Establishment of Endoscopic Diagnosis of Chronic Gastritis: Noriya Uedo, Naomi Uemura, Shuichi Ohara, Mototsugu Kato, Nobuhiro Sakaki, Takashi Ando, Masanori Ito, Sumihisa Urita, Hiroyosi Ota, Mitsuru Kaise, Tomoari Kamada, Takashi Kawai, Juniti Kawashima, Fukunori Kinjo, Shigemi Nakajima, Atsushi Mitsunaga, Kazunari Murakami, Kazuyoshi Yagi, Nobuaki Yagi, Norimasa Yoshida, Takao Wakabayashi, Hirofumi Niwa, Saburo Nakazawa, Masaharu Tatsuta, Kazumasa Miki, Michio Kaminishi.

Correspondence: Sachiyo Nomura, Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Email: snomura-gi@umin.ac.jp

Abstract

Aim

Gastritis is an important pathological state that causes gastric atrophy and cancer. The Sydney System is a well-used classification for histological evaluation for gastritis. However, there is no concordance with endoscopic findings. In the present study, we tried to establish endoscopic criteria and diagnosis for the inflammation activity of gastric mucosa.

Methods

A prospective multicenter study was conducted and 24 facilities participated. Two hundred and seventy patients received endoscopic examinations and 15 endoscopic features were evaluated. Biopsy specimens were taken from five points, and evaluated by a single pathologist for mononuclear cell infiltration and polymorphonuclear cell infiltration. Sensitivity, specificity, positive predictive value, negative predictive value, area under curve of receiver operating characteristics (AUC/ROC) of each endoscopic finding to histological gastritis were calculated.

Results

There was no single endoscopic finding that was highly specific for mononuclear cell infiltration and polymorphonuclear cell infiltration. In the corpus, the combination of swelling of areae gastrica by the indigo carmine contrast method (IC method) and lack of a regular arrangement of collecting venules (RAC) in angle for mononuclear cell infiltration (0.887), and the combination of swelling of areae gastrica by the IC method and diffuse redness for polymorphonuclear cell infiltration (0.851) showed the highest AUC/ROC. In the antrum, the combination of diffuse redness and visibility of a vascular pattern for mononuclear cell infiltration (0.780), and the combination of visibility of vascular pattern and swelling of areae gastrica by the IC method for polymorphonuclear cell infiltration (0.795) showed the highest AUC/ROC.

Conclusion

Combination of endoscopic findings can improve diagnostic accuracy, and sensitivity of examination for inflammation.

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