Aims: Evaluating the accuracy of the modified Endoscopic ABC (Endo ABC) classification with an electronic endoscopy with narrow band imaging without magnification in diagnosing Helicobacter pylori (H. pylori)-infected gastritis. Methods: A total of 576 patients were enrolled and they underwent modified Endo ABC. They were stratified into 5 groups (A to E) based on the grades of endoscopic findings. H. pylori-infected gastritis status was determined in the following ways: current H. pylori gastritis was defined as active gastritis and/or chronic atrophic gastritis (CAG) seen on endoscopy and positive H. pylori test, naïve H. pylori gastritis was defined as regular arrangement of collecting venules in the angle of the lesser curvature without CAG and negative H. pylori test, and previous H. pylori gastritis was defined as negative H. pylori tests regardless of the presence of CAG. Results: Endo A has 97% accuracy and 100% positive predictive value in diagnosing naïve H. pylori gastritis. Endo E has 97% accuracy and 100% positive predictive value in diagnosing previous H. pylori gastritis. The accuracy of Endo B and Endo C in diagnosing current H. pylori gastritis was 89 and 82% respectively. Endo D has 87% accuracy in diagnosing previous H. pylori gastritis. Conclusion: This study showed that the modified Endo ABC classification enables to accurately determine the H. pylori-infected gastritis status.

Journal Section:
Research Article
Keywords:
Endoscopic ABC classification, Helicobacter pylori, Endoscopy
1.
International Agency for Research on Cancer. Schistosomes, Liver Flukes and Helicobacter pylori. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, vol. 61. Lyon: World Health Organization; 1994.
2.
The International Agency for Research on Cancer. Helicobacter pylori Eradication as a Strategy for Preventing Gastric Cancer. IARC Working Group Report, vol. 8. Lyon: World Health Organization; 2014.
3.
Asaka M, Kato M, Kudo M, Katagiri M, Nishikawa K, Koshiyama H, et al. Atrophic changes of gastric mucosa are caused by Helicobacter pylori infection rather than aging: studies in asymptomatic Japanese adults. Helicobacter. 1996 Mar; 1(1): 52–6.
4.
Haruma K, Kato M, Inoue K, et al. Kyoto classification of Gastritis. Tokyo: Nihon Medical Center; 2017.
5.
Sugimoto M, Ban H, Ichikawa H, Sahara S, Otsuka T, Inatomi O, et al. Efficacy of the Kyoto Classification of Gastritis in Identifying Patients at High Risk for Gastric Cancer. Intern Med. 2017; 56(6): 579–86.
6.
Shichijo S, Hirata Y, Niikura R, Hayakawa Y, Yamada A, Koike K. Association between gastric cancer and the Kyoto classification of gastritis. J Gastroenterol Hepatol. 2017 Sep; 32(9): 1581–6.
7.
Ohwada S, Inui Y, Inui M. Endoscopic ABC classification [in Japanese]. Helicobacter Research. 2011; 15: 583–4.
8.
Ohwada S, Inui M, Sohara N, et al. Su1562 Gastric Cancer Risk Stratification Based on Endoscopic Grading of Helicobacter pylori Gastritis, Atrophic Gastritis and Intestinal Metaplasia. Gastrointestinal Endoscopy. 2015; 81(5):AB329-330.
9.
Miki K. Gastric cancer screening by combined assay for serum anti-Helicobacter pylori IgG antibody and serum pepsinogen levels - “ABC method”. Proc Jpn Acad, Ser B, Phys Biol Sci. 2011; 87(7): 405–14.
10.
Murata H, Kawano S, Tsuji S, Tsujii M, Sawaoka H, Iijima H, et al. Evaluation of the PyloriTek test for detection of Helicobacter pylori infection in cases with and without eradication therapy. Am J Gastroenterol. 1998 Nov; 93(11): 2102–5.
11.
Laine L, Suchower L, Johnson E, Ronca P, Neil G. Accuracy of CLOtest after Helicobacter pylori therapy. Gastrointest Endosc. 1998 Mar; 47(3): 250–3.
12.
Ferwana M, Abdulmajeed I, Alhajiahmed A, Madani W, Firwana B, Hasan R, et al. Accuracy of urea breath test in Helicobacter pylori infection: meta-analysis. World J Gastroenterol. 2015 Jan; 21(4): 1305–14.
13.
Kato M, Saito M, Fukuda S, Kato C, Ohara S, Hamada S, et al. 13C-Urea breath test, using a new compact nondispersive isotope-selective infrared spectrophotometer: comparison with mass spectrometry. J Gastroenterol. 2004 Jul; 39(7): 629–34.
14.
Shimoyama T, Kato C, Kodama M, Kobayashi I, Fukuda Y. Applicability of a monoclonal antibody-based stool antigen test to evaluate the results of Helicobacter pylori eradication therapy. Jpn J Infect Dis. 2009 May; 62(3): 225–7.
15.
Sato M, Shimoyama T, Takahashi R, Kajiyama H, Sano Y, Sakaedani N, et al. Characterization and usefulness of stool antigen tests using a monoclonal antibody to Helicobacter pylori catalase. J Gastroenterol Hepatol. 2012 Apr; 27 Suppl 3: 23–8.
16.
Kimura K, Takemoto T. An Endoscopic Recognition of the Atrophic Border and its Significance in Chronic Gastritis. Endoscopy. 1969; 1(03): 87–97.
17.
Kato T, Yagi N, Kamada T, Shimbo T, Watanabe H, Ida K; Study Group for Establishing Endoscopic Diagnosis of Chronic Gastritis. Diagnosis of Helicobacter pylori infection in gastric mucosa by endoscopic features: a multicenter prospective study. Dig Endosc. 2013 Sep; 25(5): 508–18.
18.
Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al.; faculty members of Kyoto Global Consensus Conference. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015 Sep; 64(9): 1353–67.
19.
Okubo M, Tahara T, Shibata T, Nakamura M, Kamiya Y, Yoshioka D, et al. Usefulness of magnifying narrow-band imaging endoscopy in the Helicobacter pylori-related chronic gastritis. Digestion. 2011; 83(3): 161–6.
20.
Dohi O, Yagi N, Yoshida S, Ono S, Sanomura Y, Tanaka S, et al. Magnifying Blue Laser Imaging versus Magnifying Narrow-Band Imaging for the Diagnosis of Early Gastric Cancer: A Prospective, Multicenter, Comparative Study. Digestion. 2017; 96(3): 127–34.
21.
Kotachi T, Ito M, Boda T, Kiso M, Masuda K, Hata K, et al. Clinical Significance of Reddish Depressed Lesions Observed in the Gastric Mucosa after Helicobacter pylori Eradication. Digestion. 2018; 98(1): 48–55.
22.
Rugge M, de Boni M, Pennelli G, de Bona M, Giacomelli L, Fassan M, et al. Gastritis OLGA-staging and gastric cancer risk: a twelve-year clinico-pathological follow-up study. Aliment Pharmacol Ther. 2010 May; 31(10): 1104–11.
23.
Masuyama H, Yoshitake N, Sasai T, Nakamura T, Masuyama A, Zuiki T, et al. Relationship between the degree of endoscopic atrophy of the gastric mucosa and carcinogenic risk. Digestion. 2015; 91(1): 30–6.
24.
Majima A, Handa O, Naito Y, Dohi O, Okayama T, Yoshida N, et al. Early-Stage Gastric Cancer Can Be Found in Improved Atrophic Mucosa over Time from Successful Helicobacter pylori Eradication. Digestion. 2017; 95(3): 194–200.
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