Background/Aims: The Kyoto Classification of Gastritis was published in 2014. Although this classification is now widely used in Japan, its usefulness and convenience have not been sufficiently evaluated. This study aimed to evaluate the usefulness and convenience of this classification in the endoscopic diagnosis of Helicobacter pylori infection. Methods: We made a test for the endoscopic diagnosis of H. pylori infection comprising 30 cases who had representative endoscopic features of non-, active, or inactive gastritis. Thirty-eight participants took the test before and after a brief mini-lecture on the Kyoto Classification of Gastritis. Eighteen participants took the test again 3 months later. We investigated the accuracy before, just after, and 3 months after the mini-lecture. Results: The accuracy of endoscopists after the lecture was significantly improved in comparison to before the lecture (77.6 vs. 83.3%). Medical students also showed significantly improved accuracy after the lecture (56.7 vs. 71.7%). Among endoscopists, this improvement was maintained after 3 months. Before the lecture, the accuracy of diagnosing non-gastritis was 90.3%; it tended to be further improved 3 months later (96.5%). A >10% point increase was observed in diagnosing active (72.7–83.3%) and inactive gastritis (73.2–84.3%) at 3 months after the lecture in comparison to before the lecture. Conclusion: A brief mini-lecture on the Kyoto Classification of Gastritis improved the accuracy in the endoscopic diagnosis of gastritis, indicating that understanding this classification is useful for the prompt diagnosis of H. pylori infection during esophagogastroduodenoscopy.

Correa P. Human gastric carcinogenesis: a multistep and multifactorial process—First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res. 1992 Dec;52(24):6735–40.
Huang JQ, Sridhar S, Chen Y, Hunt RH. Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. Gastroenterology. 1998 Jun;114(6):1169–79.
Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med. 2001 Sep;345(11):784–9.
Take S, Mizuno M, Ishiki K, Nagahara Y, Yoshida T, Yokota K, et al. The effect of eradicating helicobacter pylori on the development of gastric cancer in patients with peptic ulcer disease. Am J Gastroenterol. 2005 May;100(5):1037–42.
Kamada T, Hata J, Sugiu K, Kusunoki H, Ito M, Tanaka S, et al. Clinical features of gastric cancer discovered after successful eradication of Helicobacter pylori: results from a 9-year prospective follow-up study in Japan. Aliment Pharmacol Ther. 2005 May;21(9):1121–6.
Fukase K, Kato M, Kikuchi S, Inoue K, Uemura N, Okamoto S, et al.; Japan Gast Study Group. Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet. 2008 Aug;372(9636):392–7.
Ford AC, Forman D, Hunt RH, Yuan Y, Moayyedi P. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ. 2014 May;348(may20 1):g3174.
Take S, Mizuno M, Ishiki K, Hamada F, Yoshida T, Yokota K, et al. Seventeen-year effects of eradicating Helicobacter pylori on the prevention of gastric cancer in patients with peptic ulcer; a prospective cohort study. J Gastroenterol. 2015 Jun;50(6):638–44.
Asaka M, Mabe K. Strategies for eliminating death from gastric cancer in Japan. Proc Jpn Acad, Ser B, Phys Biol Sci. 2014;90(7):251–8.
Asaka M, Kato M, Sakamoto N. Roadmap to eliminate gastric cancer with Helicobacter pylori eradication and consecutive surveillance in Japan. J Gastroenterol. 2014 Jan;49(1):1–8.
Inui M, Ohwada S, Inui Y, Kondo Y, Moro A, Sasaki K. Evaluating the Accuracy of the Endoscopic ABC Classification System in Diagnosing Helicobacter pylori-Infected Gastritis. Digestion. 2019 Apr;12:1–10.
Kamada T, Haruma K, Inoue K, Shiotani A. [Helicobacter pylori infection and endoscopic gastritis -Kyoto classification of gastritis]. Nihon Shokakibyo Gakkai Zasshi. 2015 Jun;112(6):982–93.
Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996 Oct;20(10):1161–81.
Yagi K, Nakamura A, Sekine A. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection. J Gastroenterol Hepatol. 2002 Jan;17(1):39–45.
Kato M, Terao S, Adachi K, Nakajima S, Ando T, Yoshida N, et al.; Study Group for Establishing Endoscopic Diagnosis of Chronic Gastritis. Changes in endoscopic findings of gastritis after cure of H. pylori infection: multicenter prospective trial. Dig Endosc. 2013 May;25(3):264–73.
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.
Nomura S, Ida K, Terao S, Adachi K, Kato T, Watanabe H, et al.; Research Group for Establishment of Endoscopic Diagnosis of Chronic Gastritis. Endoscopic diagnosis of gastric mucosal atrophy: multicenter prospective study. Dig Endosc. 2014 Nov;26(6):709–19.
Miyamoto M, Haruma K, Yoshihara M, Hiyama T, Sumioka M, Nishisaka T, et al. Nodular gastritis in adults is caused by Helicobacter pylori infection. Dig Dis Sci. 2003 May;48(5):968–75.
Nagata N, Shimbo T, Akiyama J, Nakashima R, Kim HH, Yoshida T, et al. Predictability of Gastric Intestinal Metaplasia by Mottled Patchy Erythema Seen on Endoscopy. Gastroenterol Res. 2011 Oct;4(5):203–9.
Watanabe K, Nagata N, Nakashima R, Furuhata E, Shimbo T, Kobayakawa M, et al. Predictive findings for Helicobacter pylori-uninfected, -infected and -eradicated gastric mucosa: validation study. World J Gastroenterol. 2013 Jul;19(27):4374–9.
Shichijo S, Nomura S, Aoyama K, Nishikawa Y, Miura M, Shinagawa T, et al. Application of Convolutional Neural Networks in the Diagnosis of Helicobacter pylori Infection Based on Endoscopic Images. EBioMedicine. 2017 Nov;25:106–11.
Itoh T, Kawahira H, Nakashima H, Yata N. Deep learning analyzes Helicobacter pylori infection by upper gastrointestinal endoscopy images. Endosc Int Open. 2018 Feb;6(2):E139–44.
Qi Q, Guo C, Ji R, Li Z, Zuo X, Li Y. Diagnostic Performance of Magnifying Endoscopy for Helicobacter pylori Infection: A Meta-Analysis. PLoS One. 2016; 11: e0168201.
Dohi O, Yagi N, Onozawa Y, Kimura-Tsuchiya R, Majima A, Kitaichi T, et al. Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection. Endosc Int Open. 2016 Jul;4(7):E800–5.
Ono S, Kato M, Tsuda M, Miyamoto S, Abiko S, Shimizu Y, et al. Lavender Color in Linked Color Imaging Enables Noninvasive Detection of Gastric Intestinal Metaplasia. Digestion. 2018;98(4):222–30.
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