Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2021; 9(13): 3014-3023
Published online May 6, 2021. doi: 10.12998/wjcc.v9.i13.3014
Updated Kimura-Takemoto classification of atrophic gastritis
Sergey M Kotelevets, Sergey A Chekh, Sergey Z Chukov
Sergey M Kotelevets, Department of Therapy, Medical Institute, North Caucasus State Academy for Humanities and Technologies, Cherkessk 369000, Russia
Sergey A Chekh, Department of Software Development, Institute of Applied Mathematics and Information Technology, North Caucasus State Academy of Humanities and Technologies, Cherkessk 369000, Russia
Sergey A Chekh, Department of Mathematics, Institute of Applied Mathematics and Information Technology, North Caucasus State Academy of Humanities and Technologies, Cherkessk 369000, Russia
Sergey Z Chukov, Department of Pathological Anatomy, Stavropol State Medical University, Stavropol 355017, Russia
Author contributions: Kotelevets SM designed the research, collected the data, and wrote the paper; Chekh SA analyzed the data, performed the statistical processing, and revised the manuscript for final submission; Chukov SZ performed the histological investigations, interpreted the biopsy results, and revised the manuscript for final submission.
Institutional review board statement: This study was approved by the Ethical Committee of North Caucasian State Academy (Minutes No. 14/20 dated 29.06.2020). The work was performed in accordance with the Declaration of Helsinki (2000) of the World Medical Association.
Informed consent statement: All patients provided informed written consent.
Conflict-of-interest statement: The authors declare that they have no potential conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sergey M Kotelevets, MD, Professor, Department of Therapy, Medical Institute, North Caucasus State Academy for Humanities and Technologies, Stavropolskaya Street 36, Cherkessk 369000, Russia. smkotelevets@mail.ru
Received: November 6, 2020
Peer-review started: November 6, 2020
First decision: January 23, 2021
Revised: February 1, 2021
Accepted: March 19, 2021
Article in press: March 19, 2021
Published online: May 6, 2021
Abstract
BACKGROUND

The Updated Sydney system for visual evaluation of gastric mucosal atrophy via endoscopic observation is subject to sampling error and interobserver variability. The Kimura-Takemoto classification system was developed to overcome these limitations.

AIM

To compare the morphological classification of atrophic gastritis between the Kimura-Takemoto system and the Updated Sydney system.

METHODS

A total of 169 patients with atrophic gastritis were selected according to diagnosis by the visual endoscopic Kimura-Takemoto method. Following the Updated Kimura-Takemoto classification system, one antrum biopsy and five gastric corpus biopsies were taken according to the visual stages of the Kimura-Takemoto system. The Updated Kimura-Takemoto classification system was then applied to each and showed 165 to have histological mucosal atrophy; the remaining 4 patients had no histological evidence of atrophy in any biopsy. The Updated Kimura-Takemoto classification was verified as a reference morphological method and applied for the diagnosis of atrophic gastritis. Adding one more biopsy from the antrum to the six biopsies according to the Updated Kimura-Takemoto classification, constitutes the updated combined Kimura-Takemoto classification and Sydney system.

RESULTS

The sensitivity for degree of mucosal atrophy assessed by the Updated Sydney system was 25% for mild, 36% for moderate, and 42% for severe, when compared with the Updated Kimura-Takemoto classification of atrophic gastritis for morphological diagnosis. Four types of multifocal atrophic gastritis were identified: sequential uniform (type 1; in 28%), sequential non-uniform (type 2; in 7%), diffuse uniform (type 3; in 23%), diffuse non-uniform (type 4; in 24%), and "alternating atrophic – non-atrophic" (type 5; in 18%). The pattern of the spread of atrophy, sequentially from the antrum to the cardiac segment of the stomach, which was described by the Updated Kimura-Takemoto system, was histologically confirmed in 82% of cases evaluated.

CONCLUSION

The Updated Sydney system is significantly inferior to the Updated Kimura-Takemoto classification for morphological verification of atrophic gastritis.

Keywords: Updated Sydney system, Kimura-Takemoto classification, Prevention, Gastric cancer, Atrophic gastritis, Morphology

Core Tip: An open question in the clinical management of gastritis is whether the current Updated Sydney system is appropriate for classification. It appears to have become obsolete in view of the increasing knowledge on atrophic gastritis. Thus, we propose a new classification system for atrophic gastritis based on morphological criteria, named as the Updated Kimura-Takemoto classification system. This new system correctly reflects the severity of histological atrophy in the gastric mucosa, exceeding the Updated Sydney system in accuracy of detecting gastric atrophy. Moreover, it has higher sensitivity for detecting mild, moderate and severe atrophic gastritis.