title: Interobserver and intraobserver agreement for gastric mucosa atrophy.
abstract: BACKGROUND
  The grade of gastric mucosa atrophy caused by Helicobacter pylori (H. pylori) infection is closely associated with the risk of gastric cancer, especially of the intestinal type. Interobserver and intraobserver agreement for endoscopic gastric mucosa atrophy in subjects with H. pylori-uninfected, currently infected and past infected was investigated.
  
  
  METHODS
  Endoscopic images of 91 patients, 34 images per patient, were assessed. The assessors were 4 endoscopist groups: Japanese and Vietnamese experienced (≥7, ≤ 15 year experience with endoscopy) and Japanese and Vietnamese beginner (≤ 3 year experience) groups. Each group comprised 3 endoscopists. The grades of atrophy were classified as 3: none to mild (C-0 and C-1), moderate (C-2 and C-3), and severe (O-1, O-2, and O-3) using the Kimura-Takemoto Classification. After a period of 2 weeks, images of all patients were reevaluated by the investigators. Interobserver and intraobserver agreement was calculated by kappa statistics.
  
  
  RESULTS
  The kappa values for the interobserver agreement in the groups of Japanese and Vietnamese experienced, and Japanese and Vietnamese beginner were 0.474, 0.408, 0.291, and 0.373, respectively. The kappa value of intraobsever agreement in the Japanese and Vietnamese experienced endoscoists ranged from 0.585 to 0.871. On the other hand, the value in the beginner endoscopists ranged wider than that in experienced endoscopists, from 0.264 to 0.866.
  
  
  CONCLUSIONS
  Our results indicated that, although intraobserver agreement for gastric mucosa atrophy was good to excellent, interobserver agreement was moderate in experienced endoscopists. This suggests that better guidelines and firm criteria may be needed to properly diagnose and grade gastric atrophy.
authors.affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. tmiwata@hiroshima-u.ac.jp.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Miwata
authors.affiliation: Department of Endoscopy, University Medical Center, Ho Chi Minh, Vietnam. quachtrongduc2002@yahoo.com.
authors.forename: Duc Trong
authors.initials: DT
authors.lastname: Quach
authors.affiliation: Health Service Center, Hiroshima University, Higashihiroshima, Japan. tohiyama@hiroshima-u.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Hiyama
authors.affiliation: Department of Internal Medicine, Tokushima Health Screening Center, Tokushima, Japan. rikaoki@syd.odn.ne.jp.
authors.forename: Rika
authors.initials: R
authors.lastname: Aoki
authors.affiliation: Department of Endoscopy, University Medical Center, Ho Chi Minh, Vietnam. huy2903@yahoo.com.
authors.forename: Huy Minh
authors.initials: HM
authors.lastname: Le
authors.affiliation: Department of Endoscopy, University Medical Center, Ho Chi Minh, Vietnam. phuongbanggia@yahoo.com.
authors.forename: Phuong Luu Ngoc
authors.initials: PL
authors.lastname: Tran
authors.affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. maito@hiroshima-u.ac.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. colon@hiroshima-u.ac.jp.
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Pathology, Hiroshima University Hospital, Hiroshima, Japan. arihiro@hiroshima-u.ac.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Arihiro
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Ichikawa, Japan. nuemura@hospk.ncgm.go.jp.
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
authors.affiliation: Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. chayama@hiroshima-u.ac.jp.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000368:Aged; D001284:Atrophy / Q000382:microbiology / Q000473:pathology; D002983:Clinical Competence; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012720:Severity of Illness Index; D014744:Vietnam