title: Can endoscopic atrophy predict histological atrophy? Historical study in United Kingdom and Japan.
abstract: OBJECTIVE
  To assess the diagnostic concordance between endoscopic and histological atrophy in the United Kingdom and Japan.
  
  
  METHODS
  Using published data, a total of 252 patients, 126 in the United Kingdom and 126 in Japan, aged 20 to 80 years, were evaluated. The extent of endoscopic atrophy was classified into five subgroups according to a modified Kimura-Takemoto classification system and was compared with histological findings of atrophy at five biopsy sites according to the updated Sydney system.
  
  
  RESULTS
  The strength of agreement of the extent of atrophy between histology and visual endoscopic inspection showed good reproducibility, with a weighted kappa value of 0.76 (P < 0.001). Multivariate analysis showed that three factors were associated with decreased concordance: Japanese ethnicity [odds ratio (OR) 0.22, 95% confidence interval (CI) 0.11-0.43], older age (OR = 0.32, 95%CI: 0.16-0.66) and endoscopic atrophy (OR = 0.10, 95%CI: 0.03-0.36). The strength of agreement between endoscopic and histological atrophy, assessed by cancer risk-oriented grading, was reproducible, with a kappa value of 0.81 (95%CI: 0.75-0.87). Only nine patients (3.6%) were endoscopically underdiagnosed with antral predominant rather than extensive atrophy and were considered false negatives.
  
  
  CONCLUSIONS
  Endoscopic grading can predict histological atrophy with few false negatives, indicating that precancerous conditions can be identified during screening endoscopy, particularly in patients in western countries.
authors.affiliation: Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Kono
authors.affiliation: Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.affiliation: Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.affiliation: Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kondo
authors.affiliation: Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gatta
authors.affiliation: Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Greg
authors.initials: G
authors.lastname: Naylor
authors.affiliation: Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Michael
authors.initials: M
authors.lastname: Dixon
authors.affiliation: Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
authors.affiliation: Shin Kono, Takuji Gotoda, Fuminori Moriyasu, Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo 160-0023, Japan.
authors.forename: Anthony
authors.initials: A
authors.lastname: Axon
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D001284:Atrophy; D001706:Biopsy; D016009:Chi-Square Distribution; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005757:Gastritis, Atrophic / Q000208:ethnology / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology; D044465:White People; D055815:Young Adult
keywords: Atrophy; Diagnosis; Endoscopy; Gastritis; Histology