Correlations Among Endoscopic, Histologic and Serologic Diagnoses for the Assessment of Atrophic Gastritis

이주엽,김나영,이혜승,Jane C Oh,권용환,최윤진,Kichul Yoon,Jae Jin Hwang,Hyun Joo Lee,AeRa Lee,정연상,조현진,윤혁,신철민,박영수,이동호 대한암예방학회 2014 Journal of cancer prevention Vol.19 No.1

Atrophic gastritis is a precancerous condition, which can be diagnosed by several methods. However, there is no consensus for the standard method. The aim of this study was to evaluate the correlations among endoscopic, histologic, and serologic findings for the diagnosis of atrophic gastritis. Methods: From March 2003 to August 2013, a total of 2,558 subjects were enrolled. Endoscopic atrophic gastritis was graded by Kimura-Takemoto classification and histological atrophic gastritis was assessed by updated Sydney system. Serological assessment of atrophic gastritis was based on serum pepsinogen test. Results: The serum pepsinogen I/II ratio showed a significant decreasing nature when the extent of atrophy increased (R2=0.837, P<0.001) and the cut-off value for distinguishing between presence and absence of endoscopic atrophic gastritis was 3.2. The serum pepsinogen I and pepsinogen I/II ratio were significantly lower when the histological atrophic gastritis progressed and the cut-off value was 3.0 for a diagnosis of histological atrophic gastritis. A significant correlation between endoscopic and histological atrophic gastritis was noted and the sensitivity and specificity of endoscopic diagnosis were 65.9% and 58.0% for antrum, 71.3% and 53.7% for corpus, respectively. Conclusions: The endoscopic, histological, and serological atrophic gastritis showed relatively good correlations. However, as these three methods have a limitation, a multifactorial assessment might be needed to ameliorate the diagnostic accuracy of atrophic gastritis.

한국 성인남자에 있어서 흡연 및 음주가 위염에 미치는 영향에 대한 환자-대조군 연구

홍윤철,박정일,이원철,이강숙,Hong, Yun-Chul,Park, Chung-Yill,Lee, Won-Chul,Lee, Kang-Sook 대한예방의학회 1992 예방의학회지 Vol.25 No.3

We performed case-control studies for the 1,138 Korean adult men. According to the results of UGIS, we classified the gastritis into the erosive gastritis, superficial gastritis, and hypertrophic gastritis. And then, we selected controls among non-gastritis group after matching. Alcohol intake and smoking history was obtained by questionnaire. And we observed the effects of alcohol intake and smoking to the each gastritis. The results obtained were as follows : 1. Smokers had a risk of getting erosive gastritis more than twice(2.6) than non-smokers and there was dose-response relationships between smoking and erosive gastritis. Alcohol intake, however, had no significant relation with the erosive gastritis. 2. Both smoking and alcohol intake had no significant relations with superficial gastritis. 3. Smoking had no significant relation with hypertrophic gastritis, but dividing between those who drank more than 100gm of alcohol a week and those who drank less, we obtained the odds ratio of 3.4 suggesting that there existed a significant relation between moderate or excessive alcohol intake and hypertrophic gastritis. 4. Among the gastritis patients, those who had erosive gastritis smoked most heavily, and those who had hypertrophic gastritis drank most excessively.

위염 및 소화성 궤양환자에서 간접형광항체법에 의한 Campylobacter pyloridis 항체의 검출

김준명,임세중,김응,박형석,이홍렬,홍천수,정윤섭 대한내과학회 1990 대한내과학회지 Vol.38 No.4

It is widely known that the pathophysiology of gastritis and peptic ulcer is based on the gastric secretion and mucosal defenses against them, but the definite mechanism has not been found. Recently, Warren and Marshall isolated a Campylobacter-like organism and suggested its relation to gastritis and peptic ulcer. Thereafter many groups have reported a close correlation between the finding of C. pyloridis and the presence and severity of gastritis and peptic ulcer. In this study, we measured antibody titers of C. pyloridis by indirect fluorescent antibody test in the sera of 125 patients from whom gastric biopsy specimens were also obtained. The results are as follows: 1) C. pyloridis was detected by culture or stain in 98. 7% of the patients in which the histological diagnosis of active chronic gastritis was made. In 43% of the patients with chronic gastritis, C. pyloridis was detected. In all of the patients with a normal histology of gastric mucosa, no C. pyloridis was detected. So, those with active chronic gastritis had significantly higher values than the lpatiensts with chronic active gastritis, C. pyloridis was detected by both culture and tissue-stain in 89% of the patients with duodenal ulcer, 75% of the patients with gastric ulcer and 62.5% of the patients without ulcers, but there was no significant difference between these groups. 2) The antibody titers of Campylobacter have been reported high in active chronic gastritis, an chronic gastritis and normal histology in sequence. Otherwise, an antibody titer greater than lt128 has been shown in 90.6% of chronic active gastritis, 72.5% of chronic gastritis and 10.0% of normal. So, the patients who were histologically normal had significantly fewer positive results than others, but there was no significant difference between patients with actve chronic gastritis and those with chronic gastritis. Among the patients with active chronic gastritis, the titers greater than 1:128 had been found in 95% of the patients with duodenal ulcer, 86% of the patients with gastric ulcer and 90% of the patients without ulcer. Between these groups, no significant difference was found. 3) If the antibody titer greater than 1:128 counts as a positive reaction, the changes of a positive reading in patients with Campylobacter pyloridis isolated from culture or staining have been found to be 91.2%. In conclusion, we provided evidence for a pathogenic role of C. pyloridis in gastritis and peptic ulcer, and it was expected that serologic tests could be of clinical importance in detecting the infection of C. pyloridis in the gastric mucosa.

위염 분류의 역사적 배경

임성균,서승영 대한상부위장관ㆍ헬리코박터학회 2023 Korean Journal of Helicobacter Upper Gastrointesti Vol.23 No.2

Gastritis is common worldwide. The combination of Helicobacter pylori (H. pylori) infection with background gastritis, including atrophic gastritis or intestinal metaplasia is implicated as an important etiopathogenetic contributor to gastric cancer. Since the gastritis classification proposed by Schindler, research has focused on classification of gastritis for accurate diagnosis and prediction of prognosis. Advances in endoscopic technology have enabled more accurate visualization of the gastric mucosa and ‘targeted’ biopsies with the emergence of newer classifications based on visual findings (Kimura-Takemoto classification) and more specific histopathological findings using targeted biopsies (Whitehead classification). Following the discovery of H. pylori, it is mandatory to consider its role as an important contributor to gastritis. Therefore, it was necessary to redefine the classification of gastritis and arrive at a consensus, which led to the establishment of an international consensus classification, referred to as the Sydney system. However, the Sydney system alone cannot predict the gastric cancer risk, and scoring systems such as the Operative Link for Gastritis Assessment and the Operative Link on Gastritis Assessment based on Intestinal Metaplasia were proposed. These systems are based on histopathological findings observed in endoscopic biopsy specimens. However, availability of high-definition images following technological advances has facilitated the emergence of a visual classification, the Kyoto classification. In contrast to the Sydney system, the Kyoto classification is based exclusively on interpretation of visual findings and focuses on detection of H. pylori infection and gastric cancer prediction. In this review, we summarize the history and background of the various classifications of gastritis.

위축성 위염의 선별을 위한 혈청 Pepsinogen 검사의 유용성

채효진,이제훈,임지향,김명신,김용구,한경자,강창석,심상인,김진일,박수헌 대한진단검사의학회 2008 Annals of Laboratory Medicine Vol.28 No.3

Background : Atrophic gastritis is a well known risk factor for gastric adenocarcinoma. Its confirmatory diagnosis requires histology via endoscopy, which is an invasive method; therefore, periodic follow up evaluation as a screening method is difficult to perform. We evaluated the clinical utility of serum pepsinogens (PG) as a biomarker for screening of atrophic gastritis. Methods : The study population consisted of 130 selected dyspeptic patients (M:F=52:78; age, 16-105 yrs; mean age, 50.8 yrs) who had undergone a diagnostic endoscopy. The serum pepsinogen test was performed by a latex turbidimetric immunoassay method (HBI, Korea) using Toshiba- 200FR automatic analyzer. The PGI, II level and PGI:PGII ratio of non-atrophic gastritis group were compared with those of atrophic gastritis group, and a correlation with Helicobacter pylori infection was examined. Cut-off points for screening of atrophic gastritis were determined. Results : The mean serum concentration of PGI showed a decline from normal (60.7 ng/mL), nonatrophic gastritis (54.2 ng/mL), and atrophic gastritis (51.8 ng/mL) to gastric adenocarcinoma (32.6 ng/mL). The mean ratio of PGI:PGII was lower in atrophic gastritis (3.2) compared to non-atrophic gastritis (4.7) (P=0.021). In patients with H. pylori infection, the mean serum PGII level was higher and the PGI:PGII ratio was lower than those in patients without H. pylori infection, and the differences were statistically significant. For screening of atrophic gastritis, the best cut-off point of PGI:PGII ratio was 4, with a sensitivity of 82.6% and specificity of 91.7%. Conclusions : The serum pepsinogen test is a useful biomarker for screening of atrophic gastritis, a well-known precancerous lesion of gastric adenocarcinoma. Measuring both pepsinogen I and II concentrations simultaneously to obtain pepsinogen I/II ratio provides a clinically useful information for the detection of atrophic gastritis. (Korean J Lab Med 2008;28:201-6)

무증상 성인에서 발견된 발적성/삼출성 위염의 중증도를 기반으로 한 헬리코박터 파일로리 감염의 예측

김원중 ( One Zoong Kim ),이경훈 ( Kyoung Hoon Rhee ),오현우 ( Hyunwoo Oh ),손병관 ( Byoung Kwan Son ),정광현 ( Kwang Hyun Chung ),이효영 ( Hyo Young Lee ),오일환 ( Il Hwan Oh ),윤지영 ( Jiyoung Yoon ),김수형 ( Soo Hyung Kim ),박 대한소화기학회 2022 대한소화기학회지 Vol.80 No.3

목적: H. pylori 감염은 시드니 분류 시스템의 내시경적 소견 중 하나인 발적성/삼출성 위염과 높은 연관성을 가지고 있다고 알려져 있다. 본 연구는 발적성/삼출성 위염의 내시경적 중증도에 따른 H. pylori 감염률을 평가하고자 하였다. 대상 및 방법: 이 연구는 전향적 연구로 검진 목적의 위내시경으로 발적성/삼출성 위염을 진단받은 무증상의 성인을 대상으로 하였다. H. pylori 감염을 진단하기 위해 급속요소분해 검사가 시행되었다. 발적성/삼출성 위염의 중증도는 시드니 분류 체계를 사용하여 2명의 관찰자가 내시경 소견을 평가하였다. 연구의 일차결과지표는 경도 발적성/삼출성 위염을 중등도 또는 중증 발적성/삼출성 위염과 비교하여 H. pylori 감염률이 차이가 있는지로 하였다. 결과: 총 177명의 환자가 포함되었다. 발적성/삼출성 위염 전체 환자의 H. pylori 감염률은 86.4%였다. 177명의 환자 중 78명은 경도, 48명은 중등도, 51명은 중증이었다. 헬리코박터 감염률은 경도와 중등도-중증 발적성/삼출성 위염 모두 유사하였다(91.0% vs. 82.8%, p=0.115). 결론: 헬리코박터 감염은 발적성/삼출성 위염에서 흔하게 관찰되었다. 그러나 발적성/삼출성 위염의 중증도에 따라서는 헬리코박터 감염은 차이가 없었다. 따라서 경도의 발적성/삼출성 위염 환자에서라도 헬리코박터 감염에 대한 검사는 필요함을 알 수 있다. Background/Aims: Helicobacter pylori (H. pylori) infection highly correlates with erythematous/exudative gastritis, which is one of the endoscopic findings of the Sydney classification system. The present study aimed to evaluate the association between endoscopic severity of erythematous/exudative gastritis and H. pylori infection. Methods: We prospectively enrolled asymptomatic adults who were diagnosed with erythematous/exudative gastritis during screening esophagogastroduodenoscopy. A rapid urease test was performed in all participants to diagnose H. pylori infection. The severity of erythematous/exudative gastritis was determined based on the Sydney classification system. Two investigators independently evaluated the endoscopic findings. The primary endpoint was H. pylori infection rate according to the severity of erythematous/ exudative gastritis (mild vs. moderate-to-severe). Results: A total of 177 patients with erythematous/exudative gastritis were included. The rate of H. pylori infection was 86.4% in all patients. Of 177 included patients, 78 were at mild degree, 48 were at moderate degree, and 51 were at severe degree. The inter- observer variation was 4.6% and kappa value was 0.593. H. pylori infection rate was similar between patients with mild erythematous/ exudative gastritis and those with moderate-to-severe erythematous/exudative gastritis (91.0% vs. 82.8%, p=0.115). Even after adjusting potential confounding variables, the severity of erythematous/exudative gastritis was not associated with H. pylori infection rate. Conclusions: H. pylori infection is commonly observed in patients with erythematous/exudative gastritis. However, the severity of erythematous/ exudative gastritis is not associated with H. pylori infection rate. (Korean J Gastroenterol 2022;80:135-141)

위염치료제의 임상시험평가지침 연구

송윤경,진선경,한의식,안미령,정주연,이이다,조일영,김동섭,지은희,박효영,오정미,신원,이선희,김인규,Song, Yun-Kyoung,Jin, Sun-Kyung,Han, Eui-Sik,Ahn, Mee-Ryung,Jung, Ju-Yeon,Lee, Rhee-Da,Cho, Il-Yong,Kim, Dong-Sub,Ji, Eun-Hee,Park, Hyo-Young,Oh, 대한약학회 2011 약학회지 Vol.55 No.4

Gastritis is the most common disease among Korean. The demand for the development of gastritis drugs has been increasing. Currently, however, there is no guideline available for the clinical evaluation of gastritis drugs worldwide. As a consequence, domestic and international pharmaceutical companies make errors in the drug development processes, and it becomes difficult for them to establish the scientific validity and objectivity of newly developed drugs. The objective of this study was to develop the Guideline for Clinical Trials Evaluation of Gastritis which can be used in improving the quality and consistency of clinical trials. First, we collected and reviewed the clinical trials on gastritis drugs that were available from Japan Pharmaceuticals and Medical Devices Agency and Korea Food and Drug Administration (KFDA), and investigated the recent research trends on clinical trials of gastritis drugs. Reviewers from KFDA and National Institute of Food and Drug Safety Evaluation and scientific experts from the pharmaceutical industries developed the guidelines through regularly scheduled meetings. Opinions and consultation from academic fields and industry experts were also obtained. This project will provide the clinical trial practitioners, investigator and reviewers the scientific and rational guidelines for performance and evaluation of clinical trials for gastritis drugs. Furthermore, we hope this guideline contributes to establishing the national competitiveness, improving the quality of clinical trial, and encouraging researches on drug development for gastritis.

Dietary Intake Assessment and Biochemical Characteristics of Blood and Urine in Patients with Chronic Gastritis

( Mi-kyeong Choi ),( Myung-hwa Kang ),( Mi-hyun Kim ) 한국임상영양학회 2015 Clinical Nutrition Research Vol.4 No.2

Chronic gastritis is a prevalent gastroentestinal disease in Korea. The purpose of this study was to investigate status of foods and nutrients intake and health related biochemical indicators in the patients with chronic gastritis. Daily food and nutrient intake, blood lipids, and antioxidant indicators in the urine, were compared between a group of 19 patients diagnosed with chronic gastritis and a control group of 27 subjects having normal gastroscopy. No significant differences were found in age, height, weight, body mass index, and blood pressure between the two groups. Daily energy intakes were 1900.6 kcal for the chronic gastritis patient group, and 1931.8 kcal for the normal control group without significant difference. No significant difference was found between the two groups in all nutrient intakes except for cholesterol. The chronic gastritis patients consumed lower amount of sugars and sweeteners but greater amount of starchy food groups such as potatoes and legumes than subjects of control group consumed. Also the chronic gastritis patients showed higher serum triglyceride concentration than the normal subjects. These results indicate that the dietary pattern of chronic gastritis patients may have relation to a change in the serum lipid level; however, more systematic research with a larger samples size is required.

Cotoneaster mongolicus Pojark. 추출물의 HCl/ethanol로 유발된 위염 mice에 대한 보호효과

최정원,이진아,신미래,박해진,노성수,Choi, Jeong Won,Lee, Jin A,Shin, Mi-Rae,Park, Hae-jin,Roh, Seong-Soo 한국생약학회 2022 생약학회지 Vol.53 No.3

Cotoneaster mongolicus Pojark. (CM), in the family Rosaceae is an endemic plant to the Mongolian region (its name: Moнroл чapraй). In Mongolia, Cotoneaster species as a crude drug is mainly used for inflammatory diseases, diarrhea, and stomach indigestion. In this study, we evaluated the gastro-protective activity underlying mechanism of CM. For in vivo experiments, mice were divided into 5 groups; normal mice (Normal), gastritis mice (Control), gastritis mice treated with sucralfate 10 mg/kg (SC), gastritis mice treated with CM 100 mg/kg (CML), gastritis mice treated with CM 200 mg/kg (CMH). Gastritis was provoked by HCl/ethanol (60% ethanol in 150 mM HCl). After oral administration of each drug, HCl/ethanol was orally administered 90 mins later to induce gastritis. CM alleviated the damage to the gastric mucosa caused. As a result of confirming the expression of protein in gastric tissue through western blot, CM significantly reduced the expression of NF-κB activated due to gastritis. Also, it significantly modulated the Nrf2-Keap1 pathway. These results indicate that CM not only inhibits the nuclear metastasis of NF-𝛋B but also modulates the Nrf2-Keap1 pathway to relieve inflammation of the gastric mucosa.

Effect of Artemisiae Argyi Folium Extract on alcohol-induced gastritis

( Seo Jeong Bok ) 대구한의대학교 제한동의학술원 2022 제한동의학술원논문집 Vol.20 No.1

Objective : Alcohol is known to cause inflammation in the stomach by decreasing the protective substances of the gastric mucosa and increasing oxidative stress. The purpose of this study was to investigate the anti-inflammatory effect of Artemisiae Argyi Folium extract (AF) on alcohol-induced gastritis. Methods : The total polyphenol and flavonoid contents of AF were confirmed through an in experiment. Also, DPPH and ABTS radical scavenging activities were confirmed. And, mice were divided into 5 groups (n=8); Normal group (Nor), alcohol-induced gastritis group (Con), sucralfate 10 mg/kg and alcohol-induced gastritis group (SC), AF 100 mg/kg and alcohol-induced gastritis group (AFL), AF 200 mg/kg and alcohol-induced gastritis group (AFH). After, level of ROS was confirmed using serum, and protein expressions were confirmed using gastric tissue. Results : In alcohol-induced gastritis, AF alleviated the damage to the gastric mucosa caused by alcohol. Also, AF decreased ROS level in serum. As a result of Western blot, AF decreased the expression of NADPH oxidase increased and decreased the expression of the NF-κB pathway due to inflammation. Moreover, it decreased the expression of adhesion molecules and chemokine proteins, and increased the expression of anti-inflammatory proteins. Conclusions : These results suggest that AF not only affects the reduction of oxidative stress in alcohol-induced gastritis, but also relieves gastric mucosa inflammation by regulating the expression of the NF-κB pathway.