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김광하 대한상부위장관ㆍ헬리코박터학회 2023 Korean Journal of Helicobacter Upper Gastrointesti Vol.23 No.2
Recent advances in endoscopic technology, including high-definition and image-enhanced endoscopy such as narrow-band imaging have facilitated close observation and detailed imaging of the gastric mucosa. Currently, endoscopy is performed in Korea primarily for evaluation of premalignant conditions and gastric cancer detection. Recent research has established the Kyoto classification of gastritis, a novel grading system for endoscopic gastritis, which enables prediction of Helicobacter pylori (H. pylori) infection. The Kyoto classification score is calculated based on the sum of scores for five main items (of 19 endoscopic findings indicative of H. pylori infection) such as atrophy, intestinal metaplasia, enlarged gastric folds, nodularity, and diffuse redness with/without regular arrangement of collecting venules (RAC). Of these five endoscopic findings, atrophy, intestinal metaplasia, enlarged gastric folds, and nodularity are associated with an increased risk and RAC with a decreased risk of gastric cancer. Previous studies have reported that a Kyoto classification score ≥2 indicates current or past H. pylori infection. An increase in the Kyoto classification score is associated with a high risk of gastric cancer; specifically, a Kyoto classification score ≥4 indicates a high risk of gastric cancer. However, H. pylori eradication is followed by disappearance of enlarged gastric folds, nodularity, and diffuse redness; therefore, this grading system cannot accurately reflect the gastric cancer risk in patients with previous H. pylori infection. Limited studies have discussed the Kyoto classification of gastritis in Korea. Therefore, further large-scale multicenter studies are warranted for validation of the Kyoto classification to predict H. pylori infection and gastric cancer risk.
김광하 대한상부위장관ㆍ헬리코박터학회 2019 Korean Journal of Helicobacter Upper Gastrointesti Vol.19 No.2
Several studies have conclusively established an association between upper gastrointestinal diseases such as gastric cancer and Helicobacter pylori (H. pylori) infection; thus, it is important to assess H. pylori infection based on endoscopic findings. The Kyoto classification of gastritis is a classification that comprehensively describes the association between an individual’s H. pylori infection status and endoscopic findings. Characteristic endoscopic findings in uninfected individuals include a regular arrangement of collecting venules, fundic gland polyps, and red streaks, among other such features. Characteristic endoscopic findings in patients with current H. pylori infection include diffuse and spotty mucosal erythema, atrophy, intestinal metaplasia, enlarged or tortuous folds, secretion of sticky mucus, mucosal nodularity, foveolar hyperplastic polyps, and/or xanthomas. Characteristic endoscopic findings in previously infected individuals include patchy and map-like mucosal erythema. This classification can reflect the risk of gastric cancer and can benefit primary care physicians, as well as expert endoscopists owing to its easy applicability in routine clinical practice.
김광하 대한상부위장관ㆍ헬리코박터학회 2017 Korean Journal of Helicobacter Upper Gastrointesti Vol.17 No.1
Like Korea, Japan is one of the countries with the highest incidence of gastric cancer and Helicobacter pylori infection. However, the guidelines on H. pylori eradication differ between Japan and Korea. Since 2013, the indications for H. pylori eradication in Japan include all H. pylori-associated gastritis for prevention of gastric cancer and H. pylori dissemination. For first-line therapy, a standard triple therapy comprising of amoxicillin, clarithromycin, and a proton pump inhibitor is used for 1 week. However, the eradication rate has recently decreased owing to the increasing resistance of H. pylori to clarithromycin. For second-line therapy, a combination of amoxicillin, metronidazole, and a proton pump inhibitor is used for 1 week, but the eradication rate is still unacceptable (≒90%). The main distinguishing aspects of eradication therapy in Japan are the low dose of antibiotics (especially clarithromycin), the short duration (7 days), the low resistance rate of H. pylori to metronidazole, the absence of a bismuth-based regimen, and the recent approval of potassium ion-competitive acid blocker for eradication therapy. (Korean J Helicobacter Up Gastrointest Res 2017;17:-10)