Original article
Clinical endoscopy
The staging of gastritis with the OLGA system by using intestinal metaplasia as an accurate alternative for atrophic gastritis

https://doi.org/10.1016/j.gie.2009.12.029Get rights and content

Background

The OLGA (operative link on gastritis assessment) staging system is based on severity of atrophic gastritis (AG). AG remains a difficult histopathologic diagnosis with low interobserver agreement, whereas intestinal metaplasia (IM) is associated with high interobserver agreement.

Objective

The aim of this study was to evaluate whether a staging system based on IM is preferable to estimate gastric cancer risk.

Design and Setting

Prospective multicenter study.

Patients

A total of 125 patients previously diagnosed with gastric IM or dysplasia.

Interventions

Surveillance endoscopy with extensive biopsy sampling.

Main Outcome Measurements

Three pathologists graded biopsy specimens according to the Sydney classification. Interobserver agreement was analyzed by kappa statistics. In the OLGA, AG was replaced by IM, creating the OLGIM.

Results

Interobserver agreement was fair for dysplasia (κ = 0.4), substantial for AG (κ = 0.6), almost perfect for IM (κ = 0.9), and improved for all stages of OLGIM compared with OLGA. Overall, 84 (67%) and 79 (63%) patients were classified as stage I-IV according to OLGA and OLGIM, respectively. Of the dysplasia patients, 5 (71%) and 6 (86%) clustered in stage III-IV of OLGA and OLGIM, respectively.

Limitation

Prospective studies should confirm the correlation between gastric cancer risk and OLGIM stages.

Conclusion

Replacement of AG by IM in the staging of gastritis considerably increases interobserver agreement. The correlation with the severity of gastritis remains at least as strong. Therefore, the OLGIM may be preferred over the OLGA for the prediction of gastric cancer risk in patients with premalignant lesions.

Section snippets

Patient selection

We studied 2 groups of patients. The first group included patients with a previous diagnosis of gastric IM or dysplasia. For that purpose, we used the records between 1994 and 2009 of the histology registries of the participating hospitals (Deventer Hospital, Deventer; Rijnstate Hospital, Arnhem; Erasmus Medical Center, Rotterdam, The Netherlands) to identify patients who were eligible for inclusion. In these registries with full coverage of all histopathological specimens, all biopsy specimens

Results

Overall, 204 patients were eligible for inclusion. Contact information was missing or wrong in 28 patients, and 51 patients refused to participate in this study. In total, 125 patients with a previous diagnosis of IM or dysplasia (69 male, 56 female) with a mean (±SD) age of 61 ± 11.7 years underwent surveillance endoscopy (Table 3). Ninety-eight patients (78%) were of Dutch origin, 53 patients (42%) had a previous history of Helicobacter pylori eradication, and 41 patients (33%) had a history

Discussion

This study demonstrates that replacement of AG by IM in the staging of gastritis increases interobserver agreement considerably. In addition, the correlation with the severity of gastritis remains at least as strong. Therefore, the OLGIM may be preferred over the OLGA for the prediction of gastric cancer risk in patients with pre-malignant gastric lesions.

Endoscopic follow-up of premalignant gastric lesions should be limited to patients at high cancer risk. H pylori virulence, environmental

Acknowledgments

The permission of the American Journal of Surgical Pathology for reusing the visual analog scale of the updated Sydney classification is kindly acknowledged.

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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