Gastritis staging in clinical practice: the OLGA staging system

Abstract

Background: The available classifications of gastritis are inconsistently used, possibly because none provides immediate prognostic/therapeutic information to clinicians. As histology reporting of hepatitis in terms of stage is clinically useful and widely accepted, an international group (Operative Link on Gastritis Assessment (OLGA)) proposed an equivalent staging system for reporting gastric histology. Gastritis staging integrates the atrophy score (obtained by biopsy) and the atrophy topography (achieved through directed biopsy mapping). Aim: To test in a prospective cross-sectional study whether OLGA staging consistently stratified patients according to their cancer risk and provided clear prognostic/therapeutic information. Methods: OLGA staging for gastric cancer risk (0-IV) and gastritis grading (overall score of the inflammatory infiltrate, grade 1-4) were applied in 439 prospectively enrolled, consecutive, dyspeptic outpatients who underwent endoscopy with standardised biopsy sampling. Incidental neoplastic lesions and coexisting peptic ulcers were recorded. Results were presented as stage (including antral (A) and corpus (C) atrophy scores) and H pylori status (eg, A = 3; C = 2: stage IV; Hp+ve). Results: Benign conditions (including duodenal ulcers; p,0.001) consistently clustered in stages 0-II, whereas all neoplastic (invasive and non-invasive) lesions clustered in stages III-IV (p,0.001). Conclusions: Gastritis staging, combined with H pylori status, provided clinically relevant information on the overall status of the gastric mucosa with implications for prognosis, therapy and management.

Gastric Cancer: Clinical Aspects, Epidemiology and Molecular Background

“…Rugge et al [35] suggested application of the Operative Link for Gastritis Assessment (OLGA) system for prediction of neoplastic progression. Ninety-three patients followed for more than 12 years by upper gastrointestinal endoscopy and serum sampling for pepsinogens and H. pylori status developed invasive or intra-epithelial neoplasia only if they have been defined as at ''high risk'' according to the OLGA staging system, at inclusion (OLGA III or IV).…”

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

“…Even assuming that the technological progress of endoscopes and more comprehensive studies can substantially change this decision, the Consensus opted to follow the European recommendation to perform, at least, the removal of two fragments in the antrum and at least two fragments in the gastric corpus, in both small and large curvature (40) . It is also recommended that histological analysis of the fragments be made under the criteria established by the updated Sydney System (41) and, where possible, through it, to promote the atrophy and intestinal metaplasia graduation as recently described by systems, OLGA -Operative Link Assessment on Gastritis -and OLGIM -Operative Link on Gastritis by Intestinal Metaplasia (18,176) .…”

What Have We Accomplished in Endoscopic Image Analysis for Atrophic Gastritis?

“…8 The diagnosis of atrophy or IM is currently based on histology of biopsy specimens from certain anatomic locations of the gastric mucosa, i.e., the updated Sydney System 9,10 or Operative Link for Gastritis Assessment. 11,12 Updated Sydney System recommends taking at least five biopsy specimens: two from the antrum, two from the corpus and one from the incisura angularis. However, multiple biopsies and histologic examination are time-consuming procedure and may not be easy to apply in usual clinical practices.…”