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

• Published in: Gastrointestinal endoscopy Vol. 71; no. 7; pp. 1150 - 1158
• Main Authors: Capelle, Lisette G., MD, de Vries, Annemarie C., MD, PhD, Haringsma, Jelle, MD, Ter Borg, Frank, MD, PhD, de Vries, Richard A., MD, PhD, Bruno, Marco J., MD, PhD, van Dekken, Herman, MD, PhD, Meijer, Jos, MD, van Grieken, Nicole C.T., MD, PhD, Kuipers, Ernst J., MD, PhD
• Format: Journal Article
• Language: English
• Published: Maryland heights, MO Mosby, Inc 01.06.2010; Elsevier
• Subjects: Aged; Biological and medical sciences; Biopsy; Diagnosis, Differential; Digestive system. Abdomen; Disease Progression; Endoscopy; Endoscopy, Gastrointestinal - methods; Female; Follow-Up Studies; Gastric Mucosa - pathology; Gastritis, Atrophic - classification; Gastritis, Atrophic - pathology; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Metaplasia - pathology; Middle Aged; Other diseases. Semiology; Precancerous Conditions - pathology; Prospective Studies; Reproducibility of Results; Risk Assessment - methods; ROC Curve; Severity of Illness Index; Stomach Neoplasms - pathology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; OLGA; OLGIM; IM; intestinal metaplasia; AG; atrophic gastritis; operative link on gastritis assessment; operative link on gastric intestinal metaplasia assessment; Digestive diseases; Premalignant lesion; Staging; Atrophic gastritis; Intestinal metaplasia; Gastric disease
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2009.12.029

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.