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


METHODS
Prospective multicenter study.


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


METHODS
Surveillance endoscopy with extensive biopsy sampling.


METHODS
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 (kappa = 0.4), substantial for AG (kappa = 0.6), almost perfect for IM (kappa = 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.


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


CONCLUSIONS
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.
Capelle
Lisette G
LG
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.
de Vries
Annemarie C
AC
Haringsma
Jelle
J
Ter Borg
Frank
F
de Vries
Richard A
RA
Bruno
Marco J
MJ
van Dekken
Herman
H
Meijer
Jos
J
van Grieken
Nicole C T
NC
Kuipers
Ernst J
EJ
D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology*; D005757:Gastritis, Atrophic / Q000145:classification / Q000473:pathology*; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000473:pathology*