title: The staging of gastritis with the OLGA system by using intestinal metaplasia as an accurate alternative for atrophic gastritis.
abstract: 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.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus University Medical Center, 3000 CA Rotterdam, The Netherlands.
authors.forename: Lisette G
authors.initials: LG
authors.lastname: Capelle
authors.forename: Annemarie C
authors.initials: AC
authors.lastname: de Vries
authors.forename: Jelle
authors.initials: J
authors.lastname: Haringsma
authors.forename: Frank
authors.initials: F
authors.lastname: Ter Borg
authors.forename: Richard A
authors.initials: RA
authors.lastname: de Vries
authors.forename: Marco J
authors.initials: MJ
authors.lastname: Bruno
authors.forename: Herman
authors.initials: H
authors.lastname: van Dekken
authors.forename: Jos
authors.initials: J
authors.lastname: Meijer
authors.forename: Nicole C T
authors.initials: NC
authors.lastname: van Grieken
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: 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*