title: The effect of incisura angularis biopsy sampling on the assessment of gastritis stage.
abstract: OBJECTIVE
  It is important to stratify patients according to the magnitude of risk for gastric cancer development; the OLGA (Operative Link for Gastritis Assessment) and OLGIM (Operative Link on Gastric Intestinal Metaplasia) staging systems of lesions in the stomach mucosa have been proposed for this purpose. There are some discrepancies in the current guidelines regarding the value of incisura angularis biopsies. The aim of our study was to assess the value of incisura angularis biopsy in staging gastritis according to the OLGA and OLGIM systems by examining the atrophic, metaplastic and inflammatory changes in the antrum, incisura angularis and corpus.
  
  
  METHODS
  We enrolled 835 patients undergoing upper endoscopy. Three expert gastrointestinal pathologists graded biopsy specimens according to the Sydney classification and the stage of gastritis was assessed by the OLGA and OLGIM systems.
  
  
  RESULTS
  The results demonstrated that severe atrophic, metaplastic and chronic inflammatory changes were more frequently observed in the incisura angularis mucosa than in the antrum or corpus mucosae (P<0.05). There was a general downgrading of stage by 18.0% for OLGA and by 4.0% for OLGIM when the incisura angularis was excluded from the staging. Furthermore, there was a 30-35% downgrading for high-risk OLGA/OLGIM stages.
  
  
  CONCLUSIONS
  The incisura angularis undergoes more severe atrophic, metaplastic and chronic inflammatory changes than the antrum and corpus. Incisura angularis biopsies should be routinely included in the biopsy sampling protocol.
authors.affiliation: aFaculty of Medicine, University of Latvia bRiga East University Hospital cDigestive Diseases Centre GASTRO dAcademic Histology Laboratory, Riga, Latvia eFaculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Sergejs
authors.initials: S
authors.lastname: Isajevs
authors.forename: Inta
authors.initials: I
authors.lastname: Liepniece-Karele
authors.forename: Dainius
authors.initials: D
authors.lastname: Janciauskas
authors.forename: Georgijs
authors.initials: G
authors.lastname: Moisejevs
authors.forename: Konrads
authors.initials: K
authors.lastname: Funka
authors.forename: Ilze
authors.initials: I
authors.lastname: Kikuste
authors.forename: Aigars
authors.initials: A
authors.lastname: Vanags
authors.forename: Ivars
authors.initials: I
authors.lastname: Tolmanis
authors.forename: Marcis
authors.initials: M
authors.lastname: Leja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001706:Biopsy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology; D005756:Gastritis / Q000150:complications / Q000473:pathology*; D005773:Gastroscopy; D006801:Humans; D008679:Metaplasia; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000473:pathology; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000209:etiology / Q000473:pathology; D055815:Young Adult