STOMACH AND DUODENUM

Gastritis staging in clinical practice: the OLGA staging system

Massimo Rugge¹, Alberto Meggio³, Gianmaria Pennelli¹, Francesco Piscioli⁴, Luciano Giacomelli⁵, Giovanni De Pretis³, David Y Graham²

¹ Department of Diagnostic Medical Sciences & Special Therapies, University of Padova & IOV-IRCCS, Padova, Italy
² Digestive Disease Division, Veterans Affairs Medical Center & Baylor College of Medicine, Houston, Texas USA
³ Department of Gastroenterology, Rovereto Hospital, Italy
⁴ Department of Pathology, Rovereto Hospital, Italy
⁵ Pathology Unit, Azienda Ospedaliera di Padova, Italy

Correspondence to:
Massimo Rugge
Anatomia Patologica, Università degli Studi di Padova, Istituto Oncologico del Veneto IOV-IRCCS, Via Aristide Gabelli, 61, 35121 Padova, Italia; massimo.rugge{at}unipd.it

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.

Abbreviations: OLGA, Operative Link on Gastritis Assessment; PPI, proton pump inhibitor

Keywords: gastritis; atrophic gastritis; OLGA staging; precancerous gastric lesions; non-invasive neoplasia

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