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Original article
Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer: a 5-year prospective study of 1755 patients
  1. Massimo Rugge1,2,
  2. Alberto Meggio3,
  3. Cecilia Pravadelli3,
  4. Mattia Barbareschi4,
  5. Matteo Fassan1,
  6. Maria Gentilini5,
  7. Manuel Zorzi2,
  8. Giovanni De Pretis3,
  9. David Y Graham6,
  10. Robert M Genta7,8
  1. 1 Department of Medicine (DIMED), Pathology Unit, University of Padua, Padova, Italy
  2. 2 Veneto Tumor Registry, Veneto Region, Padova, Italy
  3. 3 Department of Gastroenterology, Trento and Rovereto Hospital, Trento, Italy
  4. 4 Department of Pathology, St Chiara Hospital, Trento, Italy
  5. 5 Tumor Registry of Trento, Trento, Italy
  6. 6 Department of Medicine, Michael E DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA
  7. 7 Miraca Life Sciences Research Institute, Irving, Texas, USA
  8. 8 Departments of Pathology and Medicine, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Massimo Rugge, Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padova, Italy; massimo.rugge{at}


Objective Operative link on gastritis assessment (OLGA) staging for gastritis ranks the risk for gastric cancer (GC) in progressive stages (0–IV). This prospective study aimed at quantifying the cancer risk associated with each gastritis stage.

Design A cohort of 1755 consecutive patients with dyspepsia underwent initial (T-0) oesophagogastroduodenoscopy with mapped gastric biopsies, OLGA staging and assessment of Helicobacter pylori infection. Patients were followed for 55 months (median); patients with stages II III and IV underwent a second endoscopy/restaging (T-1), and those with stages 0 and I were followed clinically and through in-depth clinical and record checking. Endpoints were OLGA stage at T-1 and development of gastric epithelial neoplasia.

Results At T-0, 77.6% of patients had stage 0, 14.4% stage I, 5.1% stage II, 2.1% stage III and 0.85% stage IV. H. pylori infection was detected in 603 patients at T-0 and successfully eradicated in 602 of them; 220 had a documented history of H. pylori eradication; and 932 were H. pylori naïve-negative. Incident neoplastic lesions (prevalence=0.4%; low-grade intraepithelial neoplasia (IEN)=4; high-grade IEN=1; GC=2) developed exclusively in patients with stages III–IV. The risk for epithelial neoplasia was null in patients at stages 0, I and II (95% CI 0 to 0.4), 36.5 per 1000 person-years in patients at stage III (95% CI 13.7 to 97.4) and 63.1 per 1000 person-years in patients at stage IV (95% CI 20.3 to 195.6).

Conclusions This prospective study confirms that OLGA staging reliably predicts the risk for development of gastric epithelial neoplasia. Although no neoplastic lesions arose in H. pylori-naïve patients, the H. pylori eradication in subjects with advanced stages (III–IV) did not abolish the risk for neoplastic progression.

  • gastric cancer
  • pre-malignancy - gi tract
  • gastritis
  • helicobacter pylori

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  • MR and AM contributed equally.

  • Contributors Study concept and design: MR, AM, GDP; acquisition of data: AM, CP, MB, MF, GDP; analysis and interpretation of data: MR, AM, MG, MZ, DYG, RMG; drafting of the manuscript: MR, AM, DYG, RMG; statistical analysis: MG, MZ; obtained funding: MR.

  • Funding This work was partly supported by a grant from the Italian Association for Cancer Research (AIRC regional grant n. 6421 to MR).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.