国际慢性胃炎分期分级标准Gastritis staging in clinical practice--the OLGA staging system

国际慢性胃炎分期分级标准OLGA

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STOMACHANDDUODENUM

Gastritisstaginginclinicalpractice:theOLGAstagingsystem

MassimoRugge,AlbertoMeggio,GianmariaPennelli,FrancescoPiscioli,LucianoGiacomelli,GiovanniDePretis,DavidYGraham

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Gut2007;56:631–636.doi:10.1136/gut.2006.106666

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........................Correspondenceto:

MassimoRugge,AnatomiaPatologica,Universita`degliStudidiPadova,Istituto

OncologicodelVenetoIOV-IRCCS,ViaAristideGabelli,61,35121Padova,Italia;massimo.rugge@unipd.itRevised14September2006Accepted11October2006PublishedOnlineFirst1December2006

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Background:Theavailableclassificationsofgastritisareinconsistentlyused,possiblybecausenoneprovidesimmediateprognostic/therapeuticinformationtoclinicians.Ashistologyreportingofhepatitisintermsofstageisclinicallyusefulandwidelyaccepted,aninternationalgroup(OperativeLinkonGastritisAssessment(OLGA))proposedanequivalentstagingsystemforreportinggastrichistology.Gastritisstagingintegratestheatrophyscore(obtainedbybiopsy)andtheatrophytopography(achievedthroughdirectedbiopsymapping).

Aim:Totestinaprospectivecross-sectionalstudywhetherOLGAstagingconsistentlystratifiedpatientsaccordingtotheircancerriskandprovidedclearprognostic/therapeuticinformation.

Methods:OLGAstagingforgastriccancerrisk(0–IV)andgastritisgrading(overallscoreoftheinflammatoryinfiltrate,grade1–4)wereappliedin439prospectivelyenrolled,consecutive,dyspepticoutpatientswhounderwentendoscopywithstandardisedbiopsysampling.Incidentalneoplasticlesionsandcoexistingpepticulcerswererecorded.Resultswerepresentedasstage(includingantral(A)andcorpus(C)atrophyscores)andHpyloristatus(eg,A=3;C=2:stageIV;Hp+ve).

Results:Benignconditions(includingduodenalulcers;p,0.001)consistentlyclusteredinstages0–II,whereasallneoplastic(invasiveandnon-invasive)lesionsclusteredinstagesIII–IV(p,0.001).

Conclusions:Gastritisstaging,combinedwithHpyloristatus,providedclinicallyrelevantinformationontheoverallstatusofthegastricmucosawithimplicationsforprognosis,therapyandmanagement.

system.2223TheOLGAsystemusesthebiopsysamplingprotocolandthevisualanaloguescalesrecommendedbytheHouston-updatedSydneysystem.7IntheOLGAstagingsystem,gastricatrophyisconsideredtobethehistologicallesionrepresentativeofdiseaseprogression.Gastritisstageresultsfromcombiningtheextentofatrophyscoredhistologicallywiththetopographyofatrophyidentifiedthroughbiopsymapping.Ithasbeenalsosuggestedthatthediagnosticreportincludeinformationabouttheprobableaetiology.22

Thisprospectivecross-sectionalstudyaimedtovalidatetheOLGAgastritisstagingsystemasaroutinehistologyreportingsystem.Italsotestedwhetherthediagnosticmessageconveyedbythegastritisstageconsistentlyidentifiedpatientswithdifferentcancerriskandalsoprovidedclinicianswithclearprognosticandtherapeuticinformation.

astritisisaninflammatoryconditionofthegastricmucosa.1–6Thephenotypicspectrumofchronicgastricinflammationiswellestablished,andthebasicdistinc-tionbetweennon-atrophicandatrophicpatternsisbothinternationallyacceptedandconsistent.7–9Atrophyisdefinedas‘‘lossofappropriateglands’’andissubtypedintotwomainhistologicalvariants:atrophyresultingfromthedisappearanceofglandsandreplacementwithfibrosisofthelaminapropria;andglandularlossresultingfromreplacementofnativeglandswithmetaplastic,‘‘inappropriateforlocation’’glandularstruc-tures.17–9Long-termfollow-upstudiesconductedindifferentpopulationshaveconsistentlyconfirmedthattheextentofthemucosalatrophyparallelsgastriccancerrisk.10–17

TheSydneysystemanditsHouston-updatedversionattemptedtoimproveonWhitehead’sclassification18ofgastritisand,atthesametime,developareportingsystemtoassistthepathologist.346AlthoughtheSydneysystemiswidelycited,mostcitationsrefertoitsfour-pointgradingsystemofthehistologicallesionsandnottotherecommendedformatofbiopsyreporting.

Currently,noreportingscheme/terminologyforchronicgastritisisavailablethatisbotheasilyunderstoodbycliniciansandpatientsandalsoprovidesprognosticandtherapeuticinformationinunequivocalterms.Thissituationcontrastsmarkedlywiththatofchronichepatitis,wherethe‘‘traditional’’histologicalreportwithdescriptivelabelshasbeenreplacedbyawidelyadoptedstagingsystem.19–21Hepatitisstaginghasprovedusefulinsimplifyingmedicalcommunication,monitoringtheprogressionofthediseaseandtheeffectsoftreatment,and,atthesametime,expressingthecancerriskassociatedwiththeprogressiontocirrhosisevolution.

Thesuccessfulexperienceofhepatitisstagingpromptedaninternationalgroupofgastroenterologistsandpathologists(OperativeLinkonGastritisAssessment(OLGA))todevelopahistologicalstagingsystemforgastricinflammatorydiseasesthatwouldmeetthesameobjectivesasthehepatitisstaging

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PATIENTSANDMETHODS

Patients

Atotalof439consecutivedyspepticoutpatientsreferredtothegastroenterologyunitoftheRoveretoRegionalHospitalbetweenApril2004andApril2005wereprospectivelyenrolledinthestudy.Tominimisethevariabilityintheendoscopyprocedure(macroscopicassessmentandbiopsysamplingprotocol),onlypatientshavingconsecutiveuppergastrointest-inalendoscopyproceduresperformedbyonlyonetrainedgastroenterologist(AM),withspecificexpertiseinuppergastrointestinalendoscopy,wereenteredintothestudy.Patientclinicalhistorywasobtainedbytheendoscopistwhoperformedtheprocedure,whoalsoobtainedconsentfromthepatienttobeinvolvedinthestudy.

Exclusioncriteriawere(a)anyprevioussurgicalinterventiontotheuppergastrointestinaltractbecauseofeitheroesophagealorgastricdisease,(b)incompletegastricendoscopyprocedure

Abbreviations:OLGA,OperativeLinkonGastritisAssessment;PPI,protonpumpinhibitor

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