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==Overview==
The Updated Sydney System establishes the classification and grading of gastritis which underlines the significance of combining topographical, morphological, and etiological information to help arrive at clinical diagnosis. In clinical practice, gastritis staging is done using the OLGA (Operative Link on Gastritis Assessment) staging system for reporting [[gastric]] histology. Gastritis staging combines the [[atrophy]] score which is determined by biopsy and the [[atrophy]] topography which is determined by directed [[biopsy]] mapping.
 
==Classification==
*The Updated Sydney System establishes the classification and grading of gastritis which underlines the significance of combining topographical, morphological, and etiological information to help arrive at clinical diagnosis. <ref name="pmid8827022">{{cite journal| author=Dixon MF, Genta RM, Yardley JH, Correa P| title=Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. | journal=Am J Surg Pathol | year= 1996 | volume= 20 | issue= 10 | pages= 1161-81 | pmid=8827022 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8827022 }} </ref><br />
{|
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Classification and grading of Gastritis: Updated Sydney System'''
|-
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + | Type of Gastritis
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Etiology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gastritis synonyms
|-
| colspan="2" style="background:#DCDCDC;" align="center" + | '''Non-atrophic'''
| style="background:#F5F5F5; + " |
*''[[Helicobacter pylori]]''
*Other factors
| style="background:#F5F5F5; + " |
*Superficial
*Diffuse antral gastritis (DAG)
*Chronic antral gastritis (CAG)
*Interstitial - follicular
*Hypersecretory
*Type B*
|-
| rowspan="4" style="background:#DCDCDC;" align="center" + |'''Atrophic'''
| style="background:#DCDCDC;" align="center" + |'''Autoimmune'''
| style="background:#F5F5F5; + " |
*[[Autoimmunity]]
| style="background:#F5F5F5; + " |
*Type A*
*Diffuse corporal
*[[Pernicious anemia]]-associated
|-
| rowspan="3" style="background:#DCDCDC;" align="center" + |'''Multifocal atrophic'''
| style="background:#F5F5F5; + " |
*''[[Helicobacter pylori]]''
| style="background:#F5F5F5; + " |
*Type B*, type AB*
|-
| style="background:#F5F5F5; + " |
*Dietary
| style="background:#F5F5F5; + " |
*Environmental
|-
| style="background:#F5F5F5; + " |
*Environmental factors
| style="background:#F5F5F5; + " |
*Metaplastic
|-
| rowspan="21" style="background:#DCDCDC;" align="center" + | '''Special forms'''
| rowspan="4" style="background:#DCDCDC;" align="center" + | '''Chemical'''
| style="background:#F5F5F5; + " |
*Chemical irritation
| style="background:#F5F5F5; + " |
*Reactive
|-
| style="background:#F5F5F5; + " |
*[[Bile]]
| style="background:#F5F5F5; + " |
*Reflux
|-
| style="background:#F5F5F5; + " |
*[[NSAIDs]]
| style="background:#F5F5F5; + " |
*[[NSAID]]
|-
| style="background:#F5F5F5; + " |
*Other agents
| style="background:#F5F5F5; + " |
*Type C
|-
| style="background:#DCDCDC;" align="center" + |'''Radiation'''
| style="background:#F5F5F5; + " |
*[[Radiation injury]]
| style="background:#F5F5F5; + " |
|-
| rowspan="4" style="background:#DCDCDC;" align="center" + |'''Lymphocytic'''
| style="background:#F5F5F5; + " |
*Idiopathic? [[Immune]] mechanisms
| style="background:#F5F5F5; + " |
*Varioliform ([[endoscopic]])
|-
| style="background:#F5F5F5; + " |
*[[Gluten]]
| style="background:#F5F5F5; + " |
*[[Celiac disease]]-associated
|-
| style="background:#F5F5F5; + " |
*Drug ([[ticlopidine]])
| style="background:#F5F5F5; + " |
|-
| style="background:#F5F5F5; + " |
*''[[Helicobacter pylori]]''
| style="background:#F5F5F5; + " |
|-
| rowspan="5" style="background:#DCDCDC;" align="center" + |'''Noninfectious granulomatous'''
| style="background:#F5F5F5; + " |
*[[Crohn's disease]]
| style="background:#F5F5F5; + " |
|-
| style="background:#F5F5F5; + " |
*[[Sarcoidosis]]
| style="background:#F5F5F5; + " |
|-
| style="background:#F5F5F5; + " |
*[[Granulomatosis with polyangiitis]] and other [[vasculitides]]
| style="background:#F5F5F5; + " |
|-
| style="background:#F5F5F5; + " |
*Foreign substances
| style="background:#F5F5F5; + " |
|-
| style="background:#F5F5F5; + " |
*Idiopathic
| style="background:#F5F5F5; + " |
*Isolated [[granulomatous]]
|-
| rowspan="2" style="background:#DCDCDC;" align="center" + |'''Eosinophilic'''
| style="background:#F5F5F5; + " |
*[[Food allergy|Food sensitivity]]
| style="background:#F5F5F5; + " |
*[[Allergic]]
|-
| style="background:#F5F5F5; + " |
*Other [[allergies]]
| style="background:#F5F5F5; + " |
|-
| rowspan="2" style="background:#DCDCDC;" align="center" + |'''Other infectious gastritides'''
| style="background:#F5F5F5; + " |
*[[Bacteria]] (other than ''[[Helicobacter pylori]]'')
| style="background:#F5F5F5; + " |
*Phlegmonous
|-
| style="background:#F5F5F5; + " |
*[[Viruses]]
*[[Fungi]]
*[[Parasites]]
| style="background:#F5F5F5; + " |
|}
<br />
<br />
*In clinical practice, gastritis staging is done using the OLGA (Operative Link on Gastritis Assessment) staging system for reporting gastric histology. Gastritis staging combines the atrophy score which is determined by biopsy and the atrophy topography which is determined by directed biopsy mapping. <ref name="pmid17142647">{{cite journal| author=Rugge M, Meggio A, Pennelli G, Piscioli F, Giacomelli L, De Pretis G et al.| title=Gastritis staging in clinical practice: the OLGA staging system. | journal=Gut | year= 2007 | volume= 56 | issue= 5 | pages= 631-6 | pmid=17142647 | doi=10.1136/gut.2006.106666 | pmc=1942143 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17142647 }} </ref> <ref name="pmid18424244">{{cite journal| author=Rugge M, Correa P, Di Mario F, El-Omar E, Fiocca R, Geboes K et al.| title=OLGA staging for gastritis: a tutorial. | journal=Dig Liver Dis | year= 2008 | volume= 40 | issue= 8 | pages= 650-8 | pmid=18424244 | doi=10.1016/j.dld.2008.02.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18424244  }} </ref>
<br />
{|
! colspan="6" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Gastritis staging in clinical practice: The OLGA staging system'''
|-
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" + | '''Atrophy Score'''
! colspan="4" style="background:#4479BA; color: #FFFFFF;" + |  '''Corpus'''
|-
! style="background:#DCDCDC;" align="center" + | No Atrophy (Score: 0)
! style="background:#DCDCDC;" align="center" + | Mild Atrophy (Score: 1)
! style="background:#DCDCDC;" align="center" + | Moderate Atrophy (Score: 2)
! style="background:#DCDCDC;" align="center" + | Severe Atrophy (Score: 3)
|-
! rowspan="4" style="background:#7d7d7d; color: #FFFFFF;" align="center" + |
A
 
N


{{CMG}}
T


==Overview==
R
 
U
 
M
 
! style="background:#DCDCDC;" align="center" + | No Atrophy (Score: 0) (''including incisura angularis'')
| style="background:#F5F5F5;" align="center" + | STAGE 0
| style="background:#F5F5F5;" align="center" + | STAGE I
| style="background:#F5F5F5;" align="center" + | STAGE II
| style="background:#F5F5F5;" align="center" + | STAGE II
|-
! style="background:#DCDCDC;" align="center" + | Mild Atrophy (Score: 1)  (''including incisura angularis'')
| style="background:#F5F5F5;" align="center" + | STAGE I
| style="background:#F5F5F5;" align="center" + | STAGE I
| style="background:#F5F5F5;" align="center" + | STAGE II
| style="background:#F5F5F5;" align="center" + | STAGE III
|-
! style="background:#DCDCDC;" align="center" + | Moderate Atrophy (Score: 2)  (''including incisura angularis'')
| style="background:#F5F5F5;" align="center" + | STAGE II
| style="background:#F5F5F5;" align="center" + | STAGE II
| style="background:#F5F5F5;" align="center" + | STAGE III
| style="background:#F5F5F5;" align="center" + | STAGE IV
|-
! style="background:#DCDCDC;" align="center" + | Severe Atrophy (Score: 3)  (''including incisura angularis'')
| style="background:#F5F5F5;" align="center" + | STAGE III
| style="background:#F5F5F5;" align="center" + | STAGE III
| style="background:#F5F5F5;" align="center" + | STAGE IV
| style="background:#F5F5F5;" align="center" + | STAGE IV
|}


==Classification==
'''''Sydney system for grading of chronic gastritis'''''<ref name="pmid8827022">{{cite journal| author=Dixon MF, Genta RM, Yardley JH, Correa P| title=Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. | journal=Am J Surg Pathol | year= 1996 | volume= 20 | issue= 10 | pages= 1161-81 | pmid=8827022 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8827022  }} </ref>


There are two types of Gastritis:
{|
:*'''Acute gastritis:''' a sudden [[inflammation]] of the lining of the [[stomach]].
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Sydney system for grading of Chronic Gastritis'''
:*'''Chronic gastritis:''' inflammation of the lining of the stomach that persists for a long time.
|-
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + | Feature
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + | Definition
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" + | Grading guidelines
|-
| style="background:#DCDCDC; + " | '''Chronic inflammation'''
| style="background:#F5F5F5; + " |
*Increased [[lymphocytes]] and [[plasma cells]] in [[lamina propria]]
| style="background:#F5F5F5; + " |
* Mild, moderate or severe increase in density
|-
| style="background:#DCDCDC; + " | '''Activity'''
| style="background:#F5F5F5; + " |
*[[Neutrophil|Neutrophilic]] infiltrates of the [[lamina propria]], pits or surface [[epithelium]]
| style="background:#F5F5F5; + " |
* Mild: less than one-third of pits and surface infiltrated
* Moderate: one-third to two-thirds
* Severe: more than two-thirds
|-
| style="background:#DCDCDC; + " | [[Atrophy|'''Atrophy''']]
| style="background:#F5F5F5; + " |
*Loss of specialized glands from either [[antrum]] or corpus
| style="background:#F5F5F5; + " |
* Mild, moderate, or severe loss
|-
| style="background:#DCDCDC; + " | ''[[Helicobacter pylori|'''Helicobacter pylori''']]''
| style="background:#F5F5F5; + " |
*''[[H. pylori]]'' density
| style="background:#F5F5F5; + " |
* Mild colonization: scattered organisms covering less than one-third of the surface
* Moderate colonization: intermediate numbers
* Severe colonization: large clusters or a continuous layer over two-thirds of surface
|-
| style="background:#DCDCDC; + " | '''Intestinal [[Metaplasia]]'''
| style="background:#F5F5F5; + " |
*[[Intestinal]] [[metaplasia]] of the epithelium
| style="background:#F5F5F5; + " |
* Mild: less than one-third of mucosa involved
* Moderate: one-third to two-thirds
* Severe: more than two-thirds
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 21:49, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]}}

Overview

The Updated Sydney System establishes the classification and grading of gastritis which underlines the significance of combining topographical, morphological, and etiological information to help arrive at clinical diagnosis. In clinical practice, gastritis staging is done using the OLGA (Operative Link on Gastritis Assessment) staging system for reporting gastric histology. Gastritis staging combines the atrophy score which is determined by biopsy and the atrophy topography which is determined by directed biopsy mapping.

Classification

  • The Updated Sydney System establishes the classification and grading of gastritis which underlines the significance of combining topographical, morphological, and etiological information to help arrive at clinical diagnosis. [1]
Classification and grading of Gastritis: Updated Sydney System
Type of Gastritis Etiology Gastritis synonyms
Non-atrophic
  • Superficial
  • Diffuse antral gastritis (DAG)
  • Chronic antral gastritis (CAG)
  • Interstitial - follicular
  • Hypersecretory
  • Type B*
Atrophic Autoimmune
Multifocal atrophic
  • Type B*, type AB*
  • Dietary
  • Environmental
  • Environmental factors
  • Metaplastic
Special forms Chemical
  • Chemical irritation
  • Reactive
  • Reflux
  • Other agents
  • Type C
Radiation
Lymphocytic
Noninfectious granulomatous
  • Foreign substances
  • Idiopathic
Eosinophilic
Other infectious gastritides
  • Phlegmonous



  • In clinical practice, gastritis staging is done using the OLGA (Operative Link on Gastritis Assessment) staging system for reporting gastric histology. Gastritis staging combines the atrophy score which is determined by biopsy and the atrophy topography which is determined by directed biopsy mapping. [2] [3]


Gastritis staging in clinical practice: The OLGA staging system
Atrophy Score Corpus
No Atrophy (Score: 0) Mild Atrophy (Score: 1) Moderate Atrophy (Score: 2) Severe Atrophy (Score: 3)

A

N

T

R

U

M

No Atrophy (Score: 0) (including incisura angularis) STAGE 0 STAGE I STAGE II STAGE II
Mild Atrophy (Score: 1) (including incisura angularis) STAGE I STAGE I STAGE II STAGE III
Moderate Atrophy (Score: 2) (including incisura angularis) STAGE II STAGE II STAGE III STAGE IV
Severe Atrophy (Score: 3) (including incisura angularis) STAGE III STAGE III STAGE IV STAGE IV

Sydney system for grading of chronic gastritis[1]

Sydney system for grading of Chronic Gastritis
Feature Definition Grading guidelines
Chronic inflammation
  • Mild, moderate or severe increase in density
Activity
  • Mild: less than one-third of pits and surface infiltrated
  • Moderate: one-third to two-thirds
  • Severe: more than two-thirds
Atrophy
  • Loss of specialized glands from either antrum or corpus
  • Mild, moderate, or severe loss
Helicobacter pylori
  • Mild colonization: scattered organisms covering less than one-third of the surface
  • Moderate colonization: intermediate numbers
  • Severe colonization: large clusters or a continuous layer over two-thirds of surface
Intestinal Metaplasia
  • Mild: less than one-third of mucosa involved
  • Moderate: one-third to two-thirds
  • Severe: more than two-thirds

References

  1. ↑ 1.0 1.1 Dixon MF, Genta RM, Yardley JH, Correa P (1996). "Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994". Am J Surg Pathol. 20 (10): 1161–81. PMID 8827022.
  2. ↑ Rugge M, Meggio A, Pennelli G, Piscioli F, Giacomelli L, De Pretis G; et al. (2007). "Gastritis staging in clinical practice: the OLGA staging system". Gut. 56 (5): 631–6. doi:10.1136/gut.2006.106666. PMC 1942143. PMID 17142647.
  3. ↑ Rugge M, Correa P, Di Mario F, El-Omar E, Fiocca R, Geboes K; et al. (2008). "OLGA staging for gastritis: a tutorial". Dig Liver Dis. 40 (8): 650–8. doi:10.1016/j.dld.2008.02.030. PMID 18424244.

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