Gastritis classification

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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.
  

Classification and grading of Gastritis: Updated Sydney System
Type of Gastritis		Etiology	Gastritis synonyms
Non-atrophic		Helicobacter pylori Other factors	Superficial Diffuse antral gastritis (DAG) Chronic antral gastritis (CAG) Interstitial - follicular Hypersecretory Type B*
Atrophic	Autoimmune	Autoimmunity	Type A* Diffuse corporal Pernicious anemia-associated
	Multifocal atrophic	Helicobacter pylori	Type B*, type AB*
		Dietary	Environmental
		Environmental factors	Metaplastic
Special forms	Chemical	Chemical irritation	Reactive
		Bile	Reflux
		NSAIDs	NSAID
		Other agents	Type C
	Radiation	Radiation injury
	Lymphocytic	Idiopathic? Immune mechanisms	Varioliform (endoscopic)
		Gluten	Celiac disease-associated
		Drug (ticlopidine)
		Helicobacter pylori
	Noninfectious granulomatous	Crohn's disease
		Sarcoidosis
		Granulomatosis with polyangiitis and other vasculitides
		Foreign substances
		Idiopathic	Isolated granulomatous
	Eosinophilic	Food sensitivity	Allergic
		Other allergies
	Other infectious gastritides	Bacteria (other than Helicobacter pylori)	Phlegmonous
		Viruses Fungi Parasites

• 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.

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

Sydney system for grading of Chronic Gastritis
Feature	Definition	Grading guidelines
Chronic inflammation	Increased lymphocytes and plasma cells in lamina propria	Mild, moderate or severe increase in density
Activity	Neutrophilic infiltrates of the lamina propria, pits or surface epithelium	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	H. pylori density	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	Intestinal metaplasia of the epithelium	Mild: less than one-third of mucosa involved Moderate: one-third to two-thirds Severe: more than two-thirds