Comparative study of OLGA and OLGIM staging system and relationship with clinicopathological characteristics, gastritis stage and interobserver agreement

INTRODUCTION: Atrophic gastritic remains a difficult histopathologic diagnosis
with low interobserver agreement. The Operative Link for Gastritis
Assessment [OLGA]) has proposed a system for reporting gastritis in terms of
stage, which arranges the histological phenotypes of gastritis along a scale of
progressively increasing gastric cancer risk [1]. A recently-proposed OLGIM
system basically incorporates the same staging frame, but replaces the atrophy
with the histological assessment of intestinal metaplasia (IM) alone [2].
AIMS&METHODS: The aim of our study was to compare gastritis staging,
clinicopathological characteristic and interobserver agreement in the assessement
of gastritis by OLGA and OLGIM systems.
RESULTS: 837 patients were enrolled in the study. Overall, 280 (33.4%) and 167
(19.9%) patients were classified as stage I-IV according to OLGA and OLGIM,
respectively. In addition, the stage III-IV was observed in 25 patients staged by
OLGA, but in 24 patients staged by OLGIM. Interobserver agreement for
atrophic gastritis was moderate in antrum and incisura angularis (respectively,
kappa¼0.53 and 0.57, p50.0001), but fair for atrophic gastritis assessement in
corpus (kappa ¼ 0.38). However, interobserver agreement was almost perfect for
intestinal metaplasia assessement both in antrum, incisura angularis and corpus
(respectively, kappa¼0.82, 0.80 and 0.81, p50.0001).
There was a significant positive correlation between the patient age and gastritis
OLGA and OLGIM stage (Rho¼þ0.34; p50.0001). In addition, there was a
weak negative correlation between the serum pepsinogen-1 level, patients’s BMI
and gastritis OLGA and OLGIM stage.
CONCLUSION: OLGA and OLGIM staging systems correlated with clinicopathological
characteristics such serum pepsinogen-1, patient age and BMI.
OLGIM staging system characterized with a highest interobserver agreement,
however, substantial proportion of potentially high-risk individuals would have
been missed if OLGIM staging is applied only. Therefore we recommend to use a
combination of OLGA and OLGIM stages in routine clinical reports.
REFERENCES:
1. 1)Rugge M, Fassan M, Pizzi M, Farinati F, Sturniolo GC, Plebani M,
Graham DY. Operative link for gastritis assessment vs operative link on
intestinal metaplasia assessment. World J Gastroenterol. 2011;17(41):4596-
601.
2. Capelle LG, de Vries AC, Haringsma J, et al. The staging of gastritis with the
OLGA system by using intestinal metaplasia as an accurate alternative for
atrophic gastritis. Gastrointest Endosc 2010; 71: 1150–8