Detection of chronic atrophic gastritis at higher risk for gastric cancer in clinical practice: A multicentre study using criteria by different scientific societies

Aims We aimed to assess the detection of patients with chronic atrophic gastritis (CAG) at higher risk in clinical practice according to different criteria like the OLGIM system, the Spanish, the European (MAPS), the Italian, the American (AGA), and the British (BSG) recommendations.

Methods Consecutive first diagnostic gastroscopies performed for any indication in patients older than 18 years old were recorded prospectively in 21 Spanish hospitals between April 2021 and July 2023. Protocolized gastric biopsies were taken according to the Updated Sydney consensus. We included patients with GA or IM. We excluded patients with dysplasia, any malignancy, and suspicion of autoimmune chronic atrophic gastritis. According to Sydney's recommendation, the severity of both GA and IM was separately assessed in the antrum (including incisura) and corpus. OLGA system is not usually reported in clinical practice. Different high-risk criteria were identified and included: (A) OLGIM III-IV, (B) extensive IM but clinically significant, (C) extensive IM regardless of its severity, (D) incomplete IM, (E) extensive GA but clinically significant, and (F) extensive GA regardless its severity. High-risk patients according to different guidelines were: the Spanish [(A or B) and D], MAPS (A or B or D or E), the Italian (A or B or E), AGA (A or C or D or E) and BSG (C or F).

Results A total of 297 patients with atrophy or IM were included. The mean age was 63 (SD±0.7) years old and 57% were women. Hp infection was identified in 118 (40%) patients (23% active infection and 17% eradicated). Regarding IM, 27 (9%) patients were OLGIM III/IV, 60 (20%) patients had extensive distribution, but only 13 (4%) cases were extensive and clinically significant. The OLGIM score was not possible to be estimated in 40 (14%) patients and the type of IM was not reported in 122 (41%) patients. Regarding atrophy, 94 (32%) patients had extensive distribution, but only 25 (8%) cases were extensive and clinically significant. The severity of GA was not reported in 11 (4%) cases. Applying the high-risk criteria by different clinical guidelines, patients at higher risk would have been: the Spanish 8 (3%) cases, OLGIM III-IV 27 (9%) cases, the Italian 42 (14%) cases, MAPS 71 (24%) cases, AGA 105 (35%) cases, and BSG 114 (38%) cases. [1] [2] [3] [4] [5] [6] [7]

Conclusions The high-risk criteria for CAG differ among scientific societies which could lead to a variation from 3% to 38% among patients with CAG. Since the histological report and endoscopic sampling are not perfect, the BSG criteria would be the most sensitive in clinical practice. The histological report must be improved.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

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Publication History

Article published online:
15 April 2024