Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer: A 5-year prospective study of 1755 patients

Massimo Rugge, Alberto Meggio, Cecilia Pravadelli, Mattia Barbareschi, Matteo Fassan, Maria Gentilini, Manuel Zorzi, Giovanni De Pretis, David Y. Graham, Robert M. Genta

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective: Operative link on gastritis assessment (OLGA) staging for gastritis ranks the risk for gastric cancer (GC) in progressive stages (0-IV). This prospective study aimed at quantifying the cancer risk associated with each gastritis stage. Design: A cohort of 1755 consecutive patients with dyspepsia underwent initial (T-0) oesophagogastroduodenoscopy with mapped gastric biopsies, OLGA staging and assessment of Helicobacter pylori infection. Patients were followed for 55 months (median); patients with stages II III and IV underwent a second endoscopy/restaging (T-1), and those with stages 0 and I were followed clinically and through in-depth clinical and record checking. Endpoints were OLGA stage at T-1 and development of gastric epithelial neoplasia. Results: At T-0, 77.6% of patients had stage 0, 14.4% stage I, 5.1% stage II, 2.1% stage III and 0.85% stage IV. H. pylori infection was detected in 603 patients at T-0 and successfully eradicated in 602 of them; 220 had a documented history of H. pylori eradication; and 932 were H. pylori naïve-negative. Incident neoplastic lesions (prevalence=0.4%; low-grade intraepithelial neoplasia (IEN)=4; high-grade IEN=1; GC=2) developed exclusively in patients with stages III-IV. The risk for epithelial neoplasia was null in patients at stages 0, I and II (95% CI 0 to 0.4), 36.5 per 1000 person-years in patients at stage III (95% CI 13.7 to 97.4) and 63.1 per 1000 person-years in patients at stage IV (95% CI 20.3 to 195.6). Conclusions: This prospective study confirms that OLGA staging reliably predicts the risk for development of gastric epithelial neoplasia. Although no neoplastic lesions arose in H. pylori-naïve patients, the H. pylori eradication in subjects with advanced stages (III-IV) did not abolish the risk for neoplastic progression.

Original languageEnglish (US)
JournalGut
DOIs
StateAccepted/In press - Jan 6 2018

Fingerprint

Gastritis
Secondary Prevention
Stomach Neoplasms
Prospective Studies
Helicobacter pylori
Neoplasms
Stomach
Helicobacter Infections
Digestive System Endoscopy
Dyspepsia
Endoscopy
Biopsy

Keywords

  • gastric cancer
  • gastritis
  • helicobacter pylori
  • pre-malignancy - gi tract

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Rugge, M., Meggio, A., Pravadelli, C., Barbareschi, M., Fassan, M., Gentilini, M., ... Genta, R. M. (Accepted/In press). Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer: A 5-year prospective study of 1755 patients. Gut. https://doi.org/10.1136/gutjnl-2017-314600

Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer : A 5-year prospective study of 1755 patients. / Rugge, Massimo; Meggio, Alberto; Pravadelli, Cecilia; Barbareschi, Mattia; Fassan, Matteo; Gentilini, Maria; Zorzi, Manuel; Pretis, Giovanni De; Graham, David Y.; Genta, Robert M.

In: Gut, 06.01.2018.

Research output: Contribution to journalArticle

Rugge, M, Meggio, A, Pravadelli, C, Barbareschi, M, Fassan, M, Gentilini, M, Zorzi, M, Pretis, GD, Graham, DY & Genta, RM 2018, 'Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer: A 5-year prospective study of 1755 patients', Gut. https://doi.org/10.1136/gutjnl-2017-314600
Rugge, Massimo ; Meggio, Alberto ; Pravadelli, Cecilia ; Barbareschi, Mattia ; Fassan, Matteo ; Gentilini, Maria ; Zorzi, Manuel ; Pretis, Giovanni De ; Graham, David Y. ; Genta, Robert M. / Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer : A 5-year prospective study of 1755 patients. In: Gut. 2018.
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abstract = "Objective: Operative link on gastritis assessment (OLGA) staging for gastritis ranks the risk for gastric cancer (GC) in progressive stages (0-IV). This prospective study aimed at quantifying the cancer risk associated with each gastritis stage. Design: A cohort of 1755 consecutive patients with dyspepsia underwent initial (T-0) oesophagogastroduodenoscopy with mapped gastric biopsies, OLGA staging and assessment of Helicobacter pylori infection. Patients were followed for 55 months (median); patients with stages II III and IV underwent a second endoscopy/restaging (T-1), and those with stages 0 and I were followed clinically and through in-depth clinical and record checking. Endpoints were OLGA stage at T-1 and development of gastric epithelial neoplasia. Results: At T-0, 77.6{\%} of patients had stage 0, 14.4{\%} stage I, 5.1{\%} stage II, 2.1{\%} stage III and 0.85{\%} stage IV. H. pylori infection was detected in 603 patients at T-0 and successfully eradicated in 602 of them; 220 had a documented history of H. pylori eradication; and 932 were H. pylori na{\"i}ve-negative. Incident neoplastic lesions (prevalence=0.4{\%}; low-grade intraepithelial neoplasia (IEN)=4; high-grade IEN=1; GC=2) developed exclusively in patients with stages III-IV. The risk for epithelial neoplasia was null in patients at stages 0, I and II (95{\%} CI 0 to 0.4), 36.5 per 1000 person-years in patients at stage III (95{\%} CI 13.7 to 97.4) and 63.1 per 1000 person-years in patients at stage IV (95{\%} CI 20.3 to 195.6). Conclusions: This prospective study confirms that OLGA staging reliably predicts the risk for development of gastric epithelial neoplasia. Although no neoplastic lesions arose in H. pylori-na{\"i}ve patients, the H. pylori eradication in subjects with advanced stages (III-IV) did not abolish the risk for neoplastic progression.",
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AU - Meggio, Alberto

AU - Pravadelli, Cecilia

AU - Barbareschi, Mattia

AU - Fassan, Matteo

AU - Gentilini, Maria

AU - Zorzi, Manuel

AU - Pretis, Giovanni De

AU - Graham, David Y.

AU - Genta, Robert M.

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N2 - Objective: Operative link on gastritis assessment (OLGA) staging for gastritis ranks the risk for gastric cancer (GC) in progressive stages (0-IV). This prospective study aimed at quantifying the cancer risk associated with each gastritis stage. Design: A cohort of 1755 consecutive patients with dyspepsia underwent initial (T-0) oesophagogastroduodenoscopy with mapped gastric biopsies, OLGA staging and assessment of Helicobacter pylori infection. Patients were followed for 55 months (median); patients with stages II III and IV underwent a second endoscopy/restaging (T-1), and those with stages 0 and I were followed clinically and through in-depth clinical and record checking. Endpoints were OLGA stage at T-1 and development of gastric epithelial neoplasia. Results: At T-0, 77.6% of patients had stage 0, 14.4% stage I, 5.1% stage II, 2.1% stage III and 0.85% stage IV. H. pylori infection was detected in 603 patients at T-0 and successfully eradicated in 602 of them; 220 had a documented history of H. pylori eradication; and 932 were H. pylori naïve-negative. Incident neoplastic lesions (prevalence=0.4%; low-grade intraepithelial neoplasia (IEN)=4; high-grade IEN=1; GC=2) developed exclusively in patients with stages III-IV. The risk for epithelial neoplasia was null in patients at stages 0, I and II (95% CI 0 to 0.4), 36.5 per 1000 person-years in patients at stage III (95% CI 13.7 to 97.4) and 63.1 per 1000 person-years in patients at stage IV (95% CI 20.3 to 195.6). Conclusions: This prospective study confirms that OLGA staging reliably predicts the risk for development of gastric epithelial neoplasia. Although no neoplastic lesions arose in H. pylori-naïve patients, the H. pylori eradication in subjects with advanced stages (III-IV) did not abolish the risk for neoplastic progression.

AB - Objective: Operative link on gastritis assessment (OLGA) staging for gastritis ranks the risk for gastric cancer (GC) in progressive stages (0-IV). This prospective study aimed at quantifying the cancer risk associated with each gastritis stage. Design: A cohort of 1755 consecutive patients with dyspepsia underwent initial (T-0) oesophagogastroduodenoscopy with mapped gastric biopsies, OLGA staging and assessment of Helicobacter pylori infection. Patients were followed for 55 months (median); patients with stages II III and IV underwent a second endoscopy/restaging (T-1), and those with stages 0 and I were followed clinically and through in-depth clinical and record checking. Endpoints were OLGA stage at T-1 and development of gastric epithelial neoplasia. Results: At T-0, 77.6% of patients had stage 0, 14.4% stage I, 5.1% stage II, 2.1% stage III and 0.85% stage IV. H. pylori infection was detected in 603 patients at T-0 and successfully eradicated in 602 of them; 220 had a documented history of H. pylori eradication; and 932 were H. pylori naïve-negative. Incident neoplastic lesions (prevalence=0.4%; low-grade intraepithelial neoplasia (IEN)=4; high-grade IEN=1; GC=2) developed exclusively in patients with stages III-IV. The risk for epithelial neoplasia was null in patients at stages 0, I and II (95% CI 0 to 0.4), 36.5 per 1000 person-years in patients at stage III (95% CI 13.7 to 97.4) and 63.1 per 1000 person-years in patients at stage IV (95% CI 20.3 to 195.6). Conclusions: This prospective study confirms that OLGA staging reliably predicts the risk for development of gastric epithelial neoplasia. Although no neoplastic lesions arose in H. pylori-naïve patients, the H. pylori eradication in subjects with advanced stages (III-IV) did not abolish the risk for neoplastic progression.

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