CLASSIFICATION AND GRADING OF GASTRITIS - THE UPDATED SYDNEY SYSTEM

The Sydney System for the classification of gastritis emphasized the i mportance of combining topographical, morphological, and etiological i nformation into a schema that would help to generate reproducible and clinically useful diagnoses. To reappraise the Sydney System 4 years a fter its introduction, a group of gastrointestinal pathologists from v arious parts of the world met in Houston, Texas, in September 1994. Th e aims of the workshop were (a) to establish an agreed terminology of gastritis; (b) to identify? define, and attempt to resolve some of the problems associated with the Sydney System. This article introduces t he Sydney System as it was revised at the Houston Gastritis Workshop a nd represents the consensus of the participants. Overall, the principl es and grading of the Sydney System were only slightly modified, the g rading being aided by the provision of a visual analogue scale. The te rminology of the final classification has been improved to emphasize t he distinction between the atrophic and nonatrophic stomach; the names used for each entity were selected because they are generally accept able to both pathologists and gastroenterologists. In addition to the main categories and atrophic and nonatrophic gastritis, the special or distinctive forms are described and their respective diagnostic crite ria are provided. The article includes practical guidelines for optima l biopsy sampling of the stomach, for the use of the visual analogue s cales for grading the histopathologic features, and for the formulatio n of a comprehensive standardized diagnosis. A glossary of gastritis-r elated terms as used in this article is provided.