Atrophy and atrophic gastritis: one step beyond the Sydney system

An international workshop to evaluate the concepts of atrophy and atrophic gastritis was held in Houston in 1998. A consensus emerged that: 1) there i s a phenotype of Helicobacter pylori-associated gastritis characterized by pr-ogres sive loss of glands and intestinalization; 2) this phenotype is as sociated with increased risk of gastric ulcer and adenocarcinoma. This patt ern must be consistently recognized and reproducibly diagnosed by histopath ologists. The mucosal biopsy sampling suggested in the updated Sydney Syste m were considered adequate to evaluate a patient for atrophic gastritis. Hi stopathologists were advised to refrain from making a diagnosis of "atrophi c gastritis" unless moderate or severe unequivocal loss of gastric glands a nd/or moderate or severe metaplasia is found in at least 50% of the total g astric mucosa evaluated in the biopsy specimens. When atrophic or metaplast ic changes appear to be more limited, "chronic gastritis with focal atrophy or metaplasia" should be diagnosed, and more extensive sampling should be obtained before the entity "atrophic gastritis" can be diagnosed. Particula r attention uas devoted to the issue of "unequivocal loss of gastric glands ." In general, it was felt that it is difficult to be cer tain about loss o f glands in the presence of moderate or severe inflammation, when one canno t be sure whether the glands have actually disappear-ed of have been displa ced by the inflammatory infiltrate. In these circumstances, the term "indef inite for atrophy" can be used and the patient should be re-evaluated sever al months after the eradication of Helicobacter pylori infection.