The OLGA staging system classifies the stage of gastritis based on the extent and location of gastric atrophy identified through biopsy samples from five sites. Stages are determined by combining the histological severity of atrophy with its topographic distribution, with higher stages being more strongly associated with gastric cancer risk. Initially developed in 2006, OLGA aims to standardize gastritis reporting and risk assessment internationally. Studies have found OLGA staging useful for predicting progression to neoplasia and tailoring endoscopic surveillance strategies.

1. OLGA
OPERATIVE LINK FOR GASTRIC ASSESSMENT
DR. SANSAR BABU TIWARI
PGY II, DEPARTMENT OF PATHOLOGY
TUTH, MAHARAJGUNJ MEDICAL CAMPUS
18TH JANUARY 2021
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2. OLGA System:
 The successful experience of hepatitis staging prompted
an international group of gastroenterologists and
pathologists (Operative Link on Gastritis Assessment
(OLGA)) to develop a histological staging system for
gastric inflammatory diseases that would meet the
same objectives as the hepatitis staging system.
 An international group of gastroenterologists and
pathologists proposed a system of gastritis reporting in
terms of stage: The Operative Link for Gastritis
Assessment (OLGA) staging system.
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3. OLGA system
 Based on the evidence that the extent of histological
gastric atrophy correlates with the risk of gastric
cancer (Stages 0-IV).
 Supported by international guidelines (MAPS II, Kyoto,
Maastricht V/Florence)
Rugge et al Dig Liver Dis 2008
Capelle et al. Gastrointest Endoscopy 2010
Sugano et al. Gut 2015
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4. Past to Now: The OLGA system
 1984: Warren and Marshall proposed bacterial cause.
 1990: Guidelines for the classifications and grading of gastritis were
developed by a group of investigators in Sydney, Australia.
 1994:Updated Sydney system and established consensus terminology for
gastritis.
 2006: Diagnostic reporting system was designed to use the staging of
gastritis as a tool for assessing the risk of gastric cancer. (OLGA)
 2010: Capelle et al published an article in ASoGI endoscopy about OLGIM.
Rugge et al. wrote a letter to the editor considering IM as a part of
atrophy.
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5. Five sites for biopsy
 Two samples from antrum:
 Minor curvature
 Major curvature 3-4 cm from the
pylorus
 Two from corpus:
 Greater curvature more than 8 cm
from the cardia
 Lesser curvature less than 4 cm
proximal of the incisura angularis
 One from incisura angularis:
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A Case and Control Study of the OLGA System’s Impact on Detection of
Chronic Atrophic Gastritis in Colombia, 2016, Diana Martinez et al
- 3 containers ( Antrum, Body and incisura angularis)

6. Correa’s Precancerous cascade 6

7. OLGA vs OLGIM
 OLGA includes all form of atrophy:
 Non metaplastic atrophy (Reduction of native
glands)
 Metaplastic atrophy (Complete and incomplete)
 OLGIM includes intestinal metaplasia only:
 OLGIM has better reproducibility however it is less
sensitive .
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8. OLGA vs OLGIM 8

9. Why all about atrophy?
 Parietal cells get atrophied  Decreased acid secretion
 Increased Gastrin  Trophic hormone for gastric
mucosal cells.
 H. pylori infection  Metaplasia is a host defense
against organism.  Paneth cells have some defense
mechanism (Human defensin-5).
 Sulfomucins are more resistant than other mucins to
bacterial enzyme related degradation.
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10. Body and fundus 10

11. Antrum 11

12. Rationale for labelling:
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13. Working with the figure:
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14. Endoscopic suspicion of Atrophy:
Mottling is a common feature
14
400 patients
Normal gastroscopic but histological gastritis in 14%
Normal histology despite gastroscopic abnormality in 20%
Sleisenger and Fordtran’s Gastrointestinal and Liver Disease

15. Endoscopic suspicion of IM: Whitish
plaque is a common feature
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16. Requisition of OLGA
 Use of well-defined biopsy sampling protocol (Sydney system) is
considered the minimal requirement for reliable staging of chronic
gastritis.
 Stage is determined by the combination of the extent of atrophy (scored
histologically) with its topographic location (resulting from the mapping
protocol).
 Information about the likely cause of gastritis (Eg. Autoimmune)
 Well oriented gastric biopsy with complete thickness of mucosa.
 Full diagnosis will be:
 H pylori non-atrophic antrum-predominant gastritis
 Corpus-restricted atrophic gastritis without H. pylori infection,
suggestive of autoimmune gastritis.
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17. OLGA staging:
 The stage of gastritis is obtained by combining
the extent of atrophy scored histologically with
the topography of atrophy identified by the
multiple biopsies.
 The OLGA reporting system also includes the
etiological information obtainable from the
tissues available (H. pylori and autoimmune).
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18. OLGA: Staging table 18
None: 0%
Mild: 1-30%
Moderate: 31-60%
Severe: >60%

19. OLGA: Caveat
30%
30%
30%
60%
60%
19
None: 0%
Mild: 1-30%
Moderate: 31-60%
Severe: >60%
Sleisenger and Fordtran’s Gastrointestinal and Liver Disease

20. 20

21. The significance of OLGA staging systems in
the risk assessment of gastric cancer, Yue et
al, 2018
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22. OLGA system: Progression to Neoplasia
 Visualizes the extension of non-metaplastic atrophy,
intestinal metaplasia and pseudopyloric metaplasia
 Indicates cancer risk
 Stages 0-II: Low risk
 Stages III-IV: Strong association with gastric cancer
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23. A case control study in
Colombia
Out of 20 patients with dysplasia, 2 were in OLGA II while the remaining 18 were included in Stage
III/IV. They concluded the endoscopic surveillance of Stage II should be tailored individually.
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24. Take home points
 Updated Sydney system and OLGA staging system was coined almost
two decades ago. We can be the first to start in our country.
 As OLGA staging has shown significant relation with progression into
gastric cancer, it can have a real impact at our National Policy Level.
 Although it might seem expensive and cumbersome initially, the
overall endoscopic surveillance and follow up cost is seemed to be
significantly decreased.
 There will be a standardized stage which can be understood in any
part of the world.
 It can be used in mass screening of patients to find the prevalence of
atrophy, dysplasia and gastric cancer.
 Research can be done in this field as part of curriculum or in a broader
aspect.
 Patients with extensive atrophic gastritis (Stage III/IV) needs follow up
endoscopy every 3 years. (Eur Soc for GI Endo)
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25. Thank You!
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5 sites 3 containers