Application of OLGA (Operative link on gastritis assessment) staging system for gastritis in alcoholics- a cross sectional study

Introduction: Gastritis is an inflammatory condition of the gastric mucosa. Atrophy of the gastric mucosa is the endpoint of chronic processes, such as chronic gastritis associated with H. pylori infection. Currently, no reporting scheme/terminology for chronic gastritis is available that is both easily understood by clinicians and patients and also provides prognostic and therapeutic information in unequivocal terms. An international group Operative Link on Gastritis Assessment (OLGA) proposed a staging system for reporting gastric histology. This gastritis staging integrates the atrophy score (obtained by biopsy) and the atrophy topography (achieved through directed biopsy mapping). This prospective cross?sectional study aimed to apply the OLGA staging system for reporting gastric histology in alcoholic patients with gastritis, thus validate the OLGA gastritis staging system as a routine histology reporting system. Materials and Methods: A prospective study was conducted from October 2013 to June 2015 in the Department of Gastroenterology, M.S. Ramaiah Hospitals (M.S. Ramaiah Teaching Hospital and M.S. Ramaiah Memorial Hospital), Bangalore. 150 alcoholic patients were involved in the study. Age, sex, presenting complaints and detailed history regarding alcohol intake was taken followed by investigations like Complete Blood Count, Liver Function Tests, Renal Function Tests and ultrasound abdomen. Patients were categorised clinically into 4 groups as Alcohol Dependence Syndrome (ADS), fatty liver, Compensated Liver Disease (CLD) and Decompensated Liver Disease (DCLD). Rapid urease test was done for all the patients and 5 biopsy samples (2 from antral mucosa, 2 from oxyntic area and one from the mucosa of the incisura angularis.) were obtained and sent to the pathology department. Sections made from these gastric biopsies were stained with H and E and Giemsa stain. Sections were then evaluated for the presence of H. pylori. Severity of atrophic gastritis was noted and finally OLGA scoring was given for each patient. Results: In the 150 alcoholic patients included in the study, prevalence of H. pylori was 76%. The age and the gender did not play a role in the H. pylori infection. ADS constituted 53 patients (35.3%), Fatty liver 21 (14%), CLD 39 (26%), DCLD 37 (24.7%). H. pylori prevalence was 60.4%, 71.4%, 82.1% and 94.6% respectively. With the increase in OLGA staging, number of H. pylori positive patients increased, which is statistically significant (p value is <0> Majority of the patients with ADS belonged to OLGA stage 0 (37 cases, 69.8%) and majority of the patients with DCLD belonged to OLGA stage II (26 cases, 70.3%). The current study revealed that the OLGA staging increased with worsening of the ALD. Conclusion: The OLGA staging increases as the clinical presentation of ALD worsens. With the increase in OLGA staging, number of H. pylori positive patients increased. The new OLGA staging system proved easy to use and provides clear prognostic information.