Chronic atrophic gastritis as a precancer: the evolution of ideas from the Sydney consensus to Maastricht VI

Abstract

Aim. The purpose of the work is the evolution of systems and classifications of gastritis: Sydney Consensus (1990), Houston Modification (1994), OLGA/OLGIM (2008), Kyoto (2014), MAPS II (2019), Maastricht IV (2022). Materials and methods. During the work, 25 sources of information were used. Results. Chronic atrophic gastritis (ChAG) is a clinical and morphological diagnosis, and the presented clinical forms (types) of gastritis have characteristic morphological criteria. According to the Sydney system, changes in the antrum and body of the stomach are described separately. This has led to a lack of clear risk stratification criteria for CG and also complicates the objective analysis of regression of inflammation and atrophy. OLGA/OLGIM systems were proposed to determine the stage of atrophy and IM. The authors of the Kyoto consensus add and clarify the etiological section of ChAG. In MAPS II, ChAG and IM are considered precancerous conditions, as they increase the risk of developing gastric cancer and are the background for the occurrence of dysplasia and adenocarcinoma. For patients with dysplasia and the absence of visible changes in the mucous membrane, high-resolution endoscopy with staining is recommended. They should be examined after 6 months for a high degree of dysplasia and after 12 months for a low degree of dysplasia. Patients with IM and one localization have a high risk of developing gastric cancer. However, the high risk does not give the right to follow up in the majority of cases when high-quality endoscopy with biopsy does not show severe atrophy. Patients with IM of one location, with a family history of cancer, or with incomplete IM and persistence of H. pylori chromo endoscopy with biopsy must be done once every 3 years. Patients with extended fields of atrophic aggression (pronounced atrophic changes) or IM in the antrum and body, OLGA/OLGIM III/IV should be screened with chromoendoscopy with biopsy every 3 years. Patients with significant atrophy and familial cancer benefit from chromoendoscopy and biopsy every 1–2 years after initial diagnosis. Patients with autoimmune gastritis are recommended to be screened every 3–5 years. According to Maastricht VI, H. pylori is the main etiological factor of gastric adenocarcinoma, including proximal gastric cancer. Conclusions. After careful study and analysis, we came to the conclusion about the gradual development of the principles of evidence-based medicine in the issue of improving the clinical and morphological diagnosis of chronic atrophic gastritis as a precancerous of the stomach.