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Journal ArticleDOI

The Sydney System: histological division.

01 Jun 1991-Journal of Gastroenterology and Hepatology (J Gastroenterol Hepatol)-Vol. 6, Iss: 3, pp 209-222
TL;DR: It is appropriate to review the existing classifications and to produce a system that, in the light of new knowledge, will find widespread acceptance, was the remit given to a small multidisciplinary Working Party by the Scientific Committee of the 9th World Congresses in Gastroenterology.
Abstract: Gastritis, inflammation of the gastric mucosa, represents the stomach’s response to injury. A continuing dilemma has been the very large size of the population with gastritis in contrast to the lack of knowledge about specific causes. The discovery of Helicobacter pylori as the major cause of inflammation of the gastric antrum has helped resolve this As a result, accurate and uniform documentation of gastritis from gastric endoscopic biopsies assumes prime importance for understanding the dynamics of gastritis and has a major contribution to make to the study of the natural history of peptic ulcer disease and also, perhaps, to the evolution of gastric cancer. Increasing numbers of papers are appearing in the literature documenting the pathology of gastritis, its relation to H. pylori and the response to therapeutic agents.+” At present, a variety of classifications and systems of grading are in use, making it difficult to compare the results.10*12-21 It is therefore appropriate to review the existing classifications and to produce a system that, in the light of new knowledge, will find widespread acceptance. This was the remit given to a small multidisciplinary Working Party by the Scientific Committee of the 9th World Congresses in Gastroenterology. The Working Party sought additional advice from an ad hoc Advisory Group of European pathologists sharing a special interest in gastric pathology. T o gain widespread acceptance, any proposed classification must be simple, easy to apply, flexible, correlate with existing classifications, be sensitive to monitoring therapy and appeal to generalists as well as dedicated gastroenterologists, and diagnosticians as well as research workers.
Citations
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Journal ArticleDOI
TL;DR: The Sydney System for the classification of gastritis emphasized the importance of combining topographical, morphological, and etiological information into a schema that would help to generate reproducible and clinically useful diagnoses as discussed by the authors.
Abstract: The Sydney System for the classification of gastritis emphasized the importance of combining topographical, morphological, and etiological information into a schema that would help to generate reproducible and clinically useful diagnoses. To reappraise the Sydney System 4 years after its introduction, a group of gastrointestinal pathologists from various parts of the world met in Houston, Texas, in September 1994. The 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 the Sydney System as it was revised at the Houston Gastritis Workshop and represents the consensus of the participants. Overall, the principles and grading of the Sydney System were only slightly modified, the grading being aided by the provision of a visual analogue scale. The terminology of the final classification has been improved to emphasize the distinction between the atrophic and nonatrophic stomach; the names used for each entity were selected because they are generally acceptable 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 criteria are provided. The article includes practical guidelines for optimal biopsy sampling of the stomach, for the use of the visual analogue scales for grading the histopathologic features, and for the formulation of a comprehensive standardized diagnosis. A glossary of gastritis-related terms as used in this article is provided.

4,511 citations

Journal ArticleDOI
01 Sep 2015-Gut
TL;DR: A global consensus for gastritis was developed for the first time, which will be the basis for an international classification system and for further research on the subject.
Abstract: Objective To present results of the Kyoto Global Consensus Meeting, which was convened to develop global consensus on (1) classification of chronic gastritis and duodenitis, (2) clinical distinction of dyspepsia caused by Helicobacter pylori from functional dyspepsia, (3) appropriate diagnostic assessment of gastritis and (4) when, whom and how to treat H. pylori gastritis. Design Twenty-three clinical questions addressing the above-mentioned four domains were drafted for which expert panels were asked to formulate relevant statements. A Delphi method using an anonymous electronic system was adopted to develop the consensus, the level of which was predefined as ≥80%. Final modifications of clinical questions and consensus were achieved at the face-to-face meeting in Kyoto. Results All 24 statements for 22 clinical questions after extensive modifications and omission of one clinical question were achieved with a consensus level of >80%. To better organise classification of gastritis and duodenitis based on aetiology, a new classification of gastritis and duodenitis is recommended for the 11th international classification. A new category of H. pylori -associated dyspepsia together with a diagnostic algorithm was proposed. The adoption of grading systems for gastric cancer risk stratification, and modern image-enhancing endoscopy for the diagnosis of gastritis, were recommended. Treatment to eradicate H. pylori infection before preneoplastic changes develop, if feasible, was recommended to minimise the risk of more serious complications of the infection. Conclusions A global consensus for gastritis was developed for the first time, which will be the basis for an international classification system and for further research on the subject.

1,182 citations

Journal ArticleDOI
TL;DR: Patients with reflux esophagitis and H. pylori infection who are treated with omeprazole are at increased risk of atrophic gastritis.
Abstract: Background Helicobacter pylori infection plays an important part in the development of atrophic gastritis and intestinal metaplasia, conditions that predispose patients to gastric cancer. Profound suppression of gastric acid is associated with increased severity of gastritis caused by H. pylori, but it is not known whether acid suppression increases the risk of atrophic gastritis. Methods We studied patients from two separate cohorts who were being treated for reflux esophagitis: 72 patients treated with fundoplication in Sweden and 105 treated with omeprazole (20 to 40 mg once daily) in the Netherlands. In both cohorts, the patients were followed for an average of five years (range, three to eight). After fundoplication, the patients did not receive acid-suppressive therapy. The presence of H. pylori was assessed at the first visit by histologic evaluation in the fundoplication group and by histologic and serologic evaluation in the omeprazole group. The patients were not treated for H. pylori infection....

774 citations

Journal ArticleDOI
TL;DR: It is concluded that H pylori infection is a significant risk factor for development of atrophic gastritis and intestinal metaplasia and the causative role of this infection in gastric carcinogenesis is supported.

706 citations

Journal ArticleDOI
TL;DR: The current status of the many different techniques involved in diagnosis of H. pylori infection and their application are reviewed, highlighting the important progress which has been made in the past decade.
Abstract: The discovery of Helicobacter pylori in 1982 was the starting point of a revolution concerning the concepts and management of gastroduodenal diseases. It is now well accepted that the most common stomach disease, peptic ulcer disease, is an infectious disease, and all consensus conferences agree that the causative agent, H. pylori, must be treated with antibiotics. Furthermore, the concept emerged that this bacterium could be the trigger of various malignant diseases of the stomach, and it is now a model for chronic bacterial infections causing cancer. Most of the many different techniques involved in diagnosis of H. pylori infection are performed in clinical microbiology laboratories. The aim of this article is to review the current status of these methods and their application, highlighting the important progress which has been made in the past decade. Both invasive and noninvasive techniques will be reviewed.

679 citations


Cites methods from "The Sydney System: histological div..."

  • ...The usual recommendation derived from the Sydney system (109, 453) is to obtain 2 biopsy specimens from the antrum and 2 specimens from the corpus....

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  • ...Histological results must be reported according to guidelines drawn up in 1990, known as the Sydney system (453)....

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References
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Journal ArticleDOI
TL;DR: The bacteria were present in almost all patients with active chronic gastritis, duodenal ulcer, or gastric ulcer and thus may be an important factor in the aetiology of these diseases.

5,202 citations

Journal ArticleDOI
TL;DR: It is proposed that this disorder may progress to a chronic infection which predisposes to peptic ulceration and be linked to acute pyloric Campylobacter gastritis.
Abstract: A volunteer with histologically normal gastric mucosa received pyloric campylobacter by mouth A mild illness developed, which lasted 14 days Histologically proven gastritis was present on the tenth day after the ingestion of bacteria, but this had largely resolved by the fourteenth day The syndrome of acute pyloric campylobacter gastritis is described It is proposed that this disorder may progress to a chronic infection which predisposes to peptic ulceration

1,251 citations

Journal ArticleDOI
TL;DR: H pylori eradication, without altering acid output, will become the mainstay of duodenal ulcer treatment because it cures the disease.

940 citations

Journal ArticleDOI
TL;DR: Complete normalization of gastric mucosa after amoxicillin monotherapy provides additional strong evidence for a true cause-effect relationship between C. pyloridis colonization and gastritis.

800 citations

Journal ArticleDOI
TL;DR: In this paper, the authors estimated the prevalences of Helicobacter pylori infection and histologic gastritis in 113 asymptomatic persons, using endoscopic biopsy of the gastric antrum and corpus.
Abstract: We estimated the prevalences of Helicobacter pylori (formerly called Campylobacter pylori) infection and histologic gastritis in 113 asymptomatic persons, using endoscopic biopsy of the gastric antrum and corpus. Unsuspected lesions, mainly mucosal erosions, were revealed at endoscopy in 16 subjects (14 percent). Gastritis was found in 42 subjects (37 percent), of whom 36 (32 percent of the total) were found to be infected with H. pylori on the basis of hematoxylin-eosin staining. H. pylori was not found in any of the 71 subjects with normal histologic features. Gastritis and H. pylori were noted in both the antrum and corpus in 75 percent of those infected (n = 27). The prevalence of H. pylori infection increased from 10 percent (2 of 20 subjects) in those between the ages of 18 and 29, to 47 percent (7 of 15) in those between the ages of 60 and 69, but the effect of age did not reach statistical significance. The prevalence of gastritis increased significantly with advancing age. Stepwise logistic regression analysis revealed that the relative risk for H. pylori infection associated with recent (within six months) antibiotic use was 5.8 (95 percent confidence interval, 1.5 to 22.1), whereas the relative risk was 6.5 (95 percent confidence interval, 1.4 to 29.2) for those who had never used bismuth compounds. We conclude that histologic gastritis and H. pylori infection commonly occur in the stomach of apparently normal persons and increase in prevalence with advancing age. All the subjects with H. pylori infection had gastritis, suggesting a possible etiologic role for the bacterium in the histologic lesion.

773 citations