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Classification and Grading of Gastritis: The Updated Sydney System

Dixon, Michael F. M.D., F.R.C.Path; Genta, Robert M. M.D.; Yardley, John H. M.D.; Correa, Pelayo M.D.; the Participants in the International Workshop on the Histopathology of Gastritis, Houston 1994

American Journal of Surgical Pathology: October 1996 - Volume 20 - Issue 10 - pp 1161-1181
Original Article

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.

From the University of Leeds, England (M.F.D.); VAMC and Baylor College of Medicine, Houston, Texas (R.M.G.); Johns Hopkins University School of Medicine, Baltimore, Maryland (J.H.Y.); Louisiana State University Medical Center, New Orleans, Louisiana (P.C.), and the participants in the International Workshop on the Histopathology of Gastritis, Houston, Texas, September 1994: Kenneth P. Batts, Rochester, Minnesota, U.S.A.; Beverly B. Dahms, Cleveland, Ohio, U.S.A.; M. Isabel Filipe, London, England; Rodger C. Haggitt, Seattle, Washington, U.S.A.; Jules Haot, Brussels, Belgium; P.K. Hui, Hong Kong; Juan Lechago, Houston, Texas; Klaus Lewin, Los Angeles, California, U.S.A.; Johan A. Offerhaus, Amsterdam, The Netherlands; Ashley B. Price, Harrow, UK; Sixto Recavarren, Lima, Peru; Robert H. Riddell, Hamilton, Ontario, Canada; Pentti Sipponen, Helsinki, Finland; Enrico Solcia, Pavia, Italy; Manfred Stolte, Bayreuth, Germany; Hidenobu Watanabe, Niigata, Japan.

Address correspndence and reprint requests to Dr. Robert M. Genta, Pathology 113, VAMC, 2002 Holcombe Blvd., Houston, TX 77030, U.S.A.

This article represents a consensus of opinions expressed by members of the Houston Gastritis Workshop as interpreted by the primary authors. Individual members do not necessarily subscribe to all the opinions contained in the article.

© Lippincott-Raven Publishers