Detection of gastric precancerous conditions in daily clinical practice: a nationwide survey

Edith Lahner, Angelo Zullo, Cesare Hassan, Francesco Perri, Mário Dinis-Ribeiro, Gianluca Esposito, Emilio Di Giulio, Elisabetta Buscarini, Maria A ntonietta Bianco, Michele De Boni, Bruno Annibale

Research output: Contribution to journalArticle


BACKGROUND: The burden of gastric precancerous conditions and factors associated with their detection have not been fully investigated in community-based settings. Little is known about adherence to Sydney system for histopathology of gastric biopsies.

OBJECTIVE: We aimed to investigate what really happens in clinical practice with regard to the detection of gastric atrophy and intestinal metaplasia in dyspeptic patients.

METHODS: We performed a nationwide survey of 979 consecutive patients (50-65 years old) with dyspeptic symptoms, examined at 24 gastrointestinal endoscopy units throughout Italy. Clinical information was collected from questionnaires; a standard bioptic mapping was performed in each unit, biopsies from each patient were analyzed by histopathology performed according to daily clinical practice in each local histopathology center.

RESULTS: Separate descriptions of antral and corporal biopsies were included in 679 pathology reports (69%), whereas Sydney system was applied in 324 reports (33%). Gastric atrophy without intestinal metaplasia (GA) and gastric atrophy with intestinal metaplasia (GIM) were detected in 322 (33%) patients. The full adherence to Sydney system significantly increased the probability of detecting GIM (OR 9.6, 95% CI 5.5-16.7), GA (OR 1.92, 95% CI 1.07-3.44), and either of the conditions (OR 6.67, 95% CI 4.36-10.19).

CONCLUSIONS: This nationwide survey showed that in one-third of dyspeptic patients, gastric precancerous conditions are detected. In daily routine practice, only 1/3 of histology reports were worked out adhering to Sydney system showing that international guidelines are poorly observed in clinical practice. This may represent a critical element for surveillance strategies for gastric cancer.

Original languageEnglish
Pages (from-to)417-424
Number of pages8
Issue number6
Publication statusPublished - Dec 1 2014


  • gastric atrophy
  • Gastric cancer
  • guidelines adherence
  • intestinal metaplasia
  • Sydney system

ASJC Scopus subject areas

  • Medicine(all)

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    Lahner, E., Zullo, A., Hassan, C., Perri, F., Dinis-Ribeiro, M., Esposito, G., Di Giulio, E., Buscarini, E., Bianco, M. A. N., De Boni, M., & Annibale, B. (2014). Detection of gastric precancerous conditions in daily clinical practice: a nationwide survey. Helicobacter, 19(6), 417-424.