There are now also enhanced endoscopic techniques, such as narrow band imaging and i-scan, which make the assessment of this finding much easier. In the present study, we found that the moderate-to-severe EGA had a high sensitivity and negative predictive value for the diagnosis of high-stage gastritis. More than half of the patients in the present study would have been effectively excluded from taking systemic map biopsies if this criterion had HSP inhibitor review been applied. As the prevalence of high-stage gastritis is very low, even in high-risk populations,7 the positive predictive value of this endoscopic finding was also low. The specificity of this finding was just

57.7%, which means that many patients with moderate-to-severe EGA might have OLGA gastritis stages 0–II, and the assessment of EGA cannot replace pathological gastritis staging as the gold standard of atrophy. Because previous studies have shown that moderate-to-severe EGA is related to a high risk of developing gastric cancer,2,4 adding OLGA gastritis staging could further stratify these patients into subgroups with different risk levels of developing gastric cancer. Regarding dysplastic lesions,

Kokkola et al. reported that 68% (57/84) of mild dysplastic lesions in the stomach had no visible endoscopic findings and were only detected by random biopsy specimens.24 Low-grade dysplastic lesions in the present study, not surprisingly, also shared the same characteristics.

The detection and surveillance of these Selleckchem Crizotinib lesions are crucial, as a recent study, which is based on data from the Dutch nation-wide histopathology registry, reported that the annual incidence of medchemexpress gastric cancer was 0.6% in the first 5 years.25 Interestingly, the present study showed that 85.7% (6/7) of the dysplastic lesions, like high-stage gastritis, also clustered in patients with moderate-to-severe EGA (P = 0.028). Although moderate-to-severe EGA has been shown to be a risk factor of gastric cancer in several studies,2,4,5 the pathological results of the present study showed that patients with this endoscopic finding could be further stratified into subgroups with different risk levels of gastric cancer. In our opinion, a detailed baseline pathological examination should be carried out in all of these patients, so that individualized follow-up frequencies can be defined for each subgroup. To conclude, moderate-to-severe EGA has a high sensitivity and negative predictive value for high-stage OLGA gastritis. As gastric neoplastic lesions cluster in patients with high-stage gastritis, this endoscopic finding could select the subgroup of patients who will benefit from taking systemic map biopsies and the appropriate candidates for a potentially cost-effective surveillance program in regions with low-to-moderate incidence of gastric cancer.