Introduction

Atrophic gastritis (AG) is a well-established precursor of gastric cancer, and its most frequent aetiological agent is Helicobacter pylori (H. pylori). Accurate risk stratification is essential to optimise endoscopic surveillance and resource allocation. The Operative Link on Gastritis Assessment (OLGA) system offers a histological staging tool to quantify the severity of gastric atrophy and associated cancer risk. Despite high H. pylori endemicity in Colombia, local data on the prevalence of advanced OLGA stages remains scarce. This study aimed to elucidate the distribution of OLGA stages and their correlation with age and H. pylori status in a large dyspeptic cohort.

Aims & Methods

We conducted a cross-sectional, observational study of adult patients undergoing upper gastrointestinal endoscopy for dyspepsia between January 2019 and December 2023 at a high-volume reference centre in Bogotá, Colombia. All cases followed the updated Sydney biopsy protocol, with five mapped gastric samples analysed by experienced gastrointestinal pathologists. The OLGA system was applied to stage gastric atrophy (0–IV). H. pylori detection was based on histology using Giemsa and H&E stains. Demographic variables, H. pylori status, OLGA stage, and histological features were recorded. Data were processed using SPSS v26, and statistical significance was set at p<0.05.

Results

Out of 6,746 patients (mean age: 59 years; 73.4% female), 99% exhibited low-risk OLGA stages (0–II). Only 3 patients (0.04%) presented with advanced OLGA stages (III–IV). A positive correlation was noted between increasing age and the frequency of gastric atrophy, although this did not correspond to an increase in advanced stages. H. pylori infection was confirmed in 82% of the cohort, showing an upward trend over the study period. Interestingly, no cases of H. pylori infection were observed among patients with OLGA III–IV. The majority of infections were restricted to the antrum. Gastric dysplasia and cancer were rare events, both observed in <1% of patients. The association between H. pylori and gastric cancer did not reach statistical significance (OR 0.49; 95% CI 0.23–1.04; p=0.07).

Conclusion

Despite the high prevalence of H. pylori, the frequency of advanced OLGA stages remains remarkably low in Colombian dyspeptic patients. These findings reinforce the utility of the OLGA system, coupled with Sydney protocol biopsies, as a valuable approach to risk stratification. Only 1% of patients would benefit from endoscopic surveillance under international guidelines, suggesting that widespread follow-up may be unnecessary and potentially wasteful.

References

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