Gastric mucosal atrophy: interobserver consistency using new criteria for classification and grading

Aliment Pharmacol Ther. 2002 Jul;16(7):1249-59. doi: 10.1046/j.1365-2036.2002.01301.x.


Background and aims: Considerable difficulties persist amongst pathologists in agreeing on the presence and severity of gastric atrophy. An international group of pathologists pursued the following aims: (i) to generate an acceptable definition and a simple reproducible classification of gastric atrophy; and (ii) to develop guidelines for the recognition of atrophy useful for increasing agreement among observers.

Methods: After redefining atrophy as the 'loss of appropriate glands' and examining histological samples from different gastric compartments, three categories were identified: (i) negative; (ii) indefinite; (iii) atrophy, with and without intestinalization. Atrophy was graded on a three-level scale. Interobserver reproducibility of the classification was tested by kappa statistics (general and weighted) in a series of 48 cases.

Results: The medians of the general agreement and weighted kappa values were 0.78 and 0.73, respectively. The weighted kappa coefficients, obtained by cross-tabulating the evaluation of each pathologist against all others, were, with only one exception, > 0.4 (moderate to excellent agreement).

Conclusions: By using the definition of atrophy as the loss of appropriate glands and distinguishing the two main morphological entities of metaplastic and non-metaplastic types, a high level of agreement was achieved by a group of gastrointestinal pathologists trained in different cultural contexts.

Publication types

  • Consensus Development Conference
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Atrophy / classification
  • Atrophy / pathology
  • Biopsy
  • Gastric Mucosa / pathology
  • Gastritis, Atrophic / classification*
  • Gastritis, Atrophic / pathology*
  • Humans
  • Observer Variation
  • Pyloric Antrum / pathology
  • Reproducibility of Results
  • Severity of Illness Index