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Canadian Journal of Gastroenterology
Volume 15 (2001), Issue 9, Pages 591-598

The Updated Sydney System: Classification and Grading of Gastritis as the Basis of Diagnosis and Treatment

Manfred Stolte1 and Alexander Meining2

1Department of Pathology, Klinikum Bayreuth, Bayreuth, Germany
2Medical Department II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

Received 11 August 1999; Accepted 16 November 1999

Copyright © 2001 Hindawi Publishing Corporation. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (, which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.


In recent years, the importance of the histological diagnosis of gastritis on the basis of routinely obtained antral and corpus biopsies has increased enormously, which is owed not least of all to the discovery of Helicobacter pylori. The introduction of the Sydney system made it possible, for the first time, to grade histological parameters, identify topographical distribution and, finally, make a statement about the etiopathogenesis of the gastritis. Of pathogenetic importance is, in the first instance, the differentiation between gastritis with and gastritis without H pylori infection. The group of H pylori-associated gastritis can be further subdivided into forms of gastritis whose morphological distribution patterns usually identify them as sequelae of H pylori infection, while the group of gastritis unassociated with H pylori, can be differentiated into autoimmune, chemically induced reactive gastritis, ex-H pylori gastritis, Helicobacter heilmannii gastritis, Crohn's gastritis and a number of special forms of gastritis.