Gut Liver.  2019 Nov;13(6):596-603. 10.5009/gnl19181.

Diagnosis and Management of Gastric Intestinal Metaplasia: Current Status and Future Directions

• Huang RJ
• Choi AY
• Truong CD
• Yeh MM
• Hwang JH

• KMID: 2464307
• DOI: http://doi.org/10.5009/gnl19181

Abstract

Gastric intestinal metaplasia (GIM) is a known premalignant condition of the human stomach along the pathway to gastric cancer (GC). Histologically, GIM represents the replacement of normal gastric mucosa by mucin-secreting intestinal mucosa. Helicobacter pylori infection is the most common etiologic agent of GIM development worldwide. The prevalence of GIM is heterogeneous among different regions of the world and correlates with the population endemicity of H. pylori carriage, among other environmental factors. GC remains the third leading cause of cancer-related mortality globally. GIM is usually diagnosed by upper endoscopy with biopsy, and histologic scoring systems have been developed to risk-stratify patients at highest risk for progression to GC. Several recent endoscopic imaging modalities may improve the optical detection of GIM and early GC. Appropriate surveillance of GIM may be cost effective and represents an opportunity for the early diagnosis and therapy of GC. Certain East Asian nations have established population-level programs for the screening and surveillance of GIM; guidelines regarding GIM surveillance have also recently been published in Europe. By contrast, few data exist regarding the appropriateness of surveillance of GIM in the United States. In this review, we discuss the pathogenesis, epidemiology, diagnosis, and management of GIM with an emphasis on the role of appropriate endoscopic surveillance.

Keyword

Helicobacter pylori; Epidemiology; Stomach

MeSH Terms

Asian Continental Ancestry Group
Biopsy
Diagnosis*
Early Diagnosis
Endoscopy
Epidemiology
Europe
Gastric Mucosa
Helicobacter pylori
Humans
Intestinal Mucosa
Mass Screening
Metaplasia*
Mortality
Prevalence
Stomach
Stomach Neoplasms
United States