Management of Gastric Intestinal Metaplasia

Publication Date: December 9, 2019

AGA Recommendations for Management of Gastric Intestinal Metaplasia

In patients with GIM, the AGA recommends testing for H. pylori followed by eradication over no testing and eradication. ( Moderate , Strong )

In patients with GIM the AGA suggests against routine use of endoscopic surveillance.
Comments: Patients with GIM at higher risk for gastric cancer who put a high value on potential but uncertain reduction in gastric cancer mortality, and who put a low value on potential risks of surveillance endoscopies, may reasonably elect for surveillance.a ( Very Low , Conditional (weak) )
Patients with GIM specifically at higher risk of gastric cancer include those with:
  • Incomplete vs. complete GIM
  • Extensive vs. limited GIM
  • Family history of gastric cancer
Patients at overall increased risk for gastric cancer include:
  • Racial/ethnic minorities
  • Immigrants from high incidence regions

In patients with GIM, the AGA suggests against routine repeat short interval endoscopy with biopsies for the purpose of risk stratification.
Comments: Based on shared decision making, patients with GIM and high risk stigmata, concerns about completeness of baseline endoscopy, and/or who are at overall increased risk for gastric cancer (racial/ethnic minorities, immigrants from regions with high gastric cancer incidence, or individuals with family history of first-degree relative with gastric cancer) may reasonably elect for repeat endoscopy within 1 year for risk stratification. ( Very Low , Conditional (weak) )
a There are insufficient data to guide optimal surveillance interval. Based on indirect evidence regarding cumulative gastric cancer incidence among patients with GIM, repeat upper endoscopy with careful mucosal visualization and gastric biopsies of the antrum and body and any concerning lesions may be considered in 3-5 years among patients with incidentally detected GIM, if shared decision-making favors surveillance.

Recommendation Grading




Management of Gastric Intestinal Metaplasia

Authoring Organization

Publication Month/Year

December 9, 2019

Document Type


External Publication Status


Country of Publication


Document Objectives

Inform management of patients with GIM incidentally detected on gastric biopsies in routine clinical practice.

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant




Gastric Intestinal Metaplasia, GIM

Source Citation

Gupta S, Li D, El Serag HB, Davitkov P, Altayar O, Sultan S, Falck-Ytter Y, Mustafa RA, AGA Clinical Practice Guidelines on Management of Gastric Intestinal Metaplasia, Gastroenterology (2020), doi:

Supplemental Methodology Resources

Technical Review, Technical Review