- Gastric cancer is the 3rd leading cause of cancer death worldwide.
- Chronic infection with Helicobacter pylori (H. pylori) is the primary risk factor for (intestinal-type) non-cardia gastric cancer, with at least 80% of the global gastric cancer burden attributable to this pathogen.
- Gastric intestinal metaplasia (GIM) may represent the histologic step just prior to development of dysplasia.
AGA Recommendations for Management of Gastric Intestinal Metaplasia
|Statement||Strength of recommendation||Quality of evidence|
|1. In patients with GIM, the AGA recommends testing for H. pylori followed by eradication over no testing and eradication.||Strong||Moderate|
|2. 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
Patients with GIM specifically at higher risk of gastric cancer include those with:
Patients at overall increased risk for gastric cancer include:
|3. 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.