title: Intestinal metaplasia surveillance: searching for the road-map.
abstract: Atrophic gastritis and intestinal metaplasia (IM) of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, a pragmatic management has been performed in Western countries in patients with these premalignant conditions. Recently, formal European guidelines have been delivered on this topic. Basically, it has been recommended that patients with extensive atrophic gastritis (AG) and/or extensive IM should be offered endoscopic surveillance every 3 years. On the contrary, no scheduled endoscopic/histological control has been advised for those patients with precancerous conditions confined to the antrum. In this commentary, we highlighted some potential weaknesses in the management formally recommended by the new guidelines. In detail, we discussed that AG and IM patients do not share the same gastric cancer risk, at least in Western countries, deserving a different approach. Some factors significantly associated with gastric cancer risk, such as IM type, first-degree family history of gastric cancer, and smoking habit have not been considered in tailoring the endoscopic follow-up. Finally, some data would suggest that a 3-year follow-up in patients with extensive gastric precancerous conditions could result in an inadequate secondary prevention.
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, 00153 Rome, Italy. zullo66@yahoo.it
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.forename: Bruno
authors.initials: B
authors.lastname: Annibale
mesh_terms: D005757:Gastritis, Atrophic / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D005773:Gastroscopy / Q000592:standards*; D006801:Humans; D008679:Metaplasia; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control; D013997:Time Factors
keywords: Atrophic gastritis; Follow-up; Gastric cancer; Guidelines; Intestinal metaplasia
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