AGA Technical Review on Gastric Intestinal Metaplasia—Epidemiology and Risk Factors

AGA Clinical Practice Guidelines on Management of Gastric Intestinal Metaplasia

“…Risk assessment should be individualized. Patients with GIM at higher risk of gastric cancer include those with incomplete (at least partial colonic type) vs complete (small intestinal type) intestinal metaplasia (3.3-fold RR based on low quality of evidence); family history of gastric cancer (4.5-fold RR based on very low quality of evidence); and extensive (involving the gastric body plus either antrum and/or incisura) vs limited GIM (involving the gastric antrum and/or incisura only; 2.1-fold RR based on very low quality of evidence (see Table 2 in Altayar et al, 10 ). Although the TR did not find evidence supporting increased risk for gastric cancer among racial/ethnic minorities or immigrants with documented GIM, an overall increased risk for gastric cancer (irrespective of presence/absence of GIM) has been established among these groups, and may be considered as part of decision-making regarding surveillance.…”

“…Pooled prevalence of GIM among 897,371 individuals with gastric biopsies was estimated to be 4.8% (95% CI, 4.8%-4.9%). 10 As such, the panel recognizes that any recommendations for surveillance of GIM could impact a significant proportion of individuals undergoing endoscopy with biopsy. A limitation of this meta-analysis is that most of the data were from a single study reporting on prevalence of GIM among gastric biopsies routinely submitted for We are very confident that the true effect lies close to that of the estimate of the effect.…”

“…A reader's understanding of this guideline will be optimized and enhanced by reading the accompanying 2 technical reviews (TRs), which provide an overview and synthesis of the evidence used to inform this guideline. 9,10 linked mainly to risk for non-cardia gastric cancer. For ease of presentation, we refer to non-cardia gastric cancer as "gastric cancer" throughout this article.…”

The Vexing Problem of Incidental Gastric Intestinal Metaplasia: Do the AGA Guidelines Help?

“…In this issue of Gastroenterology, the American Gastroenterological Association (AGA) published a new guideline (and 2 supporting technical reviews) that address the evidence-based management of incidental GIM targeting the US population. [6][7][8] In accordance with the AGA Clinical Guideline Development Process, this guideline was informed by a methodologically rigorous review of the relevant evidence published in 2 technical reviews. The technical review panel systematically reviewed the evidence related to H pylori testing and treatment, surveillance based on risk assessment, and the role of a repeat short-term endoscopy in patients incidentally found to have GIM on routine upper endoscopy.…”

“…The pooled prevalence of GIM identified from pathology specimens in the United States is estimated to be about 5%. 6,7 Routine use of repeat endoscopy and surveillance would have the potential to impact a substantial number of patients.…”