AGA Institute Quality Measure Development for the Management of Gastric Intestinal Metaplasia with Helicobacter pylori

Abstract

Gastric cancer is the third leading cause of cancer-related deaths worldwide, with more than 1 million incident cases diagnosed globally. 1 Non-cardia intestinal-type gastric cancer, the most common subtype of gastric cancer, develops through the Correa cascade in which chronic inflammation of normal gastric mucosa leads to atrophic gastritis, followed by gastric intestinal metaplasia (GIM), dysplasia, and ultimately gastric cancer. 2 GIM has an estimated prevalence of 4.8% in the United States based on an analysis of gastric biopsies from a large pathology database, but higher rates of GIM have been reported in certain racial and ethnic groups (14.8% in Asian Americans, 18.2% in Native Americans, 25.5% in African Americans, and 29.5% in Hispanic Americans). 3 ,4 Additional risk factors for GIM include tobacco use, autoimmune gastritis, and living or immigrating from an endemic area. The annual risk of progression from GIM to non-cardia intestinal-type gastric cancer is 0.16%, and factors such as persistent Helicobacter pylori infection, family history, anatomic extent and location of GIM, and histologic subtypes may confer increased risk of progression to gastric cancer. 5 Studies of U.S. endoscopists show variation in the management of patients with GIM, including use and interval for endoscopic surveillance, prompting the development of guidelines for the management of GIM.