The natural course of gastric intestinal metaplasia in Turkish Patients: A single-center observational cohort study
Objective: Gastric intestinal metaplasia (GIM) is considered as a predisposing lesion for the development of gastric cancer and isrecommended to be kept under surveillance in designated intervals. We aimed to assess the natural course of GIM in a large Turkishcohort.Materials and Methods: We retrospectively reviewed findings from pathology reports of gastric biopsies conducted between 2011 to2018 to reveal patients diagnosed with solitary GIM in their index pathology report. Progression of GIM was pre-defined as; lowgradedysplasia (LGD), high-grade dysplasia (HGD), or gastric malignancy.Results: The median follow-up period of the study population was 34 (12-128) months. Out of 109 patients with GIM at the entry, 54(49.6%) patients had stable GIM, whereas 53 (48.6%) cases had no signs of GIM at their final endoscopy. Only two (1.8%) patientsprogressed to LGD, but no HGD or malignancy was detected in the follow-up.Conclusion: Although, considered as a premalignant lesion and offered surveillance globally, progression of GIM was very low in alarge Turkish cohort. Further prospective studies in larger cohorts are required to enlighten the obscure strategies in the surveillanceof gastric malignancy.
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- [1] Huang RJ, Choi AY, Truong CD, Yeh MM, Hwang JH.
Diagnosis and management of gastric intestinal metaplasia:
current status and future directions. Gut Liver 2019;13:596-
603. doi: 10.5009/gnl19181.
- [2] Graham DY. Helicobacter pylori update: gastric cancer,
reliable therapy, and possible benefits. Gastroenterology
2015;148:719-31 e3. doi: 10.1053/j.gastro.2015.01.040.
- [3] Zhu H, Xu H. Demographic and lifestyle risk factors for gastric
intestinal metaplasia among US veterans. Am J Gastroenterol
2020;115:381-7. doi: 10.14309/ajg.0000000000000498.
- [4] Oh S, Kim N, Yoon H, et al. Risk factors of atrophic gastritis
and intestinal metaplasia in first-degree relatives of gastric
cancer patients compared with age-sex matched controls. J
Cancer Prev 2013;18:149-60. doi: 10.15430/jcp.2013.18.2.149.
- [5] Trieu JA, Bilal M, Saraireh H, Wang AY. Update on the
diagnosis and management of gastric intestinal metaplasia in
the USA. Dig Dis Sci 2019;64:1079-88. doi: 10.1007/s10620-
019-05526-5.
- [6] Yee YK, Wong KW, Hui CK, et al. Prevalence and time trend of
intestinal metaplasia in Hong Kong. J Gastroenterol Hepatol
2009;24:896-9. doi: 10.1111/j.1440-1746.2009.05799.x.
- [7] Wong BC, Lam SK, Wong WM, et al. Helicobacter pylori
eradication to prevent gastric cancer in a high-risk region of
China: a randomized controlled trial. JAMA 2004;291:187-94.
doi: 10.1001/jama.291.2.187.
- [8] Olmez S, Aslan M, Erten R, Sayar S, Bayram I. The
Prevalence of gastric intestinal metaplasia and distribution of
helicobacter pylori infection, atrophy, dysplasia, and cancer in
its subtypes. Gastroenterol Res Pract 2015;2015:434039. doi:
10.1155/2015/434039.
- [9] Choi AY, Strate LL, Fix MC, et al. Association of gastric
intestinal metaplasia and East Asian ethnicity with the risk
of gastric adenocarcinoma in a U.S. population. Gastrointest
Endosc 2018;87:1023-8. doi: 10.1016/j.gie.2017.11.010.
- [10] Song H, Ekheden IG, Zheng Z, Ericsson J, Nyren O, Ye W.
Incidence of gastric cancer among patients with gastric
precancerous lesions: observational cohort study in a low risk
Western population. BMJ 2015;351:h3867. doi: 10.1136/bmj.
h3867.
- [11] Liu KS, Wong IO, Leung WK. Helicobacter pylori associated
gastric intestinal metaplasia: Treatment and surveillance.
World J Gastroenterol 2016;22:1311-20. doi: 10.3748/wjg.v22.
i3.1311.
- [12] Park YH, Kim N. Review of atrophic gastritis and intestinal
metaplasia as a premalignant lesion of gastric cancer. J Cancer
Prev 2015;20:25-40. doi: 10.15430/JCP.2015.20.1.25.
- [13] Pimentel-Nunes P, Libanio D, Marcos-Pinto R, et al.
Management of epithelial precancerous conditions and
lesions in the stomach (MAPS II): European Society of
Gastrointestinal Endoscopy (ESGE), European Helicobacter
and Microbiota Study Group (EHMSG), European Society of
Pathology (ESP), and Sociedade Portuguesa de Endoscopia
Digestiva (SPED) guideline update 2019. Endoscopy
2019;51:365-88. doi: 10.1055/a-0859-1883.
- [14] den Hoed CM, Holster IL, Capelle LG, et al. Follow-up of
premalignant lesions in patients at risk for progression to
gastric cancer. Endoscopy 2013;45:249-56. doi: 10.1055/s-
0032-1326379.
- [15] den Hollander WJ, Holster IL, den Hoed CM, et al. Surveillance
of premalignant gastric lesions: a multicentre prospective
cohort study from low incidence regions. Gut 2019;68:585-93.
doi: 10.1136/gutjnl-2017-314498.
- [16] Hwang YJ, Kim N, Lee HS, et al. Reversibility of atrophic
gastritis and intestinal metaplasia after Helicobacter pylori
eradication - a prospective study for up to 10 years. Aliment
Pharmacol Ther 2018;47:380-90. doi: 10.1111/apt.14424.
- [17] Pittayanon R, Rerknimitr R, Klaikaew N, et al. The risk of
gastric cancer in patients with gastric intestinal metaplasia in
5-year follow-up. Aliment Pharmacol Ther 2017;46:40-5. doi:
10.1111/apt.14082.
- [18] Xirouchakis E, Laoudi F, Tsartsali L, Spiliadi C, Georgopoulos
SD. Screening for gastric premalignant lesions with narrow
band imaging, white light and updated Sydney protocol or
both? Dig Dis Sci 2013;58:1084-90. doi: 10.1007/s10620-012-
2431-x.