Attention patients with gastrointestinal metaplasia!

Introduction Gastric cancer (GC) is the fifth most common cancer in the world and the third leading cause of cancer-related deaths.
The main reason for its high mortality is the late detection.

Gastrointestinal metaplasia (IM) is a common precancerous lesion of gastric mucosa, which is related to the increased risk of GC.

Operational link for gastric intestinal metaplasia assessment (OLGIM) has been used to stratify IM patients.

The European Society of Gastrointestinal Endoscopy recommends that patients with high-risk IM (ie OLGIM III-IV) repeat endoscopic monitoring within 3 years.

However, due to the lack of supporting clinical evidence from large prospective studies and the heterogeneity of gastric mucosal sampling and reporting practices, the clinical adoption rate of IM monitoring is still very low.

To explore the incidence of GC caused by IM, and to verify the practicality of OLGIM for risk stratification of IM patients in areas with low-to-moderate GC incidence.

Researchers such as Lee conducted a prospective, longitudinal and multicenter study in Singapore.

Research Methods The study included 2980 subjects who underwent gastroscopy with standard gastric mucosal sampling from January 2004 to December 2010, and planned to undergo regular endoscopy in the third and fifth years.

The subjects also matched the missed diagnosis of early gastric tumor (EGN) with the National Disease Registry Office.

Results of the study 21 patients were diagnosed with EGN.

IM is a significant risk factor for EGN (adjusted HR 5.
36; 95% CI 1.
51-19.
0; p<0.
01).

The age-adjusted incidence of EGN in patients with and without IM was 133.
9 and 12.
5 per 100,000-years, respectively. OLGIM III-IV patients have the greatest risk of EGN (adjusted HR 20.
7; 95%CI 5.
04-85.
6; p<0.
01).

Serum trefoil factor 3 (AUROC 0.
749) can distinguish Helicobacter pylori-negative OLGIM III-IV patients.

Compared with OLGIM stage II patients (median 50.
7 months; range 28.
5-73.
3 months; p=0.
01), the time interval from baseline to the onset of EGN in OLGIM stage III-IV patients (median 22.
7 months; range) 12.
7-44.
8 months; p=0.
01) is also shorter.

Patients with OLGIM stage II also have a significant EGN risk (adjusted HR 7.
34; 95% CI 1.
60-33.
7; p=0.
02).

In OLGIM stage II–IV patients, a significant history of smoking further increases the risk of EGN.

Conclusion Based on the above results, the researchers recommend a risk stratification method for IM patients.
High-risk patients (OLGIM III-IV) should undergo endoscopic monitoring within 2 years, and intermediate-risk patients (OLGIM II) should undergo endoscopic monitoring within 5 years.

At the same time, the researchers also emphasized the hope to improve risk awareness and encourage clinical use of standardized gastric mucosal sampling and OLGIM histological reports.

Yimaitong compiled and compiled from: Lee JWJ, Zhu F, Srivastava S, et al.
Severity of gastric intestinal metaplasia predicts the risk of gastric cancer: a prospective multicentre cohort study (GCEP)[J].
Gut,2021.
doi: 10.
1136 /gutjnl-2021-324057