New evidence-based clinical guidelines from the American Gastroenterological Association (AGA) provide recommendations for managing patients with gastric intestinal metaplasia detected as part of routine upper endoscopy.
The guidelines note that these endoscopies may be performed for reasons including workup of endoscopically identified gastropathy/presumed gastritis, evaluation of dyspepsia, or exclusion of Helicobacter pylori infection. The guidelines are intended to enhance decision making for patients in North America and do not apply to screening for gastric cancer, management of patients with dysplasia of the gastric mucosa, gastric adenocarcinoma, and/or autoimmune gastritis. They were published Dec. 6 by Gastroenterology.
In patients with gastric intestinal metaplasia, the guidelines recommend testing for H. pylori followed by eradication over no testing and eradication (strong recommendation, moderate-quality evidence). The guidelines suggest against routine use of endoscopic surveillance (conditional recommendation, very low-quality evidence); however, they noted that surveillance could be reasonably chosen by patients with gastric intestinal metaplasia at higher risk for gastric cancer who place a high value on a potential but uncertain reduction in gastric cancer mortality and a low value on potential risks of surveillance endoscopies.
The guidelines suggest against routine repeated short-interval endoscopy with biopsies for risk stratification (conditional recommendation, very low-quality evidence). Based on shared decision making, patients may reasonably elect repeated endoscopy within one year for risk stratification if they have gastric intestinal metaplasia and high-risk stigmata, are concerned about completeness of baseline endoscopy, and/or are at overall increased risk for gastric cancer, the guidelines said.
The evidence supporting the guidelines' recommendations was overall very low, and additional research is needed, the authors said. They called for future studies on the impact of surveillance versus no surveillance on outcomes, as well as the importance of extensive versus limited gastric intestinal metaplasia on risk for gastric cancer, among other topics.