AGA released a new clinical practice guideline in Gastroenterology with recommendations for the management of patients with GIM detected as part of routine upper endoscopy for reasons including work up of endoscopically identified gastropathy/presumed gastritis, dyspepsia or exclusion of Helicobacter pylori (H. pylori).
1. In patients with GIM, AGA recommends testing for H. pylori followed by eradication over no testing and eradication. (Strong recommendation: moderate quality evidence)
2. In patients with GIM, AGA suggests against routine use of endoscopic surveillance. (Conditional recommendation: very low-quality evidence)
Comment: Patients with GIM at higher risk for gastric cancer who put a high value on potential but uncertain reduction in gastric cancer mortality, and who put a low value on potential risks of surveillance endoscopies, may reasonably elect for surveillance.
Patients with GIM specifically at higher risk of gastric cancer include those with:
- Incomplete vs. complete GIM
- Extensive vs. limited GIM
- Family history of gastric cancer
Patients at overall increased risk for gastric cancer include:
- Racial/ethnic minorities
- Immigrants from high incidence regions
3. In patients with GIM, AGA suggests against routine repeat short interval endoscopy with biopsies for the purpose of risk stratification. (Conditional recommendation: very low-quality evidence)
Comment: Based on shared decision making, patients with GIM and high risk stigmata, concerns about completeness of baseline endoscopy, and/or who are at overall increased risk for gastric cancer (racial/ethnic minorities, immigrants from regions with high gastric cancer incidence, or individuals with family history of first-degree relative with gastric cancer) may reasonably elect for repeat endoscopy within one year for risk stratification.
Read the AGA Institute guidelines for management of gastric intestinal metaplasia to review the complete recommendations.
This guideline will be published in the February print issue of Gastroenterology with additional resources to help you implement in your practice.