Approach to the management of patients with gastric intestinal metaplasia

* In patients with known risk factors for gastric cancer, who are amenable to endoscopic surveillance, we generally perform a repeat endoscopy with gastric biopsy mapping within one year. In patients without known risk factors for gastric cancer, but who are amenable to endoscopic surveillance if indicated, we perform a repeat upper endoscopy within three years.
¶ Infection with H. pylori is initially assessed by the histologic evaluation of gastric biopsy samples. In the event of negative biopsies for H. pylori, infection status should be determined with serology. Any patient with positive serology who does not have a definitive history of having been treated for H. pylori should receive treatment, even if biopsies are negative.
Δ General measures to decrease the risk of gastric cancer include smoking cessation and moderation of alcohol intake.
◊ Surveillance endoscopic evaluation includes detailed visual inspection with high-resolution endoscopes, narrow band imaging if there is local expertise, and gastric biopsy mapping.
§ These recommendations do not apply to individuals with hereditary gastric cancer syndromes. Refer to UpToDate topics on gastric cancer for additional details.
¥ In patients with limited or complete GIM who do not have additional risk factors for gastric cancer, evidence to support routine endoscopic surveillance is lacking. GIM surveillance should be driven by shared patient-physician decision making.