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The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines | Gut
<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE html> <html lang="en" dir="ltr" version="HTML+RDFa+MathML 1.1" xmlns:dc="http://purl.org/dc/terms/" xmlns:foaf="http://xmlns.com/foaf/0.1/" xmlns:og="http://ogp.me/ns#" xmlns:rdfs="http://www.w3.org/2000/01/rdf-schema#" xmlns:sioc="http://rdfs.org/sioc/ns#" xmlns:sioct="http://rdfs.org/sioc/types#" xmlns:skos="http://www.w3.org/2004/02/skos/core#" xmlns:xsd="http://www.w3.org/2001/XMLSchema#" xmlns:mml="http://www.w3.org/1998/Math/MathML"> <head profile="http://www.w3.org/1999/xhtml/vocab"> <!--[if IE]><![endif]--> <link rel="dns-prefetch" href="//securepubads.g.doubleclick.net" /> <link rel="dns-prefetch" href="//d1bxh8uas1mnw7.cloudfront.net" /> <link rel="dns-prefetch" href="//scholar.google.com" /> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="shortcut icon" href="https://gut.bmj.com/sites/default/themes/bmjj/favicon.ico" type="image/vnd.microsoft.icon" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <script>window.dataLayer = window.dataLayer || [];window.dataLayer.push({"page":{"hwTitle":"The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines","hwUrl":"https://gut.bmj.com/content/73/10/1607","hwPath":"/content/73/10/1607","hwType":"journal page"},"user":{"hwMemberID":"","hwLoggedIntoInstitutionID":"","hwLoggedIntoInstitution":"","hwAccessUsageTerms":"guest","hwRegisteredUser":"no","hwHasFullTextAccess":"no","hwEntitled":"no","mail":"e3b0c44298fc1c149afbf4c8996fb92427ae41e4649b934ca495991b7852b855"},"content":{"hwIssueDate":"2024-10-01","hwIssueDateTime":"2024-10-01 00:00:00","hwPublicationDate":"2024-09-09","hwPublicationDateTime":"2024-09-09 07:20:38","hwNlmArticleType":"research-article","hwDOI":"10.1136/gutjnl-2024-333029","hwAuthors":"Mario Dinis-Ribeiro,Shailja Shah,Hashem El-Serag,Matthew Banks,Noriya Uedo,Hisao Tajiri,Luiz Gonzaga Coelho,Diogo Libanio,Edith Lahner,Antonio Rollan,Jing-Yuan Fang,Leticia Moreira,Jan Bornschein,Peter Malfertheiner,Ernst J Kuipers,Emad M El-Omar","hwContributors":"","hwIsEarlyRelease":"no","hwEissn":"1468-3288","hwPissn":"0017-5749","hwVolume":"73","hwIssue":"10","hwArticleType":"Stomach","hwTabView":"main_tab","hwViewType":"","hwAccessType":"Paywall","hwOpenAccess":"no","hwFreeAccess":"no","hwTaxonomy":"","hwCorpusCode":"gutjnl","hwType":"article","hwSubtitle":null,"hwOverline":null,"hwPisaId":"gutjnl;73/10/1607","hwFirstPage":"1607","hwLastPage":"1617","hwIsLatestVersion":"yes","hwIsCurrentIssue":"no","hwIsOpenIssue":"no","hwHasFullText":"yes","hwHasPDF":"yes","hwParentTitle":"Gut: 73 (10)","hwElectronicPubDate":"2024-09-09","hwElectronicPubDateTime":"2024-09-09 07:20:38"}}); //--><!]]></script> <link rel="canonical" href="https://gut.bmj.com/content/73/10/1607" /> <meta name="Generator" content="Drupal 7 (http://drupal.org)" /> <link rel="alternate" type="application/pdf" title="Full Text (PDF)" href="/content/73/10/1607.full.pdf" /> <link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/73/10/1607.full.txt" /> <meta name="issue_cover_image" content="https://gut.bmj.com/sites/default/files/highwire/gutjnl/73/10.cover-source.jpg" /> <meta name="type" content="article" /> <meta name="category" content="research-article" /> <meta name="HW.identifier" content="/gutjnl/73/10/1607.atom" /> <meta name="HW.pisa" content="gutjnl;73/10/1607" /> <meta name="DC.Format" content="text/html" /> <meta name="DC.Language" content="en" /> <meta name="DC.Title" content="The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines" /> <meta name="DC.Identifier" content="10.1136/gutjnl-2024-333029" /> <meta name="DC.Date" content="2024-10-01" /> <meta name="DC.Publisher" content="BMJ Publishing Group" /> <meta name="DC.Rights" content="© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ." /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Relation" content="10.1136/gutjnl-2024-333684" /> <meta name="DC.Relation" content="10.1136/gutjnl-2024-333029corr1" /> <meta name="DC.Relation" content="10.1136/gutjnl-2024-333029corr1" /> <meta name="DC.Description" content="Objective During the last decade, the management of gastric intestinal metaplasia (GIM) has been addressed by several distinct international evidence-based guidelines. In this review, we aimed to synthesise these guidelines and provide clinicians with a global perspective of the current recommendations for managing patients with GIM, as well as highlight evidence gaps that need to be addressed with future research. Design We conducted a systematic review of the literature for guidelines and consensus statements published between January 2010 and February 2023 that address the diagnosis and management of GIM. Results From 426 manuscripts identified, 16 guidelines were assessed. There was consistency across guidelines regarding the purpose of endoscopic surveillance of GIM, which is to identify prevalent neoplastic lesions and stage gastric preneoplastic conditions. The guidelines also agreed that only patients with high-risk GIM phenotypes (eg, corpus-extended GIM, OLGIM stages III/IV, incomplete GIM subtype), persistent refractory Helicobacter pylori infection or first-degree family history of gastric cancer should undergo regular-interval endoscopic surveillance. In contrast, low-risk phenotypes, which comprise most patients with GIM, do not require surveillance. Not all guidelines are aligned on histological staging systems. If surveillance is indicated, most guidelines recommend a 3-year interval, but there is some variability. All guidelines recommend H. pylori eradication as the only non-endoscopic intervention for gastric cancer prevention, while some offer additional recommendations regarding lifestyle modifications. While most guidelines allude to the importance of high-quality endoscopy for endoscopic surveillance, few detail important metrics apart from stating that a systematic gastric biopsy protocol should be followed. Notably, most guidelines comment on the role of endoscopy for gastric cancer screening and detection of gastric precancerous conditions, but with high heterogeneity, limited guidance regarding implementation, and lack of robust evidence. Conclusion Despite heterogeneous populations and practices, international guidelines are generally aligned on the importance of GIM as a precancerous condition and the need for a risk-stratified approach to endoscopic surveillance, as well as H. pylori eradication when present. There is room for harmonisation of guidelines regarding (1) which populations merit index endoscopic screening for gastric cancer and GIM detection/staging; (2) objective metrics for high-quality endoscopy; (3) consensus on the need for histological staging and (4) non-endoscopic interventions for gastric cancer prevention apart from H. pylori eradication alone. Robust studies, ideally in the form of randomised trials, are needed to bridge the ample evidence gaps that exist. Data are available on reasonable request. All data analysed are available in proper databases depending on publisher." /> <meta name="DC.Contributor" content="Mario Dinis-Ribeiro" /> <meta name="DC.Contributor" content="Shailja Shah" /> <meta name="DC.Contributor" content="Hashem El-Serag" /> <meta name="DC.Contributor" content="Matthew Banks" /> <meta name="DC.Contributor" content="Noriya Uedo" /> <meta name="DC.Contributor" content="Hisao Tajiri" /> <meta name="DC.Contributor" content="Luiz Gonzaga Coelho" /> <meta name="DC.Contributor" content="Diogo Libanio" /> <meta name="DC.Contributor" content="Edith Lahner" /> <meta name="DC.Contributor" content="Antonio Rollan" /> <meta name="DC.Contributor" content="Jing-Yuan Fang" /> <meta name="DC.Contributor" content="Leticia Moreira" /> <meta name="DC.Contributor" content="Jan Bornschein" /> <meta name="DC.Contributor" content="Peter Malfertheiner" /> <meta name="DC.Contributor" content="Ernst J Kuipers" /> <meta name="DC.Contributor" content="Emad M El-Omar" /> <meta name="article:published_time" content="2024-10-01" /> <meta name="article:section" content="Stomach" /> <meta name="citation_title" content="The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines" /> <meta name="citation_abstract" lang="en" content="<h3>Objective</h3> <p>During the last decade, the management of gastric intestinal metaplasia (GIM) has been addressed by several distinct international evidence-based guidelines. In this review, we aimed to synthesise these guidelines and provide clinicians with a global perspective of the current recommendations for managing patients with GIM, as well as highlight evidence gaps that need to be addressed with future research.</p><h3>Design</h3> <p>We conducted a systematic review of the literature for guidelines and consensus statements published between January 2010 and February 2023 that address the diagnosis and management of GIM.</p><h3>Results</h3> <p>From 426 manuscripts identified, 16 guidelines were assessed. There was consistency across guidelines regarding the purpose of endoscopic surveillance of GIM, which is to identify prevalent neoplastic lesions and stage gastric preneoplastic conditions. The guidelines also agreed that only patients with high-risk GIM phenotypes (eg, corpus-extended GIM, OLGIM stages III/IV, incomplete GIM subtype), persistent refractory <i>Helicobacter pylori</i> infection or first-degree family history of gastric cancer should undergo regular-interval endoscopic surveillance. In contrast, low-risk phenotypes, which comprise most patients with GIM, do not require surveillance. Not all guidelines are aligned on histological staging systems. If surveillance is indicated, most guidelines recommend a 3-year interval, but there is some variability. All guidelines recommend <i>H. pylori</i> eradication as the only non-endoscopic intervention for gastric cancer prevention, while some offer additional recommendations regarding lifestyle modifications. While most guidelines allude to the importance of high-quality endoscopy for endoscopic surveillance, few detail important metrics apart from stating that a systematic gastric biopsy protocol should be followed. Notably, most guidelines comment on the role of endoscopy for gastric cancer screening and detection of gastric precancerous conditions, but with high heterogeneity, limited guidance regarding implementation, and lack of robust evidence.</p><h3>Conclusion</h3> <p>Despite heterogeneous populations and practices, international guidelines are generally aligned on the importance of GIM as a precancerous condition and the need for a risk-stratified approach to endoscopic surveillance, as well as <i>H. pylori</i> eradication when present. There is room for harmonisation of guidelines regarding (1) which populations merit index endoscopic screening for gastric cancer and GIM detection/staging; (2) objective metrics for high-quality endoscopy; (3) consensus on the need for histological staging and (4) non-endoscopic interventions for gastric cancer prevention apart from <i>H. pylori</i> eradication alone. Robust studies, ideally in the form of randomised trials, are needed to bridge the ample evidence gaps that exist.</p>" /> <meta name="citation_journal_title" content="Gut" /> <meta name="citation_publisher" content="BMJ Publishing Group" /> <meta name="citation_publication_date" content="2024/10/01" /> <meta name="citation_mjid" content="gutjnl;73/10/1607" /> <meta name="citation_id" content="73/10/1607" /> <meta name="citation_public_url" content="https://gut.bmj.com/content/73/10/1607" /> <meta name="citation_abstract_html_url" content="https://gut.bmj.com/content/73/10/1607.abstract" /> <meta name="citation_full_html_url" content="https://gut.bmj.com/content/73/10/1607.full" /> <meta name="citation_pdf_url" content="https://gut.bmj.com/content/gutjnl/73/10/1607.full.pdf" /> <meta name="citation_issn" content="0017-5749" /> <meta name="citation_issn" content="1468-3288" /> <meta name="citation_doi" content="10.1136/gutjnl-2024-333029" /> <meta name="citation_pmid" content="39122364" 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Berger;citation_title=Improving adherence to clinical practice guidelines for managing gastric intestinal metaplasia among gastroenterologists at a US Academic Institution;citation_pages=432-9;citation_volume=58;citation_year=2024" /> <meta name="twitter:title" content="The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:image" content="https://gut.bmj.com/sites/default/files/highwire/gutjnl/73/10.cover-source.jpg" /> <meta name="twitter:description" content="Objective During the last decade, the management of gastric intestinal metaplasia (GIM) has been addressed by several distinct international evidence-based guidelines. In this review, we aimed to synthesise these guidelines and provide clinicians with a global perspective of the current recommendations for managing patients with GIM, as well as highlight evidence gaps that need to be addressed with future research. Design We conducted a systematic review of the literature for guidelines and consensus statements published between January 2010 and February 2023 that address the diagnosis and management of GIM. Results From 426 manuscripts identified, 16 guidelines were assessed. There was consistency across guidelines regarding the purpose of endoscopic surveillance of GIM, which is to identify prevalent neoplastic lesions and stage gastric preneoplastic conditions. The guidelines also agreed that only patients with high-risk GIM phenotypes (eg, corpus-extended GIM, OLGIM stages III/IV, incomplete GIM subtype), persistent refractory Helicobacter pylori infection or first-degree family history of gastric cancer should undergo regular-interval endoscopic surveillance. In contrast, low-risk phenotypes, which comprise most patients with GIM, do not require surveillance. Not all guidelines are aligned on histological staging systems. If surveillance is indicated, most guidelines recommend a 3-year interval, but there is some variability. All guidelines recommend H. pylori eradication as the only non-endoscopic intervention for gastric cancer prevention, while some offer additional recommendations regarding lifestyle modifications. While most guidelines allude to the importance of high-quality endoscopy for endoscopic surveillance, few detail important metrics apart from stating that a systematic gastric biopsy protocol should be followed. Notably, most guidelines comment on the role of endoscopy for gastric cancer screening and detection of gastric precancerous conditions, but with high heterogeneity, limited guidance regarding implementation, and lack of robust evidence. Conclusion Despite heterogeneous populations and practices, international guidelines are generally aligned on the importance of GIM as a precancerous condition and the need for a risk-stratified approach to endoscopic surveillance, as well as H. pylori eradication when present. There is room for harmonisation of guidelines regarding (1) which populations merit index endoscopic screening for gastric cancer and GIM detection/staging; (2) objective metrics for high-quality endoscopy; (3) consensus on the need for histological staging and (4) non-endoscopic interventions for gastric cancer prevention apart from H. pylori eradication alone. Robust studies, ideally in the form of randomised trials, are needed to bridge the ample evidence gaps that exist. Data are available on reasonable request. All data analysed are available in proper databases depending on publisher." /> <meta name="og-title" property="og:title" content="The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines" /> <meta name="og-url" property="og:url" content="https://gut.bmj.com/content/73/10/1607" /> <meta name="og-site-name" property="og:site_name" content="Gut" /> <meta name="og-description" property="og:description" content="Objective During the last decade, the management of gastric intestinal metaplasia (GIM) has been addressed by several distinct international evidence-based guidelines. In this review, we aimed to synthesise these guidelines and provide clinicians with a global perspective of the current recommendations for managing patients with GIM, as well as highlight evidence gaps that need to be addressed with future research. Design We conducted a systematic review of the literature for guidelines and consensus statements published between January 2010 and February 2023 that address the diagnosis and management of GIM. Results From 426 manuscripts identified, 16 guidelines were assessed. There was consistency across guidelines regarding the purpose of endoscopic surveillance of GIM, which is to identify prevalent neoplastic lesions and stage gastric preneoplastic conditions. The guidelines also agreed that only patients with high-risk GIM phenotypes (eg, corpus-extended GIM, OLGIM stages III/IV, incomplete GIM subtype), persistent refractory Helicobacter pylori infection or first-degree family history of gastric cancer should undergo regular-interval endoscopic surveillance. In contrast, low-risk phenotypes, which comprise most patients with GIM, do not require surveillance. Not all guidelines are aligned on histological staging systems. If surveillance is indicated, most guidelines recommend a 3-year interval, but there is some variability. All guidelines recommend H. pylori eradication as the only non-endoscopic intervention for gastric cancer prevention, while some offer additional recommendations regarding lifestyle modifications. While most guidelines allude to the importance of high-quality endoscopy for endoscopic surveillance, few detail important metrics apart from stating that a systematic gastric biopsy protocol should be followed. Notably, most guidelines comment on the role of endoscopy for gastric cancer screening and detection of gastric precancerous conditions, but with high heterogeneity, limited guidance regarding implementation, and lack of robust evidence. Conclusion Despite heterogeneous populations and practices, international guidelines are generally aligned on the importance of GIM as a precancerous condition and the need for a risk-stratified approach to endoscopic surveillance, as well as H. pylori eradication when present. There is room for harmonisation of guidelines regarding (1) which populations merit index endoscopic screening for gastric cancer and GIM detection/staging; (2) objective metrics for high-quality endoscopy; (3) consensus on the need for histological staging and (4) non-endoscopic interventions for gastric cancer prevention apart from H. pylori eradication alone. Robust studies, ideally in the form of randomised trials, are needed to bridge the ample evidence gaps that exist. Data are available on reasonable request. All data analysed are available in proper databases depending on publisher." /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://gut.bmj.com/sites/default/files/highwire/gutjnl/73/10.cover-source.jpg" /> <link rel="alternate" type="application/vnd.ms-powerpoint" title="Powerpoint" href="/content/73/10/1607.ppt" /> <title>The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines | Gut</title> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__vpNY4AShvpQgcEVvM153SkXgs6rmsC1E4yzoaRH80D0__JSql6f8WjpCnC1YTwmCE5OxywyR2jRBx5Kulvx5Di0k__dGRtyN8GJBuhBvXCmXEhVK4mGQl3ZIewHeJUeSvfyQ0.css" media="all" /> <!-- OneTrust Cookies Consent Notice start --> <script src="https://cookie-cdn.cookiepro.com/scripttemplates/otSDKStub.js" type="text/javascript" charset="UTF-8" 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Please see:</h3><ul class="highwire-corrections-list"><li class="relation-65646 first last"><a href="/content/73/12/e1" class="" data-icon-position="" data-hide-link-title="0">Correction: The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines - December 01, 2024</a></li> </ul></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmjj-challenge-modal col-mobile-2 col-narrow-1 pull-right " > <div class="pane-content"> <a href="" class="" data-icon-position="" data-hide-link-title="0"><a href="#" id="chal-modal" class="article-pdf-download"><img alt="Download PDF" src="/sites/default/themes/bmjj/img/icon-pdf.png" /><strong>PDF</strong></a></a> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-entity-field pane-node-field-highwire-article-cat article-category col-narrow-9 col-normal-10" > <div class="pane-content"> <div class="field 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class="highwire-cite highwire-cite-highwire-article highwire-citation-bmjj-title clearfix"> <div class="highwire-cite-title">The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines</div> <span class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="gutjnl;gutjnl-2024-333029" data-atom-uri="/gutjnl/73/10/1607.atom" data-request-view="full"></span></span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container col-narrow-12 clear" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="jnl_template_bmjj_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://gut.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_template_bmjj_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup author-affiliates col-narrow-12 author-affiliates-corresp article" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><a href="http://orcid.org/0000-0003-0121-6850" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0003-0121-6850</a><span class="name">Mario Dinis-Ribeiro</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">1</a><span class="xref-sep">,</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">2</a>, </li><li class="contributor" id="contrib-2"><a href="http://orcid.org/0000-0002-2049-9959" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-2049-9959</a><span class="name">Shailja Shah</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">3</a>, </li><li class="contributor" id="contrib-3"><a href="http://orcid.org/0000-0001-5964-7579" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0001-5964-7579</a><span class="name">Hashem El-Serag</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">4</a>, </li><li class="contributor" id="contrib-4"><a href="http://orcid.org/0000-0002-9137-2779" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-9137-2779</a><span class="name">Matthew Banks</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">5</a>, </li><li class="contributor" id="contrib-5"><a href="http://orcid.org/0000-0002-3029-9272" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-3029-9272</a><span class="name">Noriya Uedo</span><a id="xref-aff-6-1" class="xref-aff" href="#aff-6">6</a>, </li><li class="contributor" id="contrib-6"><span class="name">Hisao Tajiri</span><a id="xref-aff-7-1" class="xref-aff" href="#aff-7">7</a>, </li><li class="contributor" id="contrib-7"><a href="http://orcid.org/0000-0002-8721-7696" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-8721-7696</a><span class="name">Luiz Gonzaga Coelho</span><a id="xref-aff-8-1" class="xref-aff" href="#aff-8">8</a>, </li><li class="contributor" id="contrib-8"><a href="http://orcid.org/0000-0003-2691-7522" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0003-2691-7522</a><span class="name">Diogo Libanio</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">1</a><span class="xref-sep">,</span><a id="xref-aff-2-2" class="xref-aff" href="#aff-2">2</a>, </li><li class="contributor" id="contrib-9"><a href="http://orcid.org/0000-0002-9503-8639" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-9503-8639</a><span class="name">Edith Lahner</span><a id="xref-aff-9-1" class="xref-aff" href="#aff-9">9</a>, </li><li class="contributor" id="contrib-10"><a href="http://orcid.org/0000-0002-4997-4098" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-4997-4098</a><span class="name">Antonio Rollan</span><a id="xref-aff-10-1" class="xref-aff" href="#aff-10">10</a>, </li><li class="contributor" id="contrib-11"><a href="http://orcid.org/0000-0003-2282-0248" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0003-2282-0248</a><span class="name">Jing-Yuan Fang</span><a id="xref-aff-11-1" class="xref-aff" href="#aff-11">11</a>, </li><li class="contributor" id="contrib-12"><a href="http://orcid.org/0000-0002-4518-8591" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-4518-8591</a><span class="name">Leticia Moreira</span><a id="xref-aff-12-1" class="xref-aff" href="#aff-12">12</a><span class="xref-sep">,</span><a id="xref-aff-13-1" class="xref-aff" href="#aff-13">13</a>, </li><li class="contributor" id="contrib-13"><span class="name">Jan Bornschein</span><a id="xref-aff-14-1" class="xref-aff" href="#aff-14">14</a>, </li><li class="contributor" id="contrib-14"><a href="http://orcid.org/0000-0001-8439-9036" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0001-8439-9036</a><span class="name">Peter Malfertheiner</span><a id="xref-aff-15-1" class="xref-aff" href="#aff-15">15</a>, </li><li class="contributor" id="contrib-15"><span class="name">Ernst J Kuipers</span><a id="xref-aff-16-1" class="xref-aff" href="#aff-16">16</a>, </li><li class="last" id="contrib-16"><a href="http://orcid.org/0000-0002-0011-3924" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-0011-3924</a><span class="name">Emad M El-Omar</span><a id="xref-aff-17-1" class="xref-aff" href="#aff-17">17</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>1</sup><span class="institution">Department of Gastroenterology</span>, <span class="institution">Porto Comprehensive Cancer Center & RISE@CI-IPO, University of Porto</span>, <span class="addr-line">Porto</span>, Portugal</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>2</sup><span class="institution">MEDCIDS (Department of Community Medicine, Health Information, and Decision)</span>, <span class="institution">University of Porto</span>, <span class="addr-line">Porto</span>, Portugal</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>3</sup><span class="institution">Division of Gastroenterology</span>, <span class="institution">University of California and Jennifer Moreno Veterans Affairs San Diego Healthcare System</span>, <span class="addr-line">San Diego</span>, <span class="addr-line">California</span>, USA</address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address><sup>4</sup><span class="institution">Gastroenterology and Hepatology</span>, <span class="institution">Baylor College of Medicine</span>, <span class="addr-line">Houston</span>, <span class="addr-line">Texas</span>, USA</address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address><sup>5</sup><span class="institution">University College London Hospital</span>, <span class="institution">University College London Hospitals NHS Foundation Trust</span>, <span class="addr-line">London</span>, UK</address></li><li class="aff"><a id="aff-6" name="aff-6"></a><address><sup>6</sup><span class="institution">Gastrointestinal Oncology</span>, <span class="institution">Osaka International Cancer Institute</span>, <span class="addr-line">Osaka</span>, Japan</address></li><li class="aff"><a id="aff-7" name="aff-7"></a><address><sup>7</sup><span class="institution">Endoscopy</span>, <span class="institution">The Jikei University School of Medicine</span>, <span class="addr-line">Tokyo</span>, Japan</address></li><li class="aff"><a id="aff-8" name="aff-8"></a><address><sup>8</sup><span class="institution">Instituto Alfa de Gastrenterologia</span>, <span class="institution">Hospital das Clínicas, Universidade Federal de Minas Gerais</span>, <span class="addr-line">Belo Horizonte</span>, Brazil</address></li><li class="aff"><a id="aff-9" name="aff-9"></a><address><sup>9</sup><span class="institution">Department of Medical-Surgical Sciences and Translational Medicine</span>, <span class="institution">Sant'Andrea Hospital</span>, <span class="addr-line">Rome</span>, Italy</address></li><li class="aff"><a id="aff-10" name="aff-10"></a><address><sup>10</sup><span class="institution">Facultad de Medicina Clinica Alemana-Universidad del Desarrollo</span>, <span class="addr-line">Santiago</span>, Chile</address></li><li class="aff"><a id="aff-11" name="aff-11"></a><address><sup>11</sup><span class="institution">Division of Gastroenterology and Hepatology</span>, <span class="institution">Shanghai Institute of Digestive Disease</span>, <span class="addr-line">Shanghai</span>, China</address></li><li class="aff"><a id="aff-12" name="aff-12"></a><address><sup>12</sup><span class="institution">Gastroenterology</span>, <span class="institution">Hospital Clinic de Barcelona</span>, <span class="addr-line">Barcelona</span>, Spain</address></li><li class="aff"><a id="aff-13" name="aff-13"></a><address><sup>13</sup><span class="institution">Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)</span>, <span class="institution">Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)</span>, <span class="addr-line">Barcelona</span>, Spain</address></li><li class="aff"><a id="aff-14" name="aff-14"></a><address><sup>14</sup><span class="institution">MRC Translational Immune Discovery Unit</span>, <span class="institution">MRC Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford</span>, <span class="addr-line">Oxford</span>, UK</address></li><li class="aff"><a id="aff-15" name="aff-15"></a><address><sup>15</sup><span class="institution">Medical Department II</span>, <span class="institution">LMU University Clinic</span>, <span class="addr-line">München</span>, Germany</address></li><li class="aff"><a id="aff-16" name="aff-16"></a><address><sup>16</sup><span class="institution">Lee Kong Chian School of Medicine, Nanyang Technological University</span>, Singapore</address></li><li class="aff"><a id="aff-17" name="aff-17"></a><address><sup>17</sup><span class="institution">UNSW Microbiome Research Centre</span>, <span class="institution">University of New South Wales</span>, <span class="addr-line">Sydney</span>, <span class="addr-line">New South Wales</span>, Australia</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1"><span class="corresp-label">Correspondence to</span> Professor Mario Dinis-Ribeiro, Department of Gastroenterology, RISE—Health Research Network, Porto, 4200-072, Portugal; <span class="em-link"><span class="em-addr">mario.ribeiro{at}ipoporto.min-saude.pt</span></span></li></ol></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup abstract-with-bc" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" id="content-block" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>Objective</strong> During the last decade, the management of gastric intestinal metaplasia (GIM) has been addressed by several distinct international evidence-based guidelines. In this review, we aimed to synthesise these guidelines and provide clinicians with a global perspective of the current recommendations for managing patients with GIM, as well as highlight evidence gaps that need to be addressed with future research.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>Design</strong> We conducted a systematic review of the literature for guidelines and consensus statements published between January 2010 and February 2023 that address the diagnosis and management of GIM.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>Results</strong> From 426 manuscripts identified, 16 guidelines were assessed. There was consistency across guidelines regarding the purpose of endoscopic surveillance of GIM, which is to identify prevalent neoplastic lesions and stage gastric preneoplastic conditions. The guidelines also agreed that only patients with high-risk GIM phenotypes (eg, corpus-extended GIM, OLGIM stages III/IV, incomplete GIM subtype), persistent refractory <em>Helicobacter pylori</em> infection or first-degree family history of gastric cancer should undergo regular-interval endoscopic surveillance. In contrast, low-risk phenotypes, which comprise most patients with GIM, do not require surveillance. Not all guidelines are aligned on histological staging systems. If surveillance is indicated, most guidelines recommend a 3-year interval, but there is some variability. All guidelines recommend <em>H. pylori</em> eradication as the only non-endoscopic intervention for gastric cancer prevention, while some offer additional recommendations regarding lifestyle modifications. While most guidelines allude to the importance of high-quality endoscopy for endoscopic surveillance, few detail important metrics apart from stating that a systematic gastric biopsy protocol should be followed. Notably, most guidelines comment on the role of endoscopy for gastric cancer screening and detection of gastric precancerous conditions, but with high heterogeneity, limited guidance regarding implementation, and lack of robust evidence.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>Conclusion</strong> Despite heterogeneous populations and practices, international guidelines are generally aligned on the importance of GIM as a precancerous condition and the need for a risk-stratified approach to endoscopic surveillance, as well as <em>H. pylori</em> eradication when present. There is room for harmonisation of guidelines regarding (1) which populations merit index endoscopic screening for gastric cancer and GIM detection/staging; (2) objective metrics for high-quality endoscopy; (3) consensus on the need for histological staging and (4) non-endoscopic interventions for gastric cancer prevention apart from <em>H. pylori</em> eradication alone. Robust studies, ideally in the form of randomised trials, are needed to bridge the ample evidence gaps that exist.</p></div></div><ul class="kwd-group"><li class="kwd">surveillance</li><li class="kwd">gastric carcinoma</li></ul><div class="section data-availability" id="sec-20"><h2 class="">Data availability statement</h2><p id="p-82">Data are available on reasonable request. All data analysed are available in proper databases depending on publisher.</p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-dfp-pane oas-ads oas-ads-mid pull-right" > <div class="pane-content"> <div id="dfp-ad-mpu-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-mpu" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-mpu"); }); </script> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-1" > <div class="pane-content"> <p><a href="https://doi.org/10.1136/gutjnl-2024-333029" target="_new">https://doi.org/10.1136/gutjnl-2024-333029</a></p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-altmetrics" > <h2 class="pane-title">Statistics from Altmetric.com</h2> <div class="pane-content"> <div data-badge-details="right" data-badge-type="medium-donut" data-doi="10.1136/gutjnl-2024-333029" data-hide-no-mentions="true" class="altmetric-embed"></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmjj-jumplinks" > <div class="pane-content"> <div class="highwire-list-wrapper"><div class="highwire-list"><ul></ul></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-2 permissions-box" > <h2 class="pane-title">Request Permissions</h2> <div class="pane-content"> <p>If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.</p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-ajax-pane-content permissions-box pane-highwire-permission-link" id="request-permissions"> <h2 class="pane-title"><span class='panels-ajax-pane-title' data-pid='new-70fd4c70-563e-4b94-ae3b-2a97f3980c13'></span></h2> <div class="pane-content"> <div class='panels-ajax-pane panels-ajax-pane-new-70fd4c70-563e-4b94-ae3b-2a97f3980c13' data-pid='new-70fd4c70-563e-4b94-ae3b-2a97f3980c13'></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><ul class="kwd-group"><li class="kwd"><a href="/keyword/surveillance" class="hw-term hw-article-keyword hw-article-keyword-surveillance" rel="nofollow">surveillance</a></li><li class="kwd"><a href="/keyword/gastric-carcinoma" class="hw-term hw-article-keyword hw-article-keyword-gastric-carcinoma" rel="nofollow">gastric carcinoma</a></li></ul><div class="section data-availability" id="sec-20"><h2 class="">Data availability statement</h2><p id="p-82">Data are available on reasonable request. All data analysed are available in proper databases depending on publisher.</p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="https://gut.bmj.com/content/73/10/1607.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup footnotes" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-other" id="fn-3"><p id="p-73"><span class="fn-label">X</span> @mdinisribeiro, @ShailjaShahMD, @diogolibanio, @MoreiraR_Leti, @emadelomar</p></li><li class="fn-other" id="fn-4"><p id="p-74">MD-R and SS contributed equally.</p></li><li class="fn-other" id="fn-5"><p id="p-75"><span class="fn-label">Correction notice</span> This article has been corrected since it publishes Online First. The first sentence of the results section in the abstract has been corrected. The author affiliations have been corrected in the online version only and not in print.</p></li><li class="fn-other" id="fn-6"><p id="p-76"><span class="fn-label">Contributors</span> MD-R, SS and EME-O developed the protocol, conducted the review and revised the final draft of the manuscript. All the authors collected data, provided input for the protocol and revised the draft of the manuscript, approving the final version. MD-R, SS and EME-O are the guarantors.</p></li><li class="fn-other" id="fn-7"><p id="p-77"><span class="fn-label">Funding</span> The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. <span class="named-content " id="named-content-1">JB is supported by the UK Medical Research Council in the context of the Clinical Academic Research Partnership (MRC CARP) scheme (Grant ref.: MR/W029960/1).</span></p></li><li class="fn-conflict" id="fn-8"><p id="p-78"><span class="fn-label">Competing interests</span> No conflicts of interest are declared by MD-R, SS, HE-S, MB, NU, HT, LGC, DL, EL, AR, J-YF, LM, JB, EJK, EME-O. PM is a member of advisory board/lecturer of Aboca, Alfasigma, Allergosan, Bayer, Biocodex, Menarini advisory boards/lectures.</p></li><li class="fn-other" id="fn-9"><p id="p-79"><span class="fn-label">Patient and public involvement</span> Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.</p></li><li class="fn-other" id="fn-10"><p id="p-80"><span class="fn-label">Provenance and peer review</span> Not commissioned; externally peer reviewed.</p></li><li class="fn-other" id="fn-11"><p id="p-81"><span class="fn-label">Supplemental material</span> This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.</p></li></ul></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-atom bmjj-linked-articles" id="linked-articles"> <h2 class="pane-title">Linked Articles</h2> <div class="pane-content"> <div class="highwire-atom-data-bmjj-linked-articles field field-highwire-atom-data field-label-hidden clearfix"><div class="field-items"><div class="highwire-list highwire-atom-data-list"><ul><li class="first odd">Commentary<div class = "highwire-article-citation bmjj-article-citation"><div class="highwire-cite"><div class="highwire-cite-title"><a href="/content/early/2024/09/18/gutjnl-2024-333684" class="bmjj-linked-article" data-icon-position="" data-hide-link-title="0">Commentary on: the management of patients with gastric intestinal metaplasia</a></div> <div class = "highwire-cite-authors"><div class="highwire-citation-authors"><span class="highwire-citation-author">David Y Graham</span> <span class="highwire-citation-author">Yi-Chia Lee</span> </div></div><div class="highwire-cite-metadata bmjj-citation-metadata"><span class="highwire-cite-metadata-journal highwire-cite-metadata">Gut </span><span class="highwire-cite-metadata-year highwire-cite-metadata">2024; </span><span class="highwire-cite-metadata-pages highwire-cite-metadata">- </span><span class="highwire-cite-metadata-date highwire-cite-metadata"><span class="label"> Published Online First:</span> 18 Sep 2024. </span><span class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">doi:</span> 10.1136/gutjnl-2024-333684 </span></div></div></div></li><li class="last even">Correction<div class = "highwire-article-citation bmjj-article-citation"><div class="highwire-cite"><div class="highwire-cite-title"><a href="/content/73/12/e1" class="bmjj-linked-article" data-icon-position="" data-hide-link-title="0">Correction: The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines</a></div> <div class = "highwire-cite-authors"><div class="highwire-citation-authors"><span class="highwire-citation-author">BMJ Publishing Group Ltd and British Society of Gastroenterology</span> </div></div><div class="highwire-cite-metadata bmjj-citation-metadata"><span class="highwire-cite-metadata-journal highwire-cite-metadata">Gut </span><span class="highwire-cite-metadata-year highwire-cite-metadata">2024; </span><span class="highwire-cite-metadata-volume highwire-cite-metadata">73 </span><span class="highwire-cite-metadata-pages highwire-cite-metadata">e1-e1 </span><span class="highwire-cite-metadata-date 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