The natural course of gastric intestinal metaplasia in Turkish Patients: A single-center observational cohort study

Year 2021, Volume: 34 Issue: 3, 229 - 233, 27.10.2021

Coskun Ozer Demırtas Mesut Koldas Metehan Yılmaz Muhammed Zahid Sahın Muhammed Talha Soykuvvet Cigdem Ataızı Celıkel Feyza Gunduz

https://doi.org/10.5472/marumj.1013580

Abstract

Objective: Gastric intestinal metaplasia (GIM) is considered as a predisposing lesion for the development of gastric cancer and is
recommended to be kept under surveillance in designated intervals. We aimed to assess the natural course of GIM in a large Turkish
cohort.
Materials and Methods: We retrospectively reviewed findings from pathology reports of gastric biopsies conducted between 2011 to
2018 to reveal patients diagnosed with solitary GIM in their index pathology report. Progression of GIM was pre-defined as; lowgrade
dysplasia (LGD), high-grade dysplasia (HGD), or gastric malignancy.
Results: The median follow-up period of the study population was 34 (12-128) months. Out of 109 patients with GIM at the entry, 54
(49.6%) patients had stable GIM, whereas 53 (48.6%) cases had no signs of GIM at their final endoscopy. Only two (1.8%) patients
progressed to LGD, but no HGD or malignancy was detected in the follow-up.
Conclusion: Although, considered as a premalignant lesion and offered surveillance globally, progression of GIM was very low in a
large Turkish cohort. Further prospective studies in larger cohorts are required to enlighten the obscure strategies in the surveillance
of gastric malignancy.

Keywords

Gastric intestinal metaplasia, Gastric cancer, Dysplasia, Surveillance

References

• [1] Huang RJ, Choi AY, Truong CD, Yeh MM, Hwang JH. Diagnosis and management of gastric intestinal metaplasia: current status and future directions. Gut Liver 2019;13:596- 603. doi: 10.5009/gnl19181.
• [2] Graham DY. Helicobacter pylori update: gastric cancer, reliable therapy, and possible benefits. Gastroenterology 2015;148:719-31 e3. doi: 10.1053/j.gastro.2015.01.040.
• [3] Zhu H, Xu H. Demographic and lifestyle risk factors for gastric intestinal metaplasia among US veterans. Am J Gastroenterol 2020;115:381-7. doi: 10.14309/ajg.0000000000000498.
• [4] Oh S, Kim N, Yoon H, et al. Risk factors of atrophic gastritis and intestinal metaplasia in first-degree relatives of gastric cancer patients compared with age-sex matched controls. J Cancer Prev 2013;18:149-60. doi: 10.15430/jcp.2013.18.2.149.
• [5] Trieu JA, Bilal M, Saraireh H, Wang AY. Update on the diagnosis and management of gastric intestinal metaplasia in the USA. Dig Dis Sci 2019;64:1079-88. doi: 10.1007/s10620- 019-05526-5.
• [6] Yee YK, Wong KW, Hui CK, et al. Prevalence and time trend of intestinal metaplasia in Hong Kong. J Gastroenterol Hepatol 2009;24:896-9. doi: 10.1111/j.1440-1746.2009.05799.x.
• [7] Wong BC, Lam SK, Wong WM, et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA 2004;291:187-94. doi: 10.1001/jama.291.2.187.
• [8] Olmez S, Aslan M, Erten R, Sayar S, Bayram I. The Prevalence of gastric intestinal metaplasia and distribution of helicobacter pylori infection, atrophy, dysplasia, and cancer in its subtypes. Gastroenterol Res Pract 2015;2015:434039. doi: 10.1155/2015/434039.
• [9] Choi AY, Strate LL, Fix MC, et al. Association of gastric intestinal metaplasia and East Asian ethnicity with the risk of gastric adenocarcinoma in a U.S. population. Gastrointest Endosc 2018;87:1023-8. doi: 10.1016/j.gie.2017.11.010.
• [10] Song H, Ekheden IG, Zheng Z, Ericsson J, Nyren O, Ye W. Incidence of gastric cancer among patients with gastric precancerous lesions: observational cohort study in a low risk Western population. BMJ 2015;351:h3867. doi: 10.1136/bmj. h3867.
• [11] Liu KS, Wong IO, Leung WK. Helicobacter pylori associated gastric intestinal metaplasia: Treatment and surveillance. World J Gastroenterol 2016;22:1311-20. doi: 10.3748/wjg.v22. i3.1311.
• [12] Park YH, Kim N. Review of atrophic gastritis and intestinal metaplasia as a premalignant lesion of gastric cancer. J Cancer Prev 2015;20:25-40. doi: 10.15430/JCP.2015.20.1.25.
• [13] Pimentel-Nunes P, Libanio D, Marcos-Pinto R, et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy 2019;51:365-88. doi: 10.1055/a-0859-1883.
• [14] den Hoed CM, Holster IL, Capelle LG, et al. Follow-up of premalignant lesions in patients at risk for progression to gastric cancer. Endoscopy 2013;45:249-56. doi: 10.1055/s- 0032-1326379.
• [15] den Hollander WJ, Holster IL, den Hoed CM, et al. Surveillance of premalignant gastric lesions: a multicentre prospective cohort study from low incidence regions. Gut 2019;68:585-93. doi: 10.1136/gutjnl-2017-314498.
• [16] Hwang YJ, Kim N, Lee HS, et al. Reversibility of atrophic gastritis and intestinal metaplasia after Helicobacter pylori eradication - a prospective study for up to 10 years. Aliment Pharmacol Ther 2018;47:380-90. doi: 10.1111/apt.14424.
• [17] Pittayanon R, Rerknimitr R, Klaikaew N, et al. The risk of gastric cancer in patients with gastric intestinal metaplasia in 5-year follow-up. Aliment Pharmacol Ther 2017;46:40-5. doi: 10.1111/apt.14082.
• [18] Xirouchakis E, Laoudi F, Tsartsali L, Spiliadi C, Georgopoulos SD. Screening for gastric premalignant lesions with narrow band imaging, white light and updated Sydney protocol or both? Dig Dis Sci 2013;58:1084-90. doi: 10.1007/s10620-012- 2431-x.