Gastric Intestinal Metaplasia

What is gastric intestinal metaplasia (GIM)? 

GIM has been identified as a premalignant condition that may be the result of an adaptive response to a variety of environmental insults, such as Helicobacter pylori infection, smoking, or high salt intake.

Gastric intestinal metaplasia is histologically identical to esophageal intestinal metaplasia.

How common is Gastric intestinal metaplasia? What is its malignant potential? 

Gastric intestinal metaplasia is extremely common in Western countries; up to 25% to 30% of the population can be affected. Individuals with GIM, especially in certain geographical regions (e.g., Japan) and in those infected with H. pylori , have greater than a tenfold increased risk of developing gastric cancer.

Patients found to have GIM with HGD are at a significant risk for developing gastric cancer and should proceed immediately to gastrectomy or endoscopic mucosal resection.

What role does endoscopic surveillance have in Gastric intestinal metaplasia? 

Endoscopic surveillance is not uniformly recommended for GIM. GIM has not been extensively studied in the United States, and recent reports suggest that the risk of progression to cancer is low for most patients. Patients at increased risk for gastric cancer, based on ethnicity or family history, may benefit from surveillance. Topographic mapping of the entire stomach should be performed if endoscopic surveillance is to be undertaken.

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