Increased prevalence of intestinal metaplasia in the gastric mucosa of the elderly: clinical implications.

Evidence which suggests a close relationship between intestinal-type gastric carcinoma (IGC) and intestinal metaplasia (IM) associated with chronic atrophic gastritis (CAG) has accumulated in the literature. The aim of this study has been to analyze retrospectively the prevalence of IM in patients with bioptically-proven chronic gastritis, as well as its age-specific distribution. A series of 230 patients, comprising 162 cases of CAG with IM (70.5%) and 68 cases of gastritis without IM (29.5%-57 superficial type, 11 CAG) was reviewed. All patients underwent upper gastrointestinal endoscopy one or more times, during which multiple biopsies were taken from the gastric mucosa. Moreover, patients were divided into two age-groups: over and under 65 years old. Three features were also investigated: location, endoscopic appearance and clinical manifestations. In agreement with other Authors, our findings showed: 1) predominance of the antral location (B-type gastritis); 2) a close relationship between prevalence of IM and increasing age, with an upward age-related trend. A statistically significant difference was noted between patients with IM and those without the lesion, emerging in the VII decade, with a further rise in the succeeding decade. In line with the literature, these findings emphasize the importance of endoscopic-bioptic follow-up, which takes on even greater significance in elderly patients, in whom an increased incidence of IGC has been reported.