Gastroenterology and Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, 00153 Rome, Italy.
World J Gastroenterol. 2013 Mar 14;19(10):1523-6. doi: 10.3748/wjg.v19.i10.1523.
Atrophic gastritis and intestinal metaplasia (IM) of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, a pragmatic management has been performed in Western countries in patients with these premalignant conditions. Recently, formal European guidelines have been delivered on this topic. Basically, it has been recommended that patients with extensive atrophic gastritis (AG) and/or extensive IM should be offered endoscopic surveillance every 3 years. On the contrary, no scheduled endoscopic/histological control has been advised for those patients with precancerous conditions confined to the antrum. In this commentary, we highlighted some potential weaknesses in the management formally recommended by the new guidelines. In detail, we discussed that AG and IM patients do not share the same gastric cancer risk, at least in Western countries, deserving a different approach. Some factors significantly associated with gastric cancer risk, such as IM type, first-degree family history of gastric cancer, and smoking habit have not been considered in tailoring the endoscopic follow-up. Finally, some data would suggest that a 3-year follow-up in patients with extensive gastric precancerous conditions could result in an inadequate secondary prevention.
萎缩性胃炎和胃的肠上皮化生（IM）是常见的，并且与胃癌的风险增加有关。在缺乏指南的情况下，西方国家对这些癌前病变患者进行了实用的管理。最近，针对这一主题发布了正式的欧洲指南。基本上，建议广泛萎缩性胃炎（AG）和/或广泛 IM 的患者每 3 年接受一次内镜监测。相反，对于那些局限于胃窦的癌前病变患者，不建议进行预定的内镜/组织学检查。在这篇评论中，我们强调了新指南正式推荐的管理方法中存在的一些潜在弱点。具体来说，我们讨论了 AG 和 IM 患者的胃癌风险并不相同，至少在西方国家是这样，因此需要采取不同的方法。一些与胃癌风险显著相关的因素，如 IM 类型、一级胃癌家族史和吸烟习惯，在制定内镜随访时并未考虑在内。最后，一些数据表明，对广泛存在胃癌前病变的患者进行 3 年随访可能导致二级预防不足。
