Identification of gastric atrophic changes: from histopathology to endoscopy.

In an aging European population, an increasing number of individuals will suffer from gastric cancer in the coming two decades. Recent research has determined the risk for gastric cancer in patients with different stages of gastric atrophy. Based on these data, it is now recommended that surveillance is offered to individuals with advanced stages of atrophic gastritis. Endoscopic biopsies of the gastric antrum and corpus are recommended in order to assess the severity and extent of gastric atrophy. This enables identification of those at highest risk of progressing to cancer. However, systematic reviews have shown that in recent years many researchers have assessed new endoscopic technologies for their accuracy in determining the severity and extent of gastric atrophy and metaplasia without the use of histology. Simple, reliable and accurate endoscopic features have been identified that can be used to either target biopsies or avoid biopsy sampling in the absence of endoscopic features of atrophy and intestinal metaplasia. This may largely simplify everyday practice. Randomized trials or large observational studies are now needed to demonstrate the accuracy of endoscopic assessment of the entire gastric mucosa and its impact on patient management.