诊断：胃肠上皮化生 - 下一步该怎么办？
Diagnosis: gastric intestinal metaplasia - what to do next?
机构信息
Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine Houston, Texas, USA.
Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padova.
出版信息
Curr Opin Gastroenterol. 2019 Nov;35(6):535-543. doi: 10.1097/MOG.0000000000000576.
PURPOSE OF REVIEW
One of the most vexing problems for gastroenterologists is what actions to take after receiving a histological diagnosis of gastric intestinal metaplasia. We approach the problem by starting with suggesting a biopsy protocol that ensures obtaining the biopsies required for diagnosis, assessing the status of the gastric mucosa, and effective communication with the pathologist and patient.
RECENT FINDINGS
The rediscovery and integration of the long history of gastric damage and repair resulting in pseudopyloric metaplasia (called SPEM) into the thinking of investigators working with animal models of gastric cancer has resulted in improved ability to separate changes associated with benign repair from those associated with inflammation-associated gastric carcinogenesis.
SUMMARY
Gastric intestinal metaplasia is a potential reversible product of injury and repair and not directly connected with carcinogenesis. Intestinal metaplasia is a biomarker for prior gastric injury and repair. The risk of gastric cancer is best assessed in relation to the severity, extent, and, most importantly, the cause of the atrophic changes.
目的综述
胃肠病学家面临的最棘手问题之一是在收到胃肠上皮化生的组织学诊断后应采取什么措施。我们从提出活检方案开始着手解决这个问题，该方案确保获取用于诊断、评估胃黏膜状况的活检，并与病理学家和患者进行有效的沟通。
最新发现
重新发现和整合导致假幽门化生（称为 SPEM）的胃损伤和修复的悠久历史，将其纳入研究胃癌动物模型的研究人员的思维中，使得将与良性修复相关的变化与与炎症相关的胃癌发生相关的变化区分开来的能力得到提高。
总结
胃肠上皮化生是损伤和修复的潜在可逆产物，与癌发生没有直接关系。肠上皮化生是既往胃损伤和修复的生物标志物。胃癌风险最好根据萎缩性改变的严重程度、范围，最重要的是，病因来评估。
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