IMAD, Department of Hepato-Gastroenterology and Digestive Oncology, Hôtel Dieu, Nantes University Hospital, INSERM 1235, 1, Place Alexis Ricordeau, 44093, Nantes, France.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
Dig Dis Sci. 2020 Jul;65(7):1899-1903. doi: 10.1007/s10620-020-06272-9.
Patients with gastric precancerous lesions (atrophic gastritis and intestinal metaplasia) have increased risk of developing gastric cancer, and adequate management and surveillance of these patients should allow to reduce gastric cancer-related mortality. The guidelines on the management of these patients have been recently published by the European Societies (MAPS II guidelines) and by the American Gastroenterological Association (AGA). The aim of this commentary is to compare these two guidelines by highlighting the common points and differences between them. Both guidelines recommend a systematic detection and eradication of Helicobacter pylori in all patients with gastric atrophy. However, there is a major difference in the recommendations for surveillance: while the MAPS II guidelines recommend systematic endoscopic surveillance in all patients with severe gastric atrophy (with or without intestinal metaplasia), the AGA guidelines focus only on intestinal metaplasia and plead against systematic surveillance, leaving the possibility of surveillance in individual patients based on shared decision between clinicians and patients. The difference between two guidelines comes essentially from the different arguments used by two authorities (randomized control studies by AGA and observational cohort studies by the European Societies), and may be, at least in part, related to the difference between the European and American health care systems and potential economic burden.
胃前病变（萎缩性胃炎和肠上皮化生）患者发生胃癌的风险增加，对这些患者进行充分的管理和监测，有望降低胃癌相关死亡率。欧洲学会（MAPS II 指南）和美国胃肠病学会（AGA）最近发布了这些患者的管理指南。本评论旨在通过突出这两个指南之间的共同点和不同点，对这两个指南进行比较。两个指南均建议对所有萎缩性胃炎患者进行系统性幽门螺杆菌检测和根除。然而，在监测建议方面存在重大差异：MAPS II 指南建议对所有严重萎缩性胃炎（伴或不伴肠上皮化生）患者进行系统内镜监测，而 AGA 指南仅关注肠上皮化生，并反对系统监测，允许根据临床医生和患者之间的共同决策，对个别患者进行监测。两个指南之间的差异主要源于两个权威机构使用的不同论据（AGA 的随机对照研究和欧洲学会的观察性队列研究），这至少部分可能与欧洲和美国的医疗保健系统以及潜在的经济负担的差异有关。
