Marcos Pedro, Gonçalves Nuno, Gama Jorge, Areia Miguel, Dinis-Ribeiro Mário
Department of Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; Department of Gastroenterology, Pêro da Covilhã Hospital, Covilhã, Portugal.
Department of Gastroenterology, Portuguese Institute of Oncology of Porto, Porto, Portugal.
Dig Liver Dis. 2025 Aug;57(8):1588-1602. doi: 10.1016/j.dld.2025.04.047. Epub 2025 May 31.
Patients with gastric atrophy (GA) and intestinal metaplasia (GIM) are considered to be at risk for gastric neoplasia (GN: dysplasia or cancer). During the last decades, standards of practice and endoscopic technologies have been developed and proposed. This meta-analysis reassesses GN incidence rates in GA and GIM patients, analyzing its evolution and the impact of standard protocols and scores.
MEDLINE, Web of Science, and Scopus were systematically searched for cohort studies and Helicobacter pylori eradication or placebo arms of randomized controlled trials published after 2009 that allowed for the determination of the GN incidence rate in patients with GA or GIM. Common or random effects models were employed to calculate incidence rates, and heterogeneity was assessed using the I² statistic.
Of 1242 studies, 15 met the inclusion criteria and were thus included. The annual incidence rates of GN (95 % confidence interval [CI]) were as follows: in GA patients, 0.21 % (95 % CI, 0.10-0.31) overall, 0.14 % (95 % CI, 0.00-0.42) for OLGA I/II, and 1.92 % (95 % CI, 1.37-2.47) for OLGA III/IV; in GIM patients, 0.57 % (95 % CI, 0.30-0.84) overall, 0.30 % (95 % CI, 0.00-0.69) for complete GIM, 1.08 % (95 % CI, 0.75-1.42) for incomplete GIM, 0.38 % (95 % CI, 0.09-0.68) for OLGIM I/II, and 1.12 % (95 % CI, 0.53-1.81) for OLGIM III/IV. When comparing studies using or not several histologic or endoscopic methods, the incidence rates of GN for both precancerous conditions were consistently higher than in those that did not: for the Sydney and/or MAPS biopsy protocols - in GA, 0.26 % (95 % CI, 0.08-0.44) vs. 0.17 % (95 % CI, 0.00-0.41); in GIM, 0.86 % (95 % CI, 0.35-1.36) vs. 0.44 % (95 % CI, 0.13-0.74); for the OLGA/OLGIM histological scores - in GA, 0.27 % (95 % CI, 0.08-0.46) vs. 0.16 % (95 % CI, 0.02-0.31); in GIM, 0.81 % (95 % CI, 0.27-1.36) vs. 0.47 % (95 % CI, 0.16-0.78); and for high-resolution endoscopy - in GA, 1.61 % (95 % CI, 0.32-2.90) vs. 0.19 % (95 % CI, 0.09-0.30); in GIM, 0.74 % (95 % CI, 0.15-1.33) vs. 0.52 % (95 % CI, 0.21-0.82).
Patients with advanced stages of GA or GIM (OLGA/OLGIM stages III/IV) present >1 % annual risk for gastric cancer, meriting surveillance. Importantly, the application of validated histological and endoscopic methods that improve the quality of procedures influences the detection rate of GN.
胃萎缩（GA）和肠化生（GIM）患者被认为有发生胃肿瘤（GN：发育异常或癌症）的风险。在过去几十年中，已制定并提出了实践标准和内镜技术。本荟萃分析重新评估了GA和GIM患者中GN的发病率，分析其演变以及标准方案和评分的影响。
系统检索MEDLINE、科学网和Scopus，查找2009年后发表的队列研究以及随机对照试验中幽门螺杆菌根除或安慰剂组，以确定GA或GIM患者中GN的发病率。采用固定效应模型或随机效应模型计算发病率，并使用I²统计量评估异质性。
在1242项研究中，15项符合纳入标准并被纳入。GN的年发病率（95%置信区间[CI]）如下：GA患者总体为0.21%（95%CI，0.10 - 0.31），OLGA I/II期为0.14%（95%CI，0.00 - 0.42），OLGA III/IV期为1.92%（95%CI，1.37 - 2.47）；GIM患者总体为0.57%（95%CI，0.30 - 0.84），完全型GIM为0.30%（95%CI，0.00 - 0.69），不完全型GIM为1.08%（95%CI，0.75 - 1.42），OLGIM I/II期为0.38%（95%CI，0.09 - 0.68），OLGIM III/IV期为1.12%（95%CI，0.53 - 1.81）。在比较使用或未使用多种组织学或内镜方法的研究时，两种癌前病变的GN发病率始终高于未使用这些方法的研究：对于悉尼和/或MAPS活检方案——GA患者中，0.26%（95%CI，0.08 - 0.44）对比0.17%（95%CI，0.00 - 0.41）；GIM患者中，0.86%（95%CI，0.35 - 1.36）对比0.44%（95%CI，0.13 - 0.74）；对于OLGA/OLGIM组织学评分——GA患者中，0.27%（95%CI，0.08 - - 0.46）对比0.16%（95%CI，0.02 - 0.31）；GIM患者中，0.81%（95%CI，0.27 - 1.36）对比0.47%（95%CI，0.16 - 0.78）；对于高分辨率内镜检查——GA患者中，1.61%（95%CI，0.32 - 2.90）对比0.19%（95%CI，0.09 - 0.30）；GIM患者中，0.74%（95%CI，0.15 - 1.33）对比0.52%（95%CI，0.21 - 0.82）。
GA或GIM晚期（OLGA/OLGIM III/IV期）患者每年患胃癌的风险>1%，值得进行监测。重要的是，应用经过验证的组织学和内镜方法提高检查质量会影响GN的检出率。
