Surveillance of patients with gastric precancerous conditions

• Published in: Baillière's best practice & research. Clinical gastroenterology Vol. 30; no. 6; pp. 913 - 922
• Main Authors: Lage, Jorge, MD, Medical Doctor and Master Degree, Uedo, Noriya, MD, Dinis-Ribeiro, Mário, MD, PhD, Yao, Kenshi, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.12.2016; Elsevier Limited
• Subjects: Atrophic gastritis; Cell cycle; Classification; Endoscopy; Endoscopy, Gastrointestinal; Gastric cancer; Gastric intestinal metaplasia; Gastric Mucosa - pathology; Gastritis, Atrophic - diagnosis; Gastroenterology and Hepatology; Helicobacter pylori; Humans; Infections; Inflammation; Medical prognosis; Metaplasia; Mortality; Mucous membrane; Population Surveillance; Practice Patterns, Physicians; Precancerous Conditions - diagnosis; Rodents; Stomach neoplasms; Stomach Neoplasms - diagnosis; Surveillance; Tumors; Gastric intestinal metaplasia; Population surveillance; Helicobacter pylori; Atrophic gastritis; Stomach neoplasms
• ISSN: 1521-6918; 1532-1916
• DOI: 10.1016/j.bpg.2016.09.004

Abstract Intestinal-type gastric adenocarcinoma arises from a multistep process starting with Helicobacter pylori infection followed by gastric atrophy, gastric intestinal metaplasia and dysplasia. Indeed, patients with gastric precancerous conditions or lesions (GPC) are at increased risk to develop gastric cancer even in regions with low incidence. Thus, the identification and surveillance of a high risk subgroup could lead to the diagnosis of cancer at early stage and improve survival. However, both endoscopic and histological accuracy and interobserver agreement in the diagnosis of GPC are still far from optimal. Also, there are conceptual differences between the West and the East in the diagnosis and surveillance of patients. In the former, multiple gastric biopsies are still recommended but Eastern gastroenterologists select patients to surveillance according to the results of endoscopy or serology. In this literature review we describe the cascade of GPC and we highlight the differences between eastern and western clinical practice.