Recently, Gut published a review of guidelines for the management of gastric intestinal metaplasia (GIM) with the goal of promoting harmonisation of the guidelines regarding indications for endoscopic screening for gastric cancer and GIM detection/staging, metrics for high-quality endoscopy and non-endoscopic interventions for gastric cancer prevention in patients with GIM.1 GIM is not a disease per se but rather is a reparative response to gastric mucosal injury that may be present, at least temporarily, as part of healing such as of an ulcer.2 Clinically, widespread GIM is best considered a manifestation of healing of another disease, typically Helicobacter pylori infection or autoimmune gastritis. When present in autoimmune gastritis, GIM has no malignant potential and is potentially completely reversible.3 In contrast, when associated with chronic H. pylori infection, GIM is typically permanent and, at most, minimally reversible.4 The underlying H. pylori -induced inflammation is carcinogenic. H. pylori -related GIM is a manifestation of the duration, extent and severity of an H. pylori infection which, in turn, is related to the risk of gastric cancer. Because GIM is easily recognised and reflects the extent and severity of the infection, it is a valuable surrogate for the risk of developing gastric cancer. This has given GIM a role in the determination of an individual’s cancer risk. However, because GIM is neither a disease nor a cause of cancer, eradication of gastric cancer should focus on the eradication of the cause, that is, H. pylori infections. The population …

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评论： 胃肠上皮化生患者的管理


最近，Gut 发表了一篇关于胃肠上皮化生 （GIM） 管理指南的综述，旨在促进关于胃癌内窥镜筛查适应症和 GIM 检测/分期、高质量内窥镜检查指标和 GIM 患者胃癌预防非内窥镜干预的指南的协调。GIM 本身不是一种疾病，而是对可能存在的胃粘膜损伤的修复反应， 至少是暂时的，作为溃疡等愈合的一部分。在临床上，广泛 GIM 最好被认为是另一种疾病愈合的表现，通常是幽门螺杆菌感染或自身免疫性胃炎。当存在于自身免疫性胃炎中时，GIM 没有恶性潜力，并且可能完全可逆.3 相反，当与慢性幽门螺杆菌感染相关时，GIM 通常是永久性的，最多是最低限度的可逆性.4 幽门螺杆菌诱导的潜在炎症是致癌的。幽门螺杆菌相关 GIM 是幽门螺杆菌感染持续时间、范围和严重程度的一种表现，而幽门螺杆菌感染又与胃癌的风险有关。由于 GIM 很容易识别并反映感染的程度和严重程度，因此它是降低患胃癌风险的宝贵指标。这使 GIM 在确定个人的癌症风险方面发挥作用。但是，由于 GIM 既不是癌症的疾病也不是癌症的原因，因此胃癌的根除应侧重于根除病因，即幽门螺杆菌感染。人口 ...