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.
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.
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.
aDepartment of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine Houston, Texas, USA
bDepartment of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padova
cVeneto Tumor Registry (RTV), Veneto Regional Authority, Padova, Italy
Correspondence to David Y. Graham, MD, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, RM 3C-190 (111D), 2002 Holcombe Boulevard, Houston, TX 77030, USA. Tel: +1 713 795 0232; e-mail: firstname.lastname@example.org