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High-risk individuals for gastric cancer would be missed for surveillance without subtyping of intestinal metaplasia


The use of Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis Assessment based on Intestinal Metaplasia (OLGIM) staging system is recommended for identifying subjects at risk for developing gastric cancer; usually high-risk lesions are considered only as stages III and IV. Accumulating evidence suggests that incomplete intestinal metaplasia (IM) is important in the development of gastric cancer. Our aim has been to identify the prevalence of incomplete IM in patients with low-risk OLGA/OLGIM stages among a high-risk general population. Healthy adult volunteers aged 40–64 years were invited to undergo upper endoscopy within a regional GISTAR pilot study in Kazakhstan (n = 166). Gastric lesions were staged according to OLGA/OLGIM staging system. High iron diamine–alcian blue (HID-AB) was used for subtyping IM. IM prevalence overall was 45.8%. Incomplete IM was present in 52.6% (type II in 30.3% and type III in 22.3%), whereas complete IM was found in 47.4% individuals. The prevalence of OLGIM I and II stage were 39.8 and 4.8%, respectively, whereas OLGIM III was observed in 1.2%. The prevalence of incomplete IM in patients stratified to OLGIM I was 54.5% (type II in 31.8% and type III in 22.7%). High prevalence of incomplete IM was detected not only in subjects with extensive IM, but in those stratified as at the OLGIM I stage. Without IM subtyping, patients with high risk of gastric cancer development would be missed for surveillance.

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Data availability

The manuscript with the results and data, figures, tables and text has been exclusively submitted for publication only to Virchows Archiv. The datasets used and/or analyzed in the present study are available from the corresponding author upon a reasonable request.


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We acknowledge Aiga Rudule for the GISTAR regional pilot study managment in Kazakhstan and Ilze Polaka for assistance in statistical analysis. The infrastructure for IM subtyping has been provided by the Academic Histology laboratory, Riga, Latvia. The assistance of BioMedES UK ( in the final drafting of this paper is acknowledged.


The work was supported in part from the grant of ERDF “H. pylori risk stratification, optimization of management and interplay with other gastric microbiota within major cancer prevention studies of international scope”; University of Latvia grant “Development, validation and implementation of an histochemical method for gastric intestinal metaplasia subtyping to access the risk of gastric cancer”, and project No. AP05133849 “Decreasing the burden of gastric cancer in Kazakhstan: evaluation of the existing situation and search for improvement possibilities” Ministry of Education and Science of the Republic of Kazakhstan.

Author information




All authors have contributed to and agreed on the content of the manuscript. SI, MBP and ML designed the study. SI, SS, ILK, MBP analysed the histopathological slides and data. SI, MBP and ML wrote the manuscript. IK, IT, LM, AT, DS, RS, TB, NI, DP participated in the patients enrollment and data collection and analysis. The ML supervised the project. All authors have reviewed the manuscript.

Corresponding author

Correspondence to Sergejs Isajevs.

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Ethics approval

The study protocol (version 4.5, revised on 7 September 2015) was approved by the Ethics Committee of the International Agency for Research on Cancer (IEC 12–36), and the National Ethics Committees in Latvia, the Ethics Committee of Riga East University Support Foundation (No.14-A/13), and the Central Medical Ethics Committee (No. 01–29.1/11). The protocol is registered in the database (NCT02047994).

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All patients signed informed consent to participate in the study.

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The manucript and data has been submitted for publication to only Virchows Archiv.

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The authors declare that they have no conflict of interest.

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Isajevs, S., Savcenko, S., Liepniece-Karele, I. et al. High-risk individuals for gastric cancer would be missed for surveillance without subtyping of intestinal metaplasia. Virchows Arch 479, 679–686 (2021).

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  • Gastric cancer
  • OLGA
  • OLGIM intestinal metaplasia
  • Subtypes
  • Risk stratification