Abstract
Patients with gastric precancerous lesions (atrophic gastritis and intestinal metaplasia) have increased risk of developing gastric cancer, and adequate management and surveillance of these patients should allow to reduce gastric cancer-related mortality. The guidelines on the management of these patients have been recently published by the European Societies (MAPS II guidelines) and by the American Gastroenterological Association (AGA). The aim of this commentary is to compare these two guidelines by highlighting the common points and differences between them. Both guidelines recommend a systematic detection and eradication of Helicobacter pylori in all patients with gastric atrophy. However, there is a major difference in the recommendations for surveillance: while the MAPS II guidelines recommend systematic endoscopic surveillance in all patients with severe gastric atrophy (with or without intestinal metaplasia), the AGA guidelines focus only on intestinal metaplasia and plead against systematic surveillance, leaving the possibility of surveillance in individual patients based on shared decision between clinicians and patients. The difference between two guidelines comes essentially from the different arguments used by two authorities (randomized control studies by AGA and observational cohort studies by the European Societies), and may be, at least in part, related to the difference between the European and American health care systems and potential economic burden.
Similar content being viewed by others
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.
Correa P, Haenszel W, Cuello C, Tannenbaum S, Archer M. A model for gastric cancer epidemiology. Lancet. 1975;2:58–60.
Correa P. Human gastric carcinogenesis: a multistep and multifactorial process—first American cancer society award lecture on cancer epidemiology and prevention. Cancer Res. 1992;52:6735–6740.
Pimentel-Nunes P, Libanio D, Marcos-Pinto R, et al. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy. 2019;51:365–388.
Dinis-Ribeiro M, Areia M, de Vries AC, et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy. 2012;44:74–94.
Gupta S, Li D, El Serag HB, et al. AGA clinical practice guidelines on management of gastric intestinal metaplasia. Gastroenterology. 2020;158:693–702.
Banks M, Graham D, Jansen M, et al. British society of gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut. 2019;68:1545–1575.
Lahner E, Zagari RM, Zullo A, et al. Chronic atrophic gastritis: natural history, diagnosis and therapeutic management. A position paper by the Italian Society of Hospital Gastroenterologists and Digestive Endoscopists [AIGO], the Italian Society of Digestive Endoscopy [SIED], the Italian Society of Gastroenterology [SIGE], and the Italian Society of Internal Medicine [SIMI]. Dig Liver Dis. 2019;51:1621–1632.
Dinis-Ribeiro M, Kuipers EJ. How to manage a patient with gastric intestinal metaplasia: an international perspective. Gastroenterology. 2020;158:1534–1537. https://doi.org/10.1053/j.gastro.2020.01.008
Rugge M, Meggio A, Pennelli G, et al. Gastritis staging in clinical practice: the OLGA staging system. Gut. 2007;56:631–636.
Capelle LG, de Vries AC, Haringsma J, et al. The staging of gastritis with the OLGA system by using intestinal metaplasia as an accurate alternative for atrophic gastritis. Gastrointest Endosc. 2010;71:1150–1158.
Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International workshop on the histopathology of gastritis, Houston 1994. Am J Surg Pathol.. 1996;20:1161–1181.
Rugge M, Fassan M, Farinati F, Genta RM. The war of the worlds: metaplastic versus nonmetaplastic atrophic gastritis Gastrointest Endosc. 2011;73:411–2; author reply 412–3.
Isajevs S, Liepniece-Karele I, Janciauskas D, et al. Gastritis staging: interobserver agreement by applying OLGA and OLGIM systems. Virchows Arch. 2014;464:403–407.
Committee ASoP, Evans JA, Chandrasekhara V, et al. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc. 2015;82:1–8.
Anderson WF, Rabkin CS, Turner N, Fraumeni JF Jr, Rosenberg PS, Camargo MC. The changing face of noncardia gastric cancer incidence among US non-Hispanic whites. J Natl Cancer Inst. 2018;110:608–615.
Arnold M, Park JY, Camargo MC, Lunet N, Forman D, Soerjomataram I. Is gastric cancer becoming a rare disease? A global assessment of predicted incidence trends to 2035. Gut. 2020;69:823–829.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Matysiak-Budnik, T., Camargo, M.C., Piazuelo, M.B. et al. Recent Guidelines on the Management of Patients with Gastric Atrophy: Common Points and Controversies. Dig Dis Sci 65, 1899–1903 (2020). https://doi.org/10.1007/s10620-020-06272-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-020-06272-9