Esophagus to Small Intestine

Gut. 2022;71(5):854–63

Lee JWJ, Zhu F, Srivastava S, Tsao SKK, Khor C, Ho KY, Fock KM, Lim WC, Ang TL, Chow WC, So JBY, Koh CJ, Chua SJ, Wong ASY, Rao J, Lim LG, Ling KL, Chia CK, Ooi CJ, Rajnakova A, Yap WM, Salto-Tellez M, Ho B, Soong R, Chia KS, Teo YY, Teh M, Yeoh KG

Severity of gastric intestinal metaplasia predicts the risk of gastric cancer: A prospective multicenter cohort study (GCEP)

Objective: To investigate the incidence of gastric cancer (GC) attributed to gastric intestinal metaplasia (IM), and validate the Operative Link on Gastric Intestinal Metaplasia (OLGIM) for targeted endoscopic surveillance in regions with low-intermediate incidence of GC.
Methods: A prospective, longitudinal and multicenter study was carried out in Singapore. The study participants comprised 2980 patients undergoing screening gastroscopy with standardized gastric mucosal sampling, from January 2004 and December 2010, with scheduled surveillance endoscopies at year 3 and 5. Participants were also matched against the National Registry of Diseases Office for missed diagnoses of early gastric neoplasia (EGN).
Results: There were 21 participants diagnosed with EGN. IM was a significant risk factor for EGN (adjusted hazard ratio [aHR] = 5.36; 95% confidence interval [CI]: 1.51–19.0; p < 0.01). The age-adjusted EGN incidence rates for patients with and without IM were 133.9 and 12.5 per 100,000 person-years. Participants with OLGIM stages III–IV were at greatest risk (aHR = 20.7; 95% CI: 5.04–85.6; p < 0.01). More than half of the EGNs (n = 4/7) attributed to baseline OLGIM III–IV developed within 2 years (range, 12.7–44.8 months). Serum trefoil factor 3 distinguishes (area under the receiver-operating characteristics [AUROC], 0.749) patients with OLGIM III–IV if they are negative for Helicobacter pylori. Participants with OLGIM II were also at significant risk of EGN (aHR = 7.34; 95% CI: 1.60–33.7; p = 0.02). A significant smoking history further increases the risk of EGN among patients with OLGIM stages II–IV.

Conclusions: The authors suggest a risk-stratified approach and recommend that high-risk patients (Operative Link on Gastric Intestinal Metaplasia [OLGIM] III–IV) have endoscopic surveillance in 2 years, intermediate-risk patients (OLGIM II) in 5 years.

Dr. K.-G. Yeoh, Department of Medicine, National University of Singapore, Singapore, Singapore,

DOI: DOI: 10.1136/gutjnl-2021-324057

Back to overview

this could be of interest:

Treat to target versus standard of care for patients with Crohn’s disease treated with ustekinumab (STARDUST): An open-label, multicenter, randomized phase 3b trial

Lancet Gastroenterol Hepatol. 2022;7(4):294–306

Endoscopic full-thickness plication for the treatment of PPI-dependent GERD: Results from a randomized, sham-controlled trial

Gut. 2022;71(4):686–94

More articles on the topic