Gastric intestinal metaplasia: when to treat? How to treat?

Purpose of review Gastric intestinal metaplasia (GIM) is an attractive target for surveillance and treatment as it can progress to gastric adenocarcinoma (GAC). Yet, GIM remains a challenging area for clinicians as most patients do not progress to cancer, and there are conflicting data regarding the benefits of surveillance and therapy. This review aims to summarize recently published GIM surveillance guidelines, to discuss, which patients with GIM may benefit from treatment, and to review pivotal and recent literature on GIM therapy. Recent findings Guidelines published by American, British, and European gastroenterology societies do not recommend universal surveillance, but do suggest endoscopic surveillance in patients with risk factors for progression to GAC. Although light examination for at least 7 min and mapping biopsies may increase yield for dysplasia and GAC. In randomized trials, Helicobacter pylori eradication reduced risk of dysplasia and cancer. In GIM with visible dysplasia and early-stage GAC, endoscopic resection improves quality of life without reducing survival compared with surgery. Endoscopic ablation therapies have shown promise for invisible or extensive dysplasia. Summary Endoscopic resection is appropriate for visible dysplasia and early-stage GAC without high-risk features that persists despite H. pylori eradication therapy. Prospective studies are needed to assess the utility of endoscopic ablation in GIM.
Source: Current Opinion in Gastroenterology - Category: Gastroenterology Tags: STOMACH AND DUODENUM: Edited by Tilak U. Shah Source Type: research

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Although environmental factors such as Helicobacter pylori, tobacco, and diet are major contributors to the development of gastric cancer (GC) worldwide, it is estimated that up to 5% to 10% of GC cases are due to an underlying hereditary susceptibility caused by germline pathogenic variants. Hereditary diffuse gastric cancer (HDGC) caused by germline pathogenic variants in the CDH1 gene is the principal familial GC syndrome. However, other well-established hereditary gastrointestinal syndromes have been associated with an increased risk of GC. In this review, we will discuss the latest insights and advances in our underst...
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Source Type: research
Gastric cancer (GC) remains one of the most common and deadly cancers worldwide, even if its incidence has decreased over time, mainly because of prevention and treatment of Helicobacter pylori infection[1]. Contrarily, the incidence of gastro-esophageal junction (GEJ) adenocarcinomas has increased, attributable to smoking and elevated body mass index (BMI) [2]. Much progress has been made in the management of advanced G/GEJ adenocarcinomas: the identification of molecular sub-groups benefiting from specific therapies (HER2 positive tumors, MSI/dMMR and EBV positive tumors, FGFR amplified tumors, etc)[3 –6], the intr...
Source: Cancer Treatment Reviews - Category: Cancer & Oncology Authors: Source Type: research
Backert The pathogen Helicobacter pylori is the first reported bacterial type-1 carcinogen playing a role in the development of human malignancies, including gastric adenocarcinoma. Cancer cell motility is an important process in this scenario, however, the molecular mechanisms are still not fully understood. Here, we demonstrate that H. pylori subverts the actin-binding protein cortactin through its type-IV secretion system and injected oncoprotein CagA, e.g., by inducing tyrosine phosphorylation of cortactin at Y-470, which triggers gastric epithelial cell scattering and motility. During infection of AGS cells, corta...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Article Source Type: research
In this study, 100 gastric tissue samples from patients with gastric cancer were examined for detection of H. pylori and EBV in tumor tissue using PCR techniques, and the clinical relevance was statistically analyzed.RESULTS: Results revealed an individual Epstein-Barr virus (EBV) infection observed in (40 %) of gastric carcinoma cases. Furthermore, the frequency of EBV infection was significantly different with intestinal and diffuse gastric cancer types [15 % vs. 85 %;
Source: Annals of Medicine - Category: Internal Medicine Authors: Source Type: research
We aimed to determine the clinical characteristics and prognosis factors of young patients with gastric cancer (GC). A total of 101 young patients with GC referred to Zhengzhou University People's Hospital, Henan province, China between January 1st, 2003 and June 1st, 2015 were retrospectively reviewed. The medical records included ages, genders, marital status, family history of tumors, comorbidity, Helicobacter pylori (H.pylori) infection, fibrinogen, prealbumin, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), tumor location, tumor size, TNM stage, differentiation of the tumor, WHO type, treatment method and ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
CONCLUSIONS: Our results indicate that the TNF-A-857*T SNP is among the risk factors associated with the risk of gastric cancer in Costa Rica.PMID:34088492 | DOI:10.1016/j.amjms.2021.01.017
Source: The American Journal of the Medical Sciences - Category: General Medicine Authors: Source Type: research
Gastric adenocarcinoma is a common and highly lethal cancer worldwide. The disease is of lower incidence in the United States and other western countries. The lower incidence is probably related in part to the decreasing incidence of gastric Helicobacter pylori infections in the west. A reverse effect of the decline in H pylori in the west has been the dramatic rise in Barrett ’s esophagus and esophageal adenocarcinoma primarily affecting white men. Adenocarcinoma of the stomach, on the other hand, excluding esophagogastric junction cancer, more commonly occurs in blacks, Hispanics, and Asians, creating health dispar...
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Tags: Foreword Source Type: research
Gastric cancer (GC), specifically gastric adenocarcinoma, is the fifth most common cancer and the third leading cause of cancer death globally and has been categorized as a neglected cancer by the World Health Organization.1,2 Usually diagnosed at advanced stages, GC has a 5-year survival rate of ∼30%.3 In the United States, there are stark disparities, with blacks, Hispanics, and Asians having a nearly 2-fold greater risk of developing or dying from GC compared with whites,4 reflecting differences in risk factors, such as Helicobacter pylori infection and smoking, as well as access to pri mary prevention5 and care.
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Tags: Preface Source Type: research
Helicobacter pylori is present in approximately one-half of the world ’s population. There are significant differences in prevalence based on region, age, race/ethnicity, and socioeconomic status. H pylori is the most common cause of infection-related cancers. Studies have demonstrated the relationship between H pylori infection and gastric adenocarcinoma and mucosa -associated lymphoid tissue lymphoma. H pylori has features and enzymatic properties allowing it to survive in the acidic stomach environment, and has specific virulence factors that promote an increased risk of gastric pathology. Eradication of H pylori ...
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Source Type: research
Endosc Int Open 2021; 09: E863-E866 DOI: 10.1055/a-1396-3854A 40-year-old man with slightly depressed (0-IIc) type gastric cancer of the pyloric anterior gastric area underwent pre-operative screening for tetralogy of Fallot and endoscopic submucosal dissection (ESD) and was tested for Helicobacter pylori antigens and antibodies. Both tests were negative. He did not have a history of eradication. Pathological diagnosis of ESD showed a well-differentiated adenocarcinoma. The tumor was CD10-positive, MUC5AC-negative, and MUC6-confocal positive; it showed differentiation with gastrointestinal phenotype. Moreover, the tumor ce...
Source: Endoscopy International Open - Category: Gastroenterology Authors: Tags: Original article Source Type: research
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