From the Guidelines
Gastric remodeling is a complex process that involves structural and functional changes in the stomach, often in response to chronic inflammation, infection, or other forms of gastric injury, and can lead to the development of gastric intestinal metaplasia (GIM) and increased risk of gastric cancer. The process of gastric remodeling is not well understood, but it is thought to involve changes in the gastric mucosa, including the loss of glandular cells and the replacement of these cells with intestinal-type cells, a process that can be driven by chronic infection with Helicobacter pylori 1. Gastric remodeling can also be influenced by other factors, such as dietary habits, smoking, and family history of gastric cancer. The diagnosis and management of gastric remodeling and GIM have been addressed by several international evidence-based guidelines, which recommend the use of endoscopic surveillance and biopsy to detect and stage gastric preneoplastic conditions 1.
- The guidelines recommend that only patients with high-risk GIM phenotypes, such as corpus-extended GIM or incomplete GIM subtype, should undergo regular-interval endoscopic surveillance 1.
- The guidelines also recommend that patients with persistent refractory Helicobacter pylori infection or first-degree family history of gastric cancer should undergo regular-interval endoscopic surveillance 1.
- The use of image-enhanced endoscopy (IEE) is recommended as the best imaging modality to accurately detect and risk-stratify GIM 1.
- The guidelines recommend that endoscopic appearances on white light endoscopy (WLE) suggestive of GIM require escalation to high-resolution IEE and, where available, magnification endoscopy 1.
- The location and extent of GIM should be clearly documented with photographic evidence, and endoscopic grading should be documented as distal gastric or proximal gastric 1.
The management of gastric remodeling and GIM should prioritize the prevention of gastric cancer, and this can be achieved through the eradication of Helicobacter pylori infection, lifestyle modifications, and regular endoscopic surveillance. The eradication of Helicobacter pylori infection is recommended as the only non-endoscopic intervention for gastric cancer prevention 1. Lifestyle modifications, such as a healthy diet and avoidance of smoking, may also be beneficial in reducing the risk of gastric cancer. Regular endoscopic surveillance is recommended for patients with high-risk GIM phenotypes or other risk factors for gastric cancer, and this should be performed at regular intervals, typically every 3 years 1.
From the Research
Definition of Gastric Remodeling
Gastric remodeling refers to the changes that occur in the stomach lining and its structure in response to various factors, such as inflammation, infection, or injury.
Causes of Gastric Remodeling
- Helicobacter pylori (H. pylori) infection, which can lead to chronic inflammation and changes in the stomach lining 2, 3, 4, 5
- Use of nonsteroidal anti-inflammatory drugs (NSAIDs), which can cause stomach ulcers and lead to remodeling 6
- Other factors, such as stress, diet, and genetics, may also contribute to gastric remodeling
Effects of Gastric Remodeling
- Changes in the stomach lining, including atrophy and metaplasia 2
- Increased risk of stomach cancer and other gastrointestinal disorders 2
- Impaired stomach function, including reduced acid secretion and motility 6