From the Guidelines
Surveillance of atrophic gastritis should involve endoscopic examinations every 3 years for patients with advanced atrophic gastritis, as recommended by the most recent guidelines 1. This approach is based on the strong association between severe atrophic gastritis and increased risk of gastric adenocarcinoma, as demonstrated by multiple observational studies 1. Key considerations for surveillance include:
- Individual risk assessment, taking into account factors such as family history of gastric cancer, extent of atrophy or intestinal metaplasia, presence of dysplasia, and ethnicity 1
- Shared decision-making between providers and patients, considering comorbidities, patient values, and priorities 1
- The use of high-resolution endoscopy and advanced imaging techniques to improve detection of early gastric cancer 1
- Regular monitoring for vitamin B12 deficiency, iron deficiency anemia, and pernicious anemia in patients with autoimmune atrophic gastritis, with supplementation as needed 1
- Eradication therapy for H. pylori-associated atrophic gastritis, which may slow progression but does not eliminate the need for surveillance 1 The optimal surveillance interval may vary depending on individual risk factors, but a 3-year interval is a reasonable starting point for patients with advanced atrophic gastritis 1. Early detection through regular surveillance allows for timely intervention and improved outcomes in these high-risk patients, as supported by observational data 1.
From the Research
Surveillance Strategies for Atrophic Gastritis
- The most common recommendation for subjects with intestinal metaplasia is an annual endoscopic follow-up 2.
- Annual endoscopic follow-up is also the most predominant recommendation for atrophic gastritis, regardless of the physicians' endoscopic experience, position, and degree of the hospital 2.
- A new program estimating individualized gastric cancer risk might be needed due to the low inter-observer agreement in the endoscopic diagnosis of atrophic gastritis and intestinal metaplasia 2.
Diagnostic Methods for Atrophic Gastritis
- Upper digestive endoscopy with biopsies is the "gold standard" for the diagnosis of chronic atrophic gastritis 3.
- Serological diagnosis is available as an alternative, mainly recommended for follow-up 3.
- There are two main methodological approaches for the evaluation of chronic atrophic gastritis: invasive examination and non-invasive serological examination using markers of gastric function 3.
Clinical Overview and Management of Atrophic Gastritis
- Atrophic gastritis is a complex syndrome that arises as a consequence of H. pylori infection or in the context of gastric autoimmunity 4.
- A case-finding strategy may be beneficial in individuals with anemia, dyspepsia, autoimmune thyropaties, and type 1 diabetes, and family history of gastric cancer 4.
- Endoscopic surveillance is indicated according to the topography of gastric atrophy and risk factors 4.
Endoscopic Surveillance for Atrophic Gastritis
- European guidelines recommend surveillance with high-quality endoscopy every 3 years for patients with autoimmune and multifocal atrophic gastritis 5.
- A 3-year follow-up endoscopic surveillance seems safe for autoimmune and multifocal AG patients, and should be offered to elderly patients who are at higher risk for gastric neoplasia 5.
- Age > 70 years is associated with a 9-fold higher probability of developing gastric epithelial neoplastic lesions 5.