From the Guidelines
Surveillance for atrophic gastritis should be individualized based on risk factors, with endoscopic follow-up every 3 years recommended for patients with advanced atrophic gastritis, as defined by anatomic extent and histological grade 1. The criteria for surveillance of atrophic gastritis include:
- Advanced atrophic gastritis, defined by anatomic extent and histological grade
- Presence of intestinal metaplasia or dysplasia
- Family history of gastric cancer
- Persistent H. pylori infection
- Other risk factors, such as immigration history from high-incidence regions or smoking history During endoscopy, multiple biopsies should be taken from both the antrum and corpus (at least 2-4 from each site) following systematic mapping protocols, such as the updated Sydney System 1. Chromoendoscopy or narrow-band imaging can improve detection of precancerous lesions 1. Surveillance should also include monitoring for vitamin B12 deficiency with annual serum B12 levels in autoimmune atrophic gastritis patients. The rationale for surveillance is that atrophic gastritis, particularly when extensive or accompanied by intestinal metaplasia, represents a precancerous condition with an increased risk of progression to gastric cancer, allowing for early detection and intervention 1. High-risk patients, including those with a family history of gastric cancer, extensive intestinal metaplasia, or persistent H. pylori infection, may require more frequent surveillance at shorter intervals, such as every 1-3 years 1. Endoscopists should work with their local pathologists to achieve consensus for consistent documentation of histologic risk-stratification parameters when atrophic gastritis with or without metaplasia is diagnosed 1. The optimal surveillance intervals remain to be determined and may vary depending on individual risk assessment 1.
From the Research
Criteria for Surveillance of Atrophic Gastritis
The criteria for surveillance of atrophic gastritis include:
- Absence of previous H. pylori eradication 2
- Atrophic changes on endoscopy or histologic confirmation of glandular atrophy 2
- Negative for a current H. pylori infection diagnosed in the absence of proton-pump inhibitors or antibiotics 2
- Absence of localized corpus atrophy, positivity for autoantibodies, or characteristic histologic findings suggestive of autoimmune gastritis 2
- OLGA/OLGIM III and IV staging, which are closely associated with progression to gastric cancer 3
- Presence of intestinal metaplasia, which is a precancerous lesion 4
Surveillance Recommendations
Surveillance recommendations for atrophic gastritis include:
- Endoscopic surveillance every 3 years for high-risk patients, including those with endoscopically severe atrophy or intestinal metaplasia 2
- Systematic endoscopic surveillance in all patients with severe gastric atrophy (with or without intestinal metaplasia) 4
- Surveillance in individual patients based on shared decision between clinicians and patients, taking into account the patient's risk factors and preferences 4
- Targeted gastric biopsies using electronic chromoendoscopy to monitor for intestinal metaplasia and other precancerous lesions 5
- First endoscopic surveillance 3 years after diagnosis, which seems safe for autoimmune and multifocal atrophic gastritis patients, especially for elderly patients who are at higher risk for gastric neoplasia 6
Risk Factors for Gastric Cancer
Risk factors for gastric cancer in patients with atrophic gastritis include:
- Severity of atrophy, with higher grades of atrophy associated with increased risk of gastric cancer 2, 3
- Presence of intestinal metaplasia, which is a precancerous lesion 4
- OLGA/OLGIM III and IV staging, which are closely associated with progression to gastric cancer 3
- Age > 70 years, which is associated with a 9-fold higher probability of developing gastric epithelial neoplastic lesions 6