What are the implications of focal intestinal metaplasia in the antrum found during an esophagogastroduodenoscopy (OGD)?

From the Guidelines

Focal intestinal metaplasia in the antrum found during an OGD requires testing for H. pylori, followed by eradication therapy if present, and consideration of surveillance endoscopy based on individual risk factors, with a suggested interval of 3 years for those with extensive metaplasia or additional risk factors, as recommended by the AGA guidelines 1. The condition occurs when normal stomach lining cells are replaced by intestinal-type cells, which is often caused by chronic inflammation from H. pylori infection or acid reflux.

• Treatment should focus on addressing the underlying cause, with eradication therapy using a proton pump inhibitor (such as omeprazole 20mg twice daily) plus two antibiotics (typically amoxicillin 1g twice daily and clarithromycin 500mg twice daily) for 7-14 days if H. pylori is present, as recommended by the AGA guidelines 1.
• For acid-related inflammation, daily acid suppression with a proton pump inhibitor like omeprazole 20mg or pantoprazole 40mg is advised.
• Lifestyle modifications are also important, including avoiding smoking, excessive alcohol, spicy foods, and NSAIDs, as suggested by the British Society of Gastroenterology guidelines 1. While intestinal metaplasia itself is not reversible, these interventions may prevent progression.
• The condition carries a slightly increased risk of gastric cancer, which is why regular surveillance is necessary, though most patients with focal antral metaplasia will never develop cancer.
• The British Society of Gastroenterology guidelines suggest that patients with limited gastric intestinal metaplasia, such as those with focal antral metaplasia, may not require surveillance unless they have additional risk factors, such as a strong family history of gastric cancer or persistent H. pylori infection 1.
• In patients with focal intestinal metaplasia in the antrum, the use of image-enhanced endoscopy (IEE) is recommended as the best imaging modality to accurately detect and risk-stratify gastric intestinal metaplasia, as suggested by the British Society of Gastroenterology guidelines 1.

From the Research

Focal Intestinal Metaplasia Antral on OGD

• Focal intestinal metaplasia antral on OGD is a condition where the normal gastric mucosa in the antrum is replaced by intestinal-type mucosa, which can be a precursor to gastric cancer 2, 3.
• The risk of progression to gastric cancer is significantly greater when intestinal metaplasia is detected in both the antrum and body of the stomach, compared to when it is only detected in one location 4.
• Helicobacter pylori infection is a common cause of intestinal metaplasia, and eradication of the infection can reduce the risk of progression to gastric cancer 2, 5.
• Surveillance and treatment guidelines for intestinal metaplasia vary, but endoscopic surveillance is recommended for patients with risk factors for progression to gastric cancer, and endoscopic resection or ablation therapies may be effective for visible dysplasia and early-stage gastric cancer 2, 3.
• The effectiveness of Helicobacter pylori eradication therapy can vary depending on the treatment regimen and the presence of antibiotic resistance, with some studies showing high eradication rates with sequential or hybrid therapy regimens 5, 6.