Gastric Cancer - Intestinal Metaplasia - Endoscopy (7 of 7)

Inflammation in these lesions caused by chemicals is minimal or lacking; therefore, the term gastropathy or chemical gastropathy is more appropriate to describe these lesions than is the term chemical or reactive gastritis as proposed by the updated Sydney classification of gastritis. Importantly, mixed forms of gastropathy and other types of gastritis, especially H pylori gastritis, may coexist. Intestinal-type gastric carcinoma is frequently accompanied by widespread intestinal metaplasia. Gastric cancer is believed to arise via a multistage process that includes chronic gastritis, gastric atrophy, usually with intestinal metaplasia, and finally dysplasia. It remains unclear whether intestinal metaplasia is a premalignant condition or a marker for increased risk of malignancy. The fact that intestinal metaplasia in the antrum is also found with duodenal ulcer disease, a condition associated with a low risk for the development of gastric cancer, suggests that other conditions or events are important in the pathogenesis of gastric cancer. The risk of developing gastric adenocarcinoma is highest in those with the most extensive atrophy associated with hypochlorhydria or achlorhydria. It has been suggested that there is a relation between cancer risk and the subtype of intestinal metaplasia, with the incidence of cancer being highest among patients with intestinal metaplasia subtype III. Confirmation of this hypothesis would suggest that typing of intestinal metaplasia could provide a simple approach to identify those at highest risk, and would allow resources to be directed to surveillance of that small group. Our study was designed to ask whether the results regarding the presence and type of intestinal metaplasia are reproducible or consistent on follow up of the same individual and whether type III metaplasia led to a high frequency of dysplasia.