EGD Masterclass: EoE, Strictures, and Pre-malignant Gastric Conditions (On-demand) | January 2023-Madhav Desai_H Pylori, Atrophic Gastritis and Gastric Intestinal Metaplasia

Madhav Desai_H Pylori, Atrophic Gastritis and Gastric Intestinal Metaplasia

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This document discusses the prevalence and consequences of H. pylori infection, as well as the risk of gastric cancer progression among individuals with atrophic gastritis (AG) and gastric intestinal metaplasia (GIM). The use of endoscopy for diagnosis and sampling is highlighted, along with the management of H. pylori infection and its eradication. The prevalence of H. pylori in the United States is mentioned, with studies reporting a prevalence rate of 35.6%. The association between H. pylori infection and gastric cancer is also discussed, with H. pylori accounting for 89% of non-cardia gastric cancer cases.<br /><br />The document also explores the endoscopic features of H. pylori gastritis, including nodularity, enlarged gastric folds, and sticky mucous. The benefits of H. pylori eradication for symptomatic relief and cancer prevention are emphasized, with studies showing a 32% pooled risk reduction in incident gastric cancer and a 33% pooled risk reduction in mortality from gastric cancer among patients with GIM. The association between long-term use of proton pump inhibitors (PPIs) and an increased risk of gastric cancer, even after H. pylori eradication therapy, is also discussed.<br /><br />The document goes on to discuss chronic atrophic gastritis (CAG) and its risk of progression to gastric cancer, as well as the endoscopic features and staging of CAG. It emphasizes the importance of assessing the extent of atrophic gastritis using endoscopy and obtaining biopsies from suspected atrophic/metaplastic areas for histopathological confirmation and risk stratification.<br /><br />Gastric intestinal metaplasia (GIM) is also discussed, along with its increased risk of gastric cancer and variable rates of progression. The document provides details on the endoscopic appearance of GIM, such as small grey-white plaques and mottled patchy erythema, and discusses the management of GIM, including careful endoscopy with sampling, H. pylori testing and eradication, and individualized risk assessment.<br /><br />The document concludes by emphasizing the need for a meticulous examination during surveillance and the importance of discussing the risk and benefits of surveillance with patients. A personal approach to the management of H. pylori, CAG, and GIM is also provided. Overall, the document highlights the significance of H. pylori infection, its consequences, and the importance of proper management and surveillance to prevent gastric cancer.

Keywords

H. pylori infection

gastric cancer progression

atrophic gastritis

gastric intestinal metaplasia

endoscopy

H. pylori eradication

prevalence of H. pylori

proton pump inhibitors

chronic atrophic gastritis

gastric intestinal metaplasia management