EGD Masterclass: EoE, Strictures, and Pre-malignant Gastric Conditions (Virtual Only) | 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 provides an overview of 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). It discusses the use of endoscopy in diagnosis and sampling, as well as the management strategies for these conditions.<br /><br />The prevalence of H. Pylori infection is reported to be around 35.6% in the United States, with 1 in 3 individuals affected. H. Pylori infection is a known carcinogen and is responsible for 89% of non-cardia gastric cancer cases. It is important to consider H. Pylori testing in individuals with gastric/duodenal ulcers, GIM, gastric cancer, erosive/nodular gastropathy, abdominal pain, anemia, or any symptoms or endoscopic findings that may indicate the presence of H. Pylori.<br /><br />The document highlights that the use of proton pump inhibitors (PPIs) can decrease the likelihood of H. Pylori detection and increase the risk of non-H. Pylori gastritis and intestinal metaplasia. It also discusses the prevalence of H. Pylori infection among U.S. veterans, with higher rates observed in certain demographics and increasing rates of antibiotic resistance.<br /><br />Endoscopic features suggestive of chronic H. Pylori gastritis include the absence of collecting venules, antral nodularity, enlarged gastric folds, enlargement and destruction of gastric glands, sticky tenacious adherent mucous, turbid gastric juice, and xanthomas.<br /><br />The document emphasizes the importance of H. Pylori eradication for symptom relief and cancer prevention. It cites robust data showing a 32% risk reduction in incident gastric cancer and a 33% risk reduction in mortality due to gastric cancer with H. Pylori eradication. It also discusses the role of H. Pylori eradication in reducing the risk of metachronous gastric cancer after endoscopic resection of early gastric cancer.<br /><br />The document addresses the management of AG and GIM, emphasizing the need for careful endoscopy with sampling to assess the severity and extent of these conditions. It recommends individualizing risk assessment and making shared decisions regarding surveillance based on multiple risk factors, including the type and extent of GIM, family history, and racial/ethnic background.<br /><br />In conclusion, the document highlights the importance of recognizing and managing H. Pylori infection, AG, and GIM to prevent the progression to gastric cancer. It underscores the significance of thorough endoscopic examination, risk stratification, and surveillance in individuals at risk for these conditions.

Keywords

H. Pylori infection

gastric cancer progression

atrophic gastritis

gastric intestinal metaplasia

endoscopy

prevalence of H. Pylori infection

proton pump inhibitors

H. Pylori eradication

chronic H. Pylori gastritis

management of AG