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World J Gastroenterol. Jan 21, 2016; 22(3): 1311-1320
Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1311
Helicobacter pylori associated gastric intestinal metaplasia: Treatment and surveillance
Kevin Sze-Hang Liu, Irene Oi-Ling Wong, Wai K Leung
Kevin Sze-Hang Liu, Wai K Leung, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
Irene Oi-Ling Wong, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
Author contributions: Liu KSH, Wong IOL and Leung WK prepared literature review and wrote the paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Wai K Leung, MD, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China. waikleung@hku.hk
Telephone: +852-22553348 Fax: +852-28162863
Received: May 12, 2015
Peer-review started: May 14, 2015
First decision: July 14, 2015
Revised: August 4, 2015
Accepted: November 30, 2015
Article in press: November 30, 2015
Published online: January 21, 2016
Processing time: 248 Days and 5.7 Hours
Abstract

Gastric cancer (GC) is one of the leading causes of cancer related death in the world, particularly in East Asia. According to the Correa’s cancer cascade, non-cardia GC is usually developed through a series of mucosal changes from non-atrophic gastritis to atrophic gastritis (AG), intestinal metaplasia (IM), dysplasia and adenocarcinoma. Atrophic gastritis and IM are therefore generally considered to be pre-neoplastic gastric lesions. Helicobacter pylori (H. pylori) infection is an important initiating and promoting step of this gastric carcinogenesis cascade. Emerging long-term data showed that eradication of H. pylori reduced the risk of subsequent cancer development. It however remains confusing whether eradication of the bacterium in individuals with pre-neoplastic gastric lesions could regress these changes as well as in preventing cancer. Whilst H. pylori eradication could likely regress AG, the presence of IM may be a point of no return in this cascade. Hence, surveillance by endoscopy may be indicated in those with extensive IM or those with incomplete IM, particularly in populations with high GC risk. The optimal interval and the best tool of surveillance endoscopy remains to be determined in future studies.

Keywords: Helicobacter pylori; Gastric cancer; Intestinal metaplasia; Treatment; Surveillance

Core tip: Gastric intestinal metaplasia (IM) is generally considered to be a pre-neoplastic gastric lesion, which is usually triggered by chronic Helicobacter pylori (H. pylori) infection. However, the role of H. pylori eradication in treating gastric IM remains controversial. It remains uncertain whether the presence of gastric IM signifies an irreversible step of histological progression. Despite the definite increase in risk of gastric cancer development, the role of endoscopic surveillance remains dubious. This review will summarize the latest literature on treatment and surveillance of gastric IM.