Pathology of Gastric Intestinal Metaplasia: Clinical Implications

Intestinal metaplasia (IM) of the gastric mucosa is a relatively frequent precancerous lesion (1). The inclusion of IM in a gastric biopsy pathology report often creates uncertainty for the gastroenterologist about the appropriate management. Although the risk of gastric cancer is increased in the presence of IM, the overall risk of gastric cancer in a patient with IM is extremely low compared with the risk of adenocarcinoma in a patient with Barrett’s esophagus (BE)(2). Although the incidence of gastric cancer is high in certain regions, such as Asia and Latin America, it is much lower in the United States and other Western countries, making it difficult to justify broad surveillance programs. The aims of this article are (i) to assist the clinician in identifying subgroups of patients with IM at increased risk for gastric cancer and (ii) to propose an algorithm for gastric IM management, considering the lack of universally accepted guidelines that can be applied to any population.