Follow up of gastric intestinal metaplasia

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Introduction

Gastric intestinal metaplasia (GIM) is considered a risk factor for gastric cancer however follow up for these patients is uncertain. New consensus guidelines published January 2012, state patients with extensive IM should be offered endoscopic surveillance every 3 years. This study looked to assess the outcomes for a cohort of patients with GIM followed up in a district general hospital.

Methods

Patients were recruited to the study using a database of patients with GIM accumulated by one consultant. Retrospective chart review was undertaken for all patients in this database. Data was collected including patient’s age, sex, assumed risk factors (smoking, alcohol intake and helicobacter pylori), relevant medications and presence of Barrett’s oesophagus. The follow up pathology was then analysed looking for progression (focal IM-extensive IM-dysplasia), regression or no change.

Results

there were 29 patients on the database, 45% were male. Age ranged from 34-79 (mean 62). Patients had been on the database between 6 months and 9 years (median 4 years). 25 patients had been rescoped annually (86%). Of these patients 28% had no change in their pathology, 48% had regressed to no IM, 8% regressed from extensive to focal IM and 12% progressed from focal to extensive IM. 1 patient (4%) developed gastric cancer in our follow up time.

Conclusion

Although the majority of patients did not progress (or did in fact regress) a proportion of patients did progress in the extent of GIM, and one went on to develop diffuse gastric carcinoma at 1 year follow up. We therefore we support follow up surveillance of this group of patients