Gastric intestinal metaplasia and gastric epithelial dysplasia – precursor lesions of gastric cancer

Abstract

Introduction. Despite worldwide decreasing trends in the incidence of gastric cancer, the disease remains a significant global health burden, one of the leading causes of cancer death worldwide, and its prevention is a priority for the health system. Intestinal-type gastric carcinoma originates in dysplastic epithelium, which, in turn, develops in the environment of chronic atrophic gastritis and gastric intestinal metaplasia. Material and methods. Narrative literature review. A bibliographic search was conducted in the databases PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline. Articles published between 2000-2024 were selected based on the following keywords: “gastric intestinal metaplasia” and “gastric epithelial dysplasia”, used in different combinations with the terms “epidemiology”, “clinical picture”, “risk factors”, “classification”, “diagnosis”, and “management” to maximize the search yield. After processing the information from the databases according to the search criteria, 215 full articles were found. The final bibliography contains 34 relevant sources, considered representative of the materials published on the subject of this summary article. Results. Gastric intestinal metaplasia represents the replacement of the gastric epithelium with two types of intestinaltype epithelium (enteric or colonic) as an adaptive response to chronic injury, while gastric epithelial dysplasia is defined as unequivocal neoplastic change of the gastric epithelium (intraepithelial neoplasia) without evidence of stromal invasion. Gastric intestinal metaplasia and gastric epithelial dysplasia are preneoplastic lesions of gastric cancer. The estimated annual risk of gastric adenocarcinoma in patients with gastric intestinal metaplasia is 0.13-0.25%, and in patients with gastric epithelial dysplasia it is 1.36%, depending on the extent and type of the lesion. Conclusions. Despite the lack of a specific treatment for gastric intestinal metaplasia, the management strategy, according to current clinical guidelines, includes eradication of Helicobacter pylori infection, screening for early detection of gastric cancer, and control of other risk factors. Appropriate management of high-grade gastric epithelial dysplasia requires endoscopic resection due to its potential for progression to carcinoma and the possibility of coexisting carcinoma. For low-grade gastric epithelial dysplasia, which has a lower risk of malignant transformation, scientists recommend annual endoscopic surveillance with biopsy and histological examination.