The American College of Gastroenterology (ACG) published its first clinical guideline on diagnosing and managing gastric premalignant conditions (GPMC) in a recent issue of the American Journal of Gastroenterology.

The newly released guideline indicated that GPMC includes atrophic gastritis, gastric intestinal metaplasia, dysplasia, and certain gastric epithelial polyps, all of which have an increased risk of progressing to gastric cancer (GC).

Douglas R. Morgan from the University of Alabama at Birmingham and colleagues established recommendations for diagnosing and managing GPMC, including surveillance for high-risk patients, performing endoscopy for diagnosis and surveillance, and endoscopic treatment of dysplasia.

The overall goals of the new guideline include decreasing GC incidence, expanding the detection of early-stage disease, and substantially increasing 5-year survival rates.

The guideline includes recommendations for endoscopic surveillance for high-risk patients with GPMC, the performance of high-quality endoscopy and image-enhanced endoscopy for diagnosis and surveillance, GPMC histology criteria and reporting, endoscopic treatment of dysplasia, the role of Helicobacter pylori eradication, general risk reduction measures, and the management of autoimmune gastritis and gastric epithelial polyps.

The authors wrote, “Gastric cancer (GC) in the United States represents an important cancer disparity because incidence rates are 2- to 13-fold greater in non-White individuals, particularly early-generation immigrants from regions of high GC incidence. The US 5-year survival rate for GC is 36%, which falls short of global standards and is driven by the fact that only a small percentage of GC in the US is diagnosed in the early, curable stage.”

The guideline indicates that the evidence is insufficient for making a recommendation on upper endoscopic screening for GC/GPMC detection in U.S. populations who are deemed high risk for GC. For individuals at high risk for GPMC progression, as defined by endoscopic, histologic, and demographic factors, surveillance endoscopy is typically recommended every 3 years, but an individualized interval may be warranted. With regard to all individuals with GPMC, H pylori testing, treatment, and eradication confirmation are recommended. The experts also noted that a lack of extensive, high-quality data regarding GPMC management are noted for U.S. populations, but data continue to accrue, and the quality of evidence presented should be interpreted accordingly.

The authors wrote, “These ACG Guidelines for the management of GPMC are a paradigm shift in US clinical practice. Implementation and change in clinical practice will require concrete targets and include training and quality initiatives. It is anticipated that this will begin to address the marked US GC disparity, and the burden on minority and marginalized populations.”

Finally, the panel of experts added, “The overarching goals are to reduce GC incidence in the United States, increase the detection of early-stage disease (early GC), and to significantly increase the 5-year survival rates in the near term.”

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