The use of clinical, histologic, and serologic parameters to predict the intragastric extent of intestinal metaplasia: a recommendation for routine practice

Annemarie de Vries, J Haringsma, RA de Vries, F ter Borg, NM Nagtzaam, Ewout Steyerberg, H (Herman) van Dekken, Ernst Kuipers

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Abstract

Background: Surveillance of intestinal metaplasia (IM) of the gastric mucosa Should be limited to patients at high risk of gastric cancer. Patients with extensive IM are at increased cancer risk; however, the intragastric extent of IM is usually unknown at the time of the initial diagnosis. Objective: To assess the predictive value of clinical, histologic, and serologic parameters for the intragastric extent of IM. Design and Setting: Prospective, multicenter study Patients: Eighty-eight patients with a previous diagnosis of IM of the gastric mucosa. Intervention: Surveillance gastroscopy with extensive random biopsy sampling. Main Outcome Measurements: Biopsy specimens were evaluated according to the Sydney classification system. In addition, serologic testing of Helicobacter pylori and cagA status, pepsinogens I and II, gastrin, and intrinsic factor antibodies was performed. The association between the available parameters and extensive IM was evaluated with logistic regression analysis. Results: In 51 patients (58%), IM was present in the biopsy specimens from at least 2 intragastric locations. The most important predictors of extensive IM were a family history of gastric cancer, alcohol use >= 1 unit/d (1 glass, approximately 10 mL or 8 g ethanol), moderate or marked IM of the index biopsy specimen, and a pepsinogen I to 11 ratio <3.0. A simple risk score based on these factors could identify extensive IM in 24 of 25 patients (sensitivity 96%). Limitation: A prospective cohort Study should confirm the proposed risk stratification. Conclusions: A risk score of clinical, histologic, and serologic parameters can predict extensive intragastric IM and may serve as a practical tool to select patients for surveillance endoscopy in routine clinical practice. (Gastrointest Endosc 2009;70:1.8-25.)
Original languageUndefined/Unknown
Pages (from-to)18-25
Number of pages8
JournalGastrointestinal Endoscopy
Volume70
Issue number1
DOIs
Publication statusPublished - 2009

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