I have a 50 y/o male patient who's with end stage renal disease pending renal transplant. He was diagnosed with complete intestinal metaplasia during pre-renal transplant OGDS surveilance, confirmed with pathology report.
His mother passed away due to gastric cancer at age of 60. He's a non smoker/teetotal. H.pylori test negative.
Follow-up of intestinal metaplasia in the stomach: When, how and why
Angelo Zullo, Cesare Hassan, Adriana Romiti, Michela Giusto, Carmine Guerriero, Roberto Lorenzetti, Salvatore MA Campo, and Silverio Tomao
Abstract
Gastric cancer remains the second most frequent cause of cancer-related mortality in the world. Screening programs in some Asian countries are impractical in the majority of other countries worldwide. Therefore, follow-up of precancerous lesions is advisable for secondary gastric cancer prevention. Intestinal metaplasia (IM) is recognized as a precancerous lesion for gastric cancer, increasing the risk by 6-fold. IM is highly prevalent in the general population, being detected in nearly 1 of every 4 patients undergoing upper endoscopy. The IM prevalence rate is significantly higher in patients with Helicobacter pylori (H. pylori) infection, in first-degree relatives of gastric cancer patients, in smokers and it increases with patient age. IM is the “breaking point” in the gastric carcinogenesis cascade and does not appear to regress following H. pylorieradication, although the cure of infection may slow its progression. Gastric cancer risk is higher in patients with incomplete-type IM, in those with both antral and gastric body involvement, and the risk significantly increases with IM extension over 20% of the gastric mucosa. Scheduled endoscopic control could be cost-effective in IM patients, depending on the yearly incidence of gastric cancer in IM patients, the stage of gastric cancer at diagnosis discovered at surveillance, and the cost of endoscopy. As a pragmatic behavior, yearly endoscopic control would appear justified in all IM patients with at least one of these conditions: (1) IM extension > 20%; (2) the presence of incomplete type IM; (3) first-degree relative of gastric cancer patients; and (4) smokers. In the remaining IM patients, a less intensive (2-3 years) could be proposed.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312926/
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