Purpose of review: One of the most vexing problems for gastroenterologists is what actions to take after receiving a histological diagnosis of gastric intestinal metaplasia. We approach the problem by starting with suggesting a biopsy protocol that ensures obtaining the biopsies required for diagnosis, assessing the status of the gastric mucosa, and effective communication with the pathologist and patient.
Recent findings: The rediscovery and integration of the long history of gastric damage and repair resulting in pseudopyloric metaplasia (called SPEM) into the thinking of investigators working with animal models of gastric cancer has resulted in improved ability to separate changes associated with benign repair from those associated with inflammation-associated gastric carcinogenesis.
Summary: Gastric intestinal metaplasia is a potential reversible product of injury and repair and not directly connected with carcinogenesis. Intestinal metaplasia is a biomarker for prior gastric injury and repair. The risk of gastric cancer is best assessed in relation to the severity, extent, and, most importantly, the cause of the atrophic changes.
Conflict of interest statement
Conflicts of interest
M.R. has no conflicts to declare.
hsa-miR-29c and hsa-miR-135b Differential Expression as Potential Biomarker of Gastric CarcinogenesisAF Vidal et al. World J Gastroenterol 22 (6), 2060-70. PMID 26877610.Our results provide evidence of epigenetic alterations in non-atrophic chronic gastritis and intestinal metaplasia and suggest that hsa-miR-29c and hsa-miR-135b are promi …
Spasmolytic Polypeptide-Expressing Metaplasia (SPEM) Associated With Gastric Cancer in IcelandAM Halldórsdóttir et al. Dig Dis Sci 48 (3), 431-41. PMID 12757153.Recent studies have described a spasmolytic polypeptide-expressing metaplastic cell lineage (SPEM) in the gastric fundic mucosa associated with both chronic H. pylori inf …
Mature Gastric Chief Cells Are Not Required for the Development of MetaplasiaH Kinoshita et al. Am J Physiol Gastrointest Liver Physiol 314 (5), G583-G596. PMID 29345968.During human gastric carcinogenesis, intestinal metaplasia is frequently seen in the atrophic stomach. In mice, a distinct type of metaplasia known as spasmolytic polypep …
Current Understanding of SPEM and Its Standing in the Preneoplastic ProcessVG Weis et al. Gastric Cancer 12 (4), 189-97. PMID 20047123. - ReviewGastric cancer is the second leading cause of cancer-related death worldwide, but the details of gastric carcinogenesis remain unclear. In humans, two preneoplastic metap …
Oxyntic Atrophy, Metaplasia, and Gastric CancerJR Goldenring et al. Prog Mol Biol Transl Sci 96, 117-31. PMID 21075342. - ReviewGastric carcinogenesis involves the loss of parietal cells (oxyntic atrophy) and subsequent replacement of the normal gastric lineages with metaplastic cells. In humans, …