New guideline on gastric premalignant cancer

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The American College of Gastroenterology has published its first clinical guideline on the diagnosis and management of gastric premalignant conditions (GPMC), which have an increased risk of progression to gastric cancer and include atrophic gastritis, gastric intestinal metaplasia, dysplasia, and certain gastric epithelial polyps.

The guideline is published in the American Journal of Gastroenterology.

Gastric cancer is two- to 13-fold greater in non-white individuals, particularly early-generation immigrants from regions of high gastric cancer incidence, with a five-year survival rate of 36% in the United States.

The new guideline includes recommendations, developed using GRADE methodology, on 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 recommendations include surveillance endoscopy, typically every three years, for individuals at high risk for GPMC according to endoscopic, histologic, and demographic factors. H. pylori testing, treatment, and eradication confirmation are recommended in all individuals with GPMC, as H. pylori eradication and early gastric cancer resection reduces the risk of gastric cancer.

The authors write that, "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.

"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 five-year survival rates in the near term."

More information: Douglas R. Morgan et al, ACG Clinical Guideline: Diagnosis and Management of Gastric Premalignant Conditions, American Journal of Gastroenterology (2025). DOI: 10.14309/ajg.0000000000003350  Journal information: American Journal of Gastroenterology