Follow-up of intestinal metaplasia in the stomach: When, how and why
Follow-up of intestinal metaplasia in the stomach: When, how and why
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DOI：
10.4251/wjgo.v4.i3.30
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发表时间：
2012-03-15
影响因子：
3
通讯作者：
Tomao, Silverio
中科院分区：
文献类型：
--
作者：
Zullo, Angelo;Hassan, Cesare;Tomao, Silverio
胃癌仍然是世界上第二大癌症相关死亡原因。一些亚洲国家的筛查计划在世界上大多数其他国家是不切实际的。因此，对癌前病变进行随访对于胃癌的二级预防是可取的。肠化生（IM）被认为是胃癌的癌前病变，使患胃癌的风险增加6倍。 IM 在一般人群中非常普遍，近每 4 名接受上消化道内窥镜检查的患者中就有 1 名被检测到。幽门螺杆菌 (H. pylori) 感染患者、胃癌患者一级亲属、吸烟者的 IM 患病率显着较高，并且随着患者年龄的增长而增加。 IM 是胃癌级联中的“转折点”，并且在幽门螺杆菌根除后似乎不会消退，尽管感染的治愈可能会减缓其进展。不完全型IM患者、胃窦和胃体均受累的患者患胃癌的风险较高，并且当IM延伸超过胃粘膜20%时，风险显着增加。定期内镜检查对于 IM 患者可能具有成本效益，具体取决于 IM 患者胃癌的年发病率、监测中发现的诊断时胃癌的分期以及内窥镜检查的费用。作为一种务实的行为，对于至少患有以下一种情况的所有 IM 患者，每年进行内窥镜控制似乎是合理的：(1) IM 延伸 > 20%； (2) 存在不完全型IM； （三）胃癌患者的一级亲属； (4) 吸烟者。对于其余的 IM 患者，可以建议进行强度较低的治疗（2-3 年）。 (C)2012年百事登。版权所有。
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 firstdegree 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. pylori eradication, 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. (C) 2012 Baishideng. All rights reserved.