Recent Guidelines on the Management of Patients with Gastric Atrophy: Common Points and Controversies

Patients with gastric precancerous lesions (atrophic gastritis and intestinal metaplasia) have increased risk of developing gastric cancer, and adequate management and surveillance of these patients should allow to reduce gastric cancer-related mortality. The guidelines on the management of these patients have been recently published by the European Societies (MAPS II guidelines) and by the American Gastroenterological Association (AGA). The aim of this commentary is to compare these two guidelines by highlighting the common points and differences between them. Both guidelines recommend a systematic detection and eradication of Helicobacter pylori in all patients with gastric atrophy. However, there is a major difference in the recommendations for surveillance: while the MAPS II guidelines recommend systematic endoscopic surveillance in all patients with severe gastric atrophy (with or without intestinal metaplasia), the AGA guidelines focus only on intestinal metaplasia and plead against systematic surveillance, leaving the possibility of surveillance in individual patients based on shared decision between clinicians and patients. The difference between two guidelines comes essentially from the different arguments used by two authorities (randomized control studies by AGA and observational cohort studies by the European Societies), and may be, at least in part, related to the difference between the European and American health care systems and potential economic burden.