Gastric intestinal metaplasia: Management and surveillance strategies

Gastric intestinal metaplasia (GIM) is a common histological finding often associated with Helicobacter pylori infection, placing patients at high risk of gastric cancer. The Correa cascade is a pathway that describes the progression of GIM from precancerous to cancerous following a sequence of inflammation-atrophy-metaplasia-dysplasia and carcinoma. Mortality can be reduced through early detection and follow-up screening. There is a wide variation in clinical management of GIM, which makes it difficult to determine the degree of adherence to established guidelines and recommendations. All guidelines emphasize the importance of high-definition endoscopy and targeted biopsy (taken separately from the antrum and corpus) to improve risk stratification. This highlights the need for standardized protocol for GIM management and risk-based follow-up. The main challenge remains the lack of global standardization leading to inconsistency in follow-up initiation and discontinuation, in addition to low adherence to guidelines due to resource limitations. This is progressively enhanced by the development of a personalized follow-up plan based on the individual patient's case and a unified risk-based surveillance protocol.