Organic Dyspepsia – Intestinal Metaplasia Cancer

Organic dyspepsia is characterized by the presence of an established organic, systemic or metabolic cause with symptoms, and resolution or improvement occurs after addressing the underlying condition. Examples include gastroesophageal refl ux disease (GERD), drug-induced mucosal injury, peptic ulcer disease, malignancy (gastric, pancreatic, colorectal), intestinal ischemia and abdominal aortic aneurysm.

Gastric intestinal metaplasia (GIM) and gastric cancer are the main concerns of untreated/undertreated dyspepsia.

GIM is a premalignant condition of the human stomach with a 10-fold increased risk of gastric cancer. 

GIM serves as a histological step before gastric dysplasia.

A high-quality esophagogastroduodenoscopy with retrofl exion and careful inspection of the cardia and fundus is recommended to identify patients who benefi t from surveillance.

Around 4-8 biopsies of two topographic sites (at the lesser and greater curvature, from both the antrum and the corpus) should be taken.

The management of GIM involves detailed and careful endoscopy with sampling, stratifying for the severity and extent of chronic atrophic gastritis and GIM, and testing and eradicating Helicobacter pylori. Risk assessment should be individualized through shared decision-making, and endoscopic surveillance every 3 to 5 years is recommended for those at higher risk, focusing on early detection and prevention. 

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