ACG releases guidelines for gastric premalignant conditions

The American College of Gastroenterology (ACG) has released its first clinical practice guideline on gastric premalignant conditions. These conditions include atrophic gastritis, gastric intestinal metaplasia, dysplasia, and certain gastric polyps. The guidelines aim to help reduce the risk of gastric cancer and improve early detection. The guidelines were published online on March 12 in The American Journal of Gastroenterology. Dr. Douglas Morgan, the first author, highlighted the need for clear guidance in the U.S. regarding these common conditions in gastroenterology. He expressed hope that these guidelines will lead to better surveillance of the stomach, similar to practices for the colon and esophagus. Gastric cancer is a significant health concern in the U.S., particularly among certain immigrant and non-White populations. The five-year survival rate for gastric cancer is currently low at 36%, mainly because many cases are not diagnosed early when treatment is most effective. The new guidelines aim to address these disparities and increase survival rates. The guideline includes several key recommendations. For high-risk patients, it suggests regular endoscopic surveillance and proper diagnostic methods. However, it advises against routine upper endoscopy for the general public and notes insufficient evidence for opportunistic screening based on specific risk factors. Noninvasive biomarkers are also not recommended for screening. High-quality endoscopic evaluations are essential for identifying premalignant conditions. These include thorough mucosal cleansing and the use of advanced imaging techniques. The guidelines emphasize the importance of collaboration between gastroenterologists and pathologists to ensure accurate reporting of histological findings. Surveillance is recommended every three years for high-risk patients with specific conditions, while those with low-risk features do not need regular endoscopic checks. The guidelines also encourage endoscopic removal of dysplastic lesions, with referrals to specialized centers for complex cases. Additionally, the guidelines strongly recommend H. pylori testing and eradication for patients with gastric premalignant conditions. However, they do not support the use of common over-the-counter medications for preventing gastric cancer. In the case of gastric epithelial polyps, the guidelines advocate for the endoscopic removal of all gastric adenomas to prevent cancer. They also emphasize the need for ongoing training and quality improvement measures to implement these guidelines effectively. Overall, the ACG's new guidelines aim to reshape the approach to gastric premalignant conditions and enhance patient care in gastrointestinal health.