[Gastric Intestinal Metaplasia: an Update on Epidemiology, Diagnosis, Risk Stratification, and Clinical Management].

Abstract

GIM is one of the main premalignant lesions in the intestinal-type gastric adenocarcinoma carcinogenesis sequence described by Correa. Its identification represents one of the cornerstones of secondary gastric cancer prevention, as it allows the selection of patients at higher risk of progression and the establishment of individualized surveillance programs. In recent years, significant advances have been made in the pathophysiological understanding of intestinal metaplasia and in endoscopic diagnostic techniques. Among the most relevant advances are virtual chromoendoscopy, the EGGIM classification, the OLGA and OLGIM histological systems, and the progressive incorporation of artificial intelligence. Current clinical guidelines have reinforced the role of high-quality endoscopy, individualized risk stratification, and systematic Helicobacter pylori eradication. This review summarizes the most recent evidence on the epidemiology, pathophysiology, classification, diagnosis, risk stratification, and clinical management of GIM, comparing the main international guidelines and incorporating perspectives on the application of artificial intelligence to gastrointestinal endoscopy.