Gastric Premalignant Conditions

Correa cascade, endoscopic diagnosis with IEE, risk-based surveillance intervals, H. pylori eradication, and dysplasia management — ACG's first GPMC guideline.

📖 4 Sections⏱ ~30 min✅ 3-question quiz

GPMC Overview

Definition, spectrum, US cancer disparity

Gastric Premalignant Conditions (GPMC)

GPMC are common, include atrophic gastritis (AG), gastric intestinal metaplasia (GIM), dysplasia, and certain polyps — all with increased risk of progression to gastric adenocarcinoma. The US 5-year survival for gastric cancer (GC) is only 36%, driven by late-stage diagnosis.

Correa Cascade: Progression to Gastric Cancer

Normal Mucosa→Chronic Gastritis (H. pylori)→Atrophic Gastritis→Intestinal Metaplasia→Dysplasia (LGD/HGD)→Gastric Adenocarcinoma

⚠️ US Cancer Disparity

GC incidence is 2–13× higher in non-White individuals, especially early-generation immigrants from East Asia, Latin America, and Eastern Europe. ACG 2025 emphasizes this disparity and targets surveillance for high-risk populations even within the US.

High-Risk Features for GC

Extensive GIM (corpus + antrum)

Incomplete-type intestinal metaplasia

GIM in first-degree relative with GC

High-risk ethnic background (East Asian, Hispanic, Eastern European)

Current or prior H. pylori infection

Autoimmune metaplastic atrophic gastritis (AMAG)

Lower-Risk Features

Antrum-limited GIM without dysplasia

No family history of GC

H. pylori successfully eradicated

Low-risk ethnic background

Complete-type intestinal metaplasia

Morgan DR et al. ACG Clinical Guideline: Diagnosis and Management of Gastric Premalignant Conditions. Am J Gastroenterol. 2025.