Recent US Gastric Cancer Prevention Recommendations: Advances, Unanswered Questions, and the Need for a Unified Approach

In the past year, two major American gastroenterology societies have introduced pivotal updates to their recommendations for gastric cancer (GC) prevention.1–3 The American College of Gastroenterology (ACG) released new guidelines on Helicobacter pylori management, recommending screen-and-treat to individuals at high-risk for GC,1 as well as guidelines on the management of gastric precursor lesions.2 Moreover, the American Gastroenterological Association (AGA) issued a clinical practice update (CPU) focusing on endoscopic screening and surveillance of high-risk groups for GC.3 These updates represent important advances in the rapidly evolving landscape of GC prevention. However, key differences in focus — between H pylori screen-and-treat vs endoscopic screening — may leave health care providers uncertain which to prioritize and which populations to consider for these interventions. In this commentary, we aim to provide a perspective on GC prevention integrating these recommendations, highlighting the unanswered questions they raise, and proposing new research avenues.