The Risk of Gastric Cancer in Asian Patients with Gastric Intestinal Metaplasia

Background: Gastric cancer (GC) has a significant impact in Asia. Delay in diagnosis and treatment leads to increased mortality and morbidity. The detection of gastric intestinal metaplasia (GIM) has the potential to be an early sign of GC, but there are controversies. Differences in GC and pre-cancerous lesions between Asians and non-Asians have also contributed to this controversy. Summary: GIM is a risk factor for developing GC in Asian adults, with more recent meta-analyses demonstrating a 3-4 fold risk in such patients. Certain GIM subtypes are more likely to develop GC, with Asian patients appearing to have more severe, diffuse, and high-risk subtypes of GIM compared to non-Asians. As a result, most international guidelines recommend endoscopic surveillance in adults with GIM, but this review article suggests it should be targeted towards those with high-risk features. This review also highlights other factors, apart from gastric histology, which are relevant in the development of GC. Factors such as Helicobacter pylori virulence, molecular and genetic mechanisms, gut microbiota, specific dietary components, and social habits as risk factors for GC are discussed. Key Messages: GIM is a risk factor for GC in the Asian population. Surveillance in a targeted population is beneficial.