Should we subtype gastric intestinal metaplasia in gastric biopsies, a single institution’s experience

Gastric intestinal metaplasia (GIM) is considered a risk factor for gastric dysplasia and adenocarcinoma. While surveillance endoscopies are often performed, particularly for incomplete GIM, the clinical value of histologic subtyping (complete, incomplete, or mixed) remains unclear. This study evaluated the progression risk of different GIM subtypes diagnosed through random gastric biopsies and their association with various clinical factors. Archived pathology data from 206 gastric biopsy cases were analyzed, including 52 negative controls, 56 complete GIM, 54 incomplete GIM, and 44 mixed GIM. Histologic slides were reviewed for subtype confirmation and other pathological changes; clinical data were extracted from medical records. Multiple linear regression was conducted for correlation analysis, and Analysis of Variance was used to compare group means. GIM was predominantly located in the antrum. Over a mean follow-up period of 52.2 months, none of the patients, including 12 under mapping surveillance, developed gastric neoplasia. Significant associations were found between Helicobacter pylori (H. pylori) and all types of GIM. H. pylori infection was also significantly associated with the extent of the GIM. Hypertension showed a trend toward significance in correlation with GIM, but no other associations were identified between GIM and demographic or clinical factors such as gender, age, smoking, diabetes mellitus, or hyperlipidemia. Our findings suggest that the routine subtyping GIM in pathology reports may not be necessary, given the lack of progression to any type of neoplasia within the follow-up period. However, the redemonstrated association between H. pylori and GIM emphasizes the importance of eradication therapy.