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Gastric intestinal metaplasia

Douglas Morgan, MD, MPH
Section Editor
Mark Feldman, MD, MACP, AGAF, FACG
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Gastric intestinal metaplasia is an intermediate precancerous gastric lesion in the gastric cancer cascade of chronic gastritis, atrophic gastritis, intestinal metaplasia, dysplasia, and adenocarcinoma [1]. Although the risk of gastric cancer is increased in patients with intestinal metaplasia, the absolute risk is low. Specific subsets of patients with intestinal metaplasia may be at higher risk for progression. However, novel biomarkers are needed to better identify high-risk subgroups, and definitive studies are essential to determine the optimal interval for surveillance in patients at increased risk for gastric cancer. In addition, innovative endoscopy imaging modalities are expected to facilitate identification of gastric intestinal metaplasia.

This topic will review the epidemiology, natural history, diagnosis, and management of distal (noncardia) gastric intestinal metaplasia. The management of intestinal metaplasia at the gastric cardia (located immediately distal to the squamocolumnar junction and proximal to the oxyntic mucosa) and its distinction from Barrett's esophagus are discussed in detail, separately. (See "Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis", section on 'Intestinal metaplasia at the GEJ and in the gastric cardia'.)


Gastric intestinal metaplasia is defined as the replacement of the surface, foveolar, and glandular epithelium in the oxyntic or antral mucosa by intestinal epithelium [2].

Subtypes — As gastric intestinal metaplasia is heterogenous, several classification systems have been proposed [3-6]. The most widely used and clinically useful classification is based on the histologic appearance with hematoxylin and eosin staining into the following subtypes:

Complete intestinal metaplasia is defined by the presence of small intestinal-type mucosa with goblet cells, a brush border, and eosinophilic enterocytes (picture 1).

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Literature review current through: Nov 2017. | This topic last updated: May 19, 2016.
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