Utility of subtyping intestinal metaplasia as marker of gastric cancer risk. A review of the evidence


  • Carlos A. González,

    Corresponding author
    • Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (IDIBELL-ICO), Barcelona, Spain
    Search for more papers by this author
  • José M. Sanz-Anquela,

    1. Department of Pathology. Hospital “Principe de Asturias”, University of Alcalá de Henares, Madrid, Spain
    Search for more papers by this author
  • Javier P. Gisbert,

    1. Department of Gastroenterology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
    Search for more papers by this author
  • Pelayo Correa

    Corresponding author
    • Division of Gastroenterology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
    Search for more papers by this author

Correspondence to: Carlos A. González, Unit of Nutrition, Environment and Cancer, Department of Epidemiology, Catalan Institute of Oncology (ICO), Barcelona, Spain, E-mail: cagonzalez@iconcologia.net and Pelayo Correa, Division of Gastroenterology, Vanderbilt University Medical Center, 2215 Garland Avenue 1030 MRB IV, Nashville, TN 37232, USA, E-mail: pelayo.correa@vanderbilt.edu


The identification and surveillance of patients with preneoplastic lesions at high risk of progressing to gastric cancer (GC) represents the most effective way of reducing the burden of GC. The incomplete type of intestinal metaplasia (IM) could be considered as the best candidate for surveillance. However, the usefulness of subtyping of IM has been considered by some authors as limited and inconsistent. A search was carried out to identify all cross-sectional (n=14) and follow-up (n=10) studies that assessed the risk of GC among subjects with different types of IM. Out of the 14 cross-sectional studies, 13 reported that the prevalence of incomplete IM was statistically significantly higher in GC than in other gastric lesions. Out of the ten follow-up studies, six found a statistically significant association between incomplete IM and subsequent GC risk. The relative risks of GC were from 4- to 11-fold higher for the presence of incomplete type in comparison to complete type or in comparison to the absence of incomplete type, among the studies that reported the magnitude of the risk. According to this comprehensive review, most of the scientific evidence supports the utility of subtyping IM as a predictor of GC risk. Recognizing its usefulness by gastroenterologists should encourage pathologists to subtype IM.