Premalignant lesions of the stomach and management of early neoplastic lesions

Although the incidence of gastric cancer (GC) is declining, it remains a significant global problem. GC is thought to arise via a series of histologically distinct premalignant stages and triggered by chronic Helicobacter pylori infection. Key to this pathway is intestinal metaplasia (IM), an intermediate stage immediately preceding dysplasia and a known risk factor in the progression to GC. This chapter focuses primarily on IM, its histological subtypes, clinical implications, and role in GC progression, and discusses the global surveillance and management guidelines for individuals with IM. The latter part of the chapter addresses the diagnosis and treatment of early GC which is a developing field in Western countries where GC is often diagnosed at an advanced stage.