Gastric Premalignant Lesions

Gastric premalignant lesions are epithelial changes, which mostly result from chronic Helicobacter pylori (H. pylori) gastritis. These lesions are part of a cascade resulting from chronic inflammation potentially leading to atrophic gastritis, intestinal metaplasia, dysplasia, and eventually gastric adenocarcinoma. Only a minority of H. pylori-infected subjects progresses to cancer. The risk of progression to cancer is influenced by host and bacterial factors. Surveillance of gastric premalignant lesions can facilitate early detection of progressive disease. High-definition endoscopy and image enhancement markedly improved identification of gastric premalignant lesions and grading of their intra gastric extension almost without the need for biopsies. The incidence of gastric cancer varies worldwide. Various primary, secondary and tertiary prevention strategies can be applied to decrease gastric cancer incidence and mortality. These include H. pylori eradication, detection of subjects at risk for progression, surveillance, and removal of dysplasia and early cancer lesions.