PDF(Sci-hub)
Abstract：
Patients with gastric precancerous lesions (atrophic gastritis and intestinal metaplasia) have increased risk of developing gastric cancer, and adequate management and surveillance of these patients should allow to reduce gastric cancer-related mortality. The guidelines on the management of these patients have been recently published by the European Societies (MAPS II guidelines) and by the American Gastroenterological Association (AGA). The aim of this commentary is to compare these two guidelines by highlighting the common points and differences between them. Both guidelines recommend a systematic detection and eradication of Helicobacter pylori in all patients with gastric atrophy. However, there is a major difference in the recommendations for surveillance: while the MAPS II guidelines recommend systematic endoscopic surveillance in all patients with severe gastric atrophy (with or without intestinal metaplasia), the AGA guidelines focus only on intestinal metaplasia and plead against systematic surveillance, leaving the possibility of surveillance in individual patients based on shared decision between clinicians and patients. The difference between two guidelines comes essentially from the different arguments used by two authorities (randomized control studies by AGA and observational cohort studies by the European Societies), and may be, at least in part, related to the difference between the European and American health care systems and potential economic burden.
摘要：
胃癌前病变（萎缩性胃炎和肠上皮化生）患者患胃癌的风险增加，对这些患者进行适当的管理和监测,可以降低胃癌相关死亡率.欧洲协会（MAPSII指南）和美国胃肠病学协会（AGA）最近发布了有关这些患者管理的指南。本评注的目的是通过强调这两个准则之间的共同点和区别来比较这两个准则。两项指南都建议对所有胃萎缩患者进行系统的幽门螺杆菌检测和根除。然而,监测建议存在重大差异：虽然MAPSII指南建议对所有患有严重胃萎缩（伴或不伴肠上皮化生）的患者进行系统的内镜监测，AGA指南只关注肠上皮化生，并呼吁不要进行系统监测，基于临床医生和患者之间的共同决策，保留对个体患者进行监测的可能性。两个指南之间的差异主要来自两个权威机构使用的不同论点（AGA的随机对照研究和欧洲学会的观察性队列研究），可能是,至少在某种程度上,与欧美医疗保健系统之间的差异和潜在的经济负担有关。
