Abstract
Nodular gastritis (NG) and gastric intestinal metaplasia (GIM) are both the aftermath of H. pylori infection. Despite vigorous attempts to eradicate H. pylori in the past 4 decades, the infection has dropped, rather unimpressively, from 58.2% to 43.1%. Prevalence has been reported as 5% for NG and 25% for GIM. NG affects children and young adults especially females, and the symptoms are those of non-specific dyspepsia, whereas GIM is asymptomatic. NG is usually diagnosed at endoscopy with classical multitudinous nodules covering the antrum but also the body, and confirmed by the histological feature of lymphoid follicles, the basis of the nodules. GIM is detected by multiple biopsies (8 has been proposed, particularly for regions with high gastric cancer rates), and is graded histologically as mild, moderate, and severe. NG is treated by eradication of the H. pylori infection; if untreated, there is a 5% chance that extensive NG could develop into diffuse gastric cancer in 3 to 5 years. GIM does not iimprove despite successful eradication of H. pylori, nor does it respond to any other medical treatment. If untreated, there is a 5.8% chance for severe GIM to develop into gastric cancer in 5 years. Management of GIM has been by surveillance, with treatment instituted once early cancer appears. Management, however, has been revolutionized recently with the introduction of endoscopic mucosal resection using Lam’s technique. It is proposed that once detected, both NG and GIM should be treated vigorously until they are healed, to prevent possible malignant change.