Asian Pacific Association of Gastroenterology task force recommendations on surveillance for Helicobacter pylori associated gastric premalignant conditions

Abstract

Background The burden of gastric cancer remains substantial in Asia. Gastric premalignant conditions, including chronic atrophic gastritis, intestinal metaplasia and dysplasia, are important intermediate stages in the gastric carcinogenesis cascade. The sojourn time allows endoscopic surveillance to have a pivotal role in early detection and timely intervention. Objective This task force was commissioned by the Asian Pacific Association of Gastroenterology to formulate recommendations for the surveillance and management of Helicobacter pylori associated gastric premalignant conditions in the region. Design A systematic literature review was conducted across multiple databases, including PubMed, Cochrane Library and Embase, focusing on studies related to gastric premalignant conditions and their surveillance, particularly from Asia. The evidence quality and strength of recommendations were appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results These recommendations address four key aspects of gastric premalignant condition surveillance: (1) epidemiology and risk factors; (2) endoscopic and histopathological diagnosis; (3) risk stratification and endoscopic surveillance strategies; and (4) management strategies. 28 statements were made after multiple rounds of voting by experts. The statements offer a comprehensive, evidence based framework designed to assist clinicians in the Asia Pacific region on the early detection and management of gastric premalignant conditions. Conclusion These statements aim to provide a structured, evidence based surveillance framework for clinical practice in the Asia Pacific region, while also identifying priority areas for future research.