A new pathway for detection, diagnosis and management of patients at risk of gastric adenocarcinoma

The Correa’s cascade from Helicobacter pylori (Hp) or autoimmune atrophic gastritis (AIAG) to gastric adenocarcinoma (GAC) presents an opportunity to detect and surveil precancerous lesions in the gastric mucosa that may be the key to early detection and improved outcomes. When chronic atrophic gastritis (CAG) and intestinal metaplasia (IM) are detected non-invasively before gastroscopy there is also the potential to opt for gastroscopy based on a patient’s risk. We present our proposed model for the serological detection of CAG based on the measurement of plasma Pepsinogens I and II, Gastrin-17, and anti-Hp IgG antibodies, in a revised pathway for patients presenting with stomach dyspepsia symptoms. With a view to improving case selection for gastroscopy, prioritising high-risk referrals, and de-prioritising gastroscopy in low-risk cases, we also consider the benefits to patients, providers, and payors in this updated model of care.