According to European guidelines, autoimmune gastritis is considered a precancerous condition despite heterogeneity of evidence, and surveillance is recommended every 3 years.[153]Dinis-Ribeiro M, Libânio D, Uchima H, et al. Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG) and European Society of Pathology (ESP) guideline update 2025. Endoscopy. 2025 May;57(5):504-54.
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http://www.ncbi.nlm.nih.gov/pubmed/40112834?tool=bestpractice.com
However, although achlorhydria due to atrophic gastritis and/or autoimmune gastritis is associated with a small increased risk for gastric adenocarcinoma and carcinoid tumors, routine monitoring has not been recommended by the AGA guidelines.[39]Busuttil RA, Boussioutas A. Intestinal metaplasia: a premalignant lesion involved in gastric carcinogenesis. J Gastroenterol Hepatol. 2009 Feb;24(2):193-201.
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[62]Hou W, Schubert ML. Treatment of gastric carcinoids. Curr Treat Options Gastroenterol. 2007 Apr;10(2):123-33.
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[67]Gupta S, Li D, El Serag HB, et al. AGA clinical practice guidelines on management of gastric intestinal metaplasia. Gastroenterology. 2020 Feb;158(3):693-702.
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[121]ASGE Standards of Practice Committee, Evans JA, Chandrasekhara V, et al. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc. 2015;82:1-8.
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[151]Lochhead P, El-Omar EM. Helicobacter pylori infection and gastric cancer. Best Pract Res Clin Gastroenterol. 2007;21(2):281-97.
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[152]Sjöblom SM, Sipponen P, Järvinen H. Gastroscopic follow up of pernicious anaemia patients. Gut. 1993 Jan;34(1):28-32.
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[154]Toh BH, van Driel IR, Gleeson PA. Pernicious anemia. N Engl J Med. 1997 Nov 13;337(20):1441-8.
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The physician should have a low index of suspicion for malignancy, and even minimal symptoms and signs warrant an upper endoscopy. Similarly, no follow-up testing is required, but it may be argued that complete blood count should be periodically monitored, perhaps yearly, for early diagnosis of anemia due to iron and/or cobalamin deficiency. Calcium and vitamin D deficiency may be monitored by periodic serum 25-hydroxyvitamin D as well as bone mineral density testing. Thyroid tests may be obtained.[155]Heidelbaugh JJ, Kim AH, Chang R, et al. Overutilization of proton-pump inhibitors: what the clinician needs to know. Therap Adv Gastroenterol. 2012 Jul;5(4):219-32.
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