Even if its incidence has decreased due to the influence of environmental and nutritional factors, gastric carcinoma remains a major concern because of its very poor prognosis. Screening for precancerous conditions, including intestinal metaplasia, is one method of improving the prognosis of gastric carcinoma. Nevertheless, the implications for the use of endoscopic surveillance in patients with intestinal metaplasia of the stomach are still unknown.

As suggested by Grötzinger et al in this issue of Gut,1 molecular changes (gain or loss of protein expression) are undoubtedly the first sign of metaplasia; the use …