在过去的十年中，胃肠上皮化生 (GIM) 的治疗已由多个不同的国际循证指南解决。在这篇综述中，我们的目的是综合这些指南，为临床医生提供当前治疗 GIM 患者的建议的全球视角，并强调未来研究需要解决的证据差距。我们对文献进行了系统回顾查看 2010 年 1 月至 2023 年 2 月期间发布的针对 GIM 诊断和管理的指南和共识声明。从确定的 426 份手稿中，对 15 份指南进行了评估。关于 GIM 内窥镜监测的目的，各指南之间存在一致性，即识别常见的肿瘤病变并分期胃肿瘤前期病症。指南还同意，只有具有高风险GIM表型（例如，体扩展GIM、OLGIM III/IV期、不完全GIM亚型）、持续难治性幽门螺杆菌感染或有胃癌一级家族史的患者才应接受定期检查。间隔内窥镜监测。相比之下，低风险表型（大多数 GIM 患者）不需要监测。并非所有指南都与组织学分期系统一致。如果需要进行监测，大多数指南建议间隔 3 年，但存在一些差异。所有指南都建议根除幽门螺杆菌作为预防胃癌的唯一非内镜干预措施，而有些指南还提供了有关生活方式改变的额外建议。虽然大多数指南都提到了高质量内窥镜检查对于内窥镜监测的重要性，但除了指出应遵循系统性胃活检方案外，很少有详细说明重要指标。值得注意的是，大多数指南都评论了内窥镜检查在胃癌筛查和胃癌前病变检测中的作用，但异质性很高，实施指导有限，并且缺乏强有力的证据。尽管人群和实践存在差异，但国际指南总体上在以下方面保持一致： GIM 作为癌前病变的重要性，以及对内镜监测采用风险分层方法的必要性，以及根除幽门螺杆菌（如果存在）的必要性。关于以下方面的指南还有协调的空间：(1)哪些人群值得进行胃癌内窥镜筛查和 GIM 检测/分期指数； (2) 高质量内窥镜检查的客观指标； (3) 对组织学分期的必要性达成共识；(4) 除单独根除幽门螺杆菌外，还采用非内镜干预措施预防胃癌。需要进行强有力的研究，最好是随机试验的形式，以弥补现有的大量证据差距。© 作者（或其雇主）2024。禁止商业重复使用。请参阅权利和权限。英国医学杂志出版。

During the last decade, the management of gastric intestinal metaplasia (GIM) has been addressed by several distinct international evidence-based guidelines. In this review, we aimed to synthesise these guidelines and provide clinicians with a global perspective of the current recommendations for managing patients with GIM, as well as highlight evidence gaps that need to be addressed with future research.We conducted a systematic review of the literature for guidelines and consensus statements published between January 2010 and February 2023 that address the diagnosis and management of GIM.From 426 manuscripts identified, 15 guidelines were assessed. There was consistency across guidelines regarding the purpose of endoscopic surveillance of GIM, which is to identify prevalent neoplastic lesions and stage gastric preneoplastic conditions. The guidelines also agreed that only patients with high-risk GIM phenotypes (eg, corpus-extended GIM, OLGIM stages III/IV, incomplete GIM subtype), persistent refractory Helicobacter pylori infection or first-degree family history of gastric cancer should undergo regular-interval endoscopic surveillance. In contrast, low-risk phenotypes, which comprise most patients with GIM, do not require surveillance. Not all guidelines are aligned on histological staging systems. If surveillance is indicated, most guidelines recommend a 3-year interval, but there is some variability. All guidelines recommend H. pylori eradication as the only non-endoscopic intervention for gastric cancer prevention, while some offer additional recommendations regarding lifestyle modifications. While most guidelines allude to the importance of high-quality endoscopy for endoscopic surveillance, few detail important metrics apart from stating that a systematic gastric biopsy protocol should be followed. Notably, most guidelines comment on the role of endoscopy for gastric cancer screening and detection of gastric precancerous conditions, but with high heterogeneity, limited guidance regarding implementation, and lack of robust evidence.Despite heterogeneous populations and practices, international guidelines are generally aligned on the importance of GIM as a precancerous condition and the need for a risk-stratified approach to endoscopic surveillance, as well as H. pylori eradication when present. There is room for harmonisation of guidelines regarding (1) which populations merit index endoscopic screening for gastric cancer and GIM detection/staging; (2) objective metrics for high-quality endoscopy; (3) consensus on the need for histological staging and (4) non-endoscopic interventions for gastric cancer prevention apart from H. pylori eradication alone. Robust studies, ideally in the form of randomised trials, are needed to bridge the ample evidence gaps that exist.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.