astric premalignant conditions (GPMC) are common and include atrophic gastritis, gastric intestinal metaplasia, dysplasia, and certain gastric epithelial polyps. GPMC have an increased risk of progression to gastric adenocarcinoma. Gastric cancer (GC) in the United States represents an important cancer disparity because incidence rates are 2- to 13-fold greater in non-White individuals, particularly early-generation immigrants from regions of high GC incidence. The US 5-year survival rate for GC is 36%, which falls short of global standards and is driven by the fact that only a small percentage of GC in the US is diagnosed in the early, curable stage. This document represents the first iteration of American College of Gastroenterology guidelines on this topic and encompasses endoscopic surveillance for high-risk patients with GPMC, the performance of high-quality endoscopy and image-enhanced endoscopy for diagnosis and surveillance, GPMC histology criteria and reporting, endoscopic treatment of dysplasia, the role of Helicobacter pylori eradication, general risk reduction measures, and the management of autoimmune gastritis and gastric epithelial polyps. There is insufficient evidence to make a recommendation on upper endoscopic screening for GC/GPMC detection in US populations deemed high-risk for GC. Surveillance endoscopy is recommended for individuals at high risk for GPMC progression, as defined by endoscopic, histologic, and demographic factors, typically every 3 years, but an individualized interval may be warranted. H. pylori testing, treatment, and eradication confirmation are recommended in all individuals with GPMC. Extensive high-quality data from US populations regarding GPMC management are lacking, but continue to accrue, and the quality of evidence for the recommendations presented herein should be interpreted with this dynamic context in mind. The GPMC research and education agendas are broad and include high-quality prospective studies evaluating opportunistic endoscopic screening for GC/GPMC, refined delineation of what constitutes "high-risk" populations, development of novel biomarkers, alignment of best practices, implementation of training programs for improved GPMC/GC detection, and evaluation of the impact of these interventions on GC incidence and mortality in the US.

胃部癌前病变（GPMC）较为常见，包括萎缩性胃炎、胃肠上皮化生、异型增生以及某些胃上皮息肉。GPMC进展为胃腺癌的风险较高。在美国，胃癌（GC）是一个重要的癌症差异问题，因为非白人群体，尤其是来自高胃癌发病率地区的早期移民，其发病率是白人群体的2至13倍。美国胃癌的5年生存率为36%，远低于全球标准，这主要是由于美国仅有少数胃癌在早期可治愈阶段被诊断出来。本文是美国胃肠病学会关于该主题的首版指南，涵盖了针对高风险GPMC患者的内镜监测、高质量内镜和图像增强内镜在诊断和监测中的应用、GPMC组织学标准和报告、异型增生的内镜治疗、幽门螺杆菌根除的作用、一般风险降低措施，以及自身免疫性胃炎和胃上皮息肉的管理。目前尚无足够证据支持对被认为具有高胃癌风险的美国人群进行上消化道内镜筛查以检测GC/GPMC。建议对具有GPMC进展高风险（根据内镜、组织学和人口统计学因素定义）的个体进行内镜监测，通常每3年一次，但可能需要个体化调整监测间隔。建议对所有GPMC患者进行幽门螺杆菌检测、治疗和根除确认。尽管目前缺乏来自美国人群的关于GPMC管理的高质量数据，但相关数据正在不断积累，因此在解读本文推荐意见的证据质量时应考虑到这一动态背景。GPMC研究和教育议程广泛，包括高质量的前瞻性研究，评估机会性内镜筛查对GC/GPMC的作用，明确“高风险”人群的定义，开发新型生物标志物，统一最佳实践，实施培训计划以提高GPMC/GC的检出率，并评估这些干预措施对美国胃癌发病率和死亡率的影响。