胃肠化生（GIM）是指胃粘膜转变为肠道表型，可以发生在胃的所有部位，包括贲门、室部和幽门粘膜。自从早期描述GIM以来，其与分化型（肠型）胃癌的关联已被广泛关注。许多流行病学研究已确认GIM与胃癌发展之间有显著关联。幽门螺杆菌（H. pylori），作为胃癌的主要病因，在GIM的易感性中起到最重要的作用。虽然GIM在胃癌发生逐步进展模型（所谓的“Correa级联”）中的作用最近引起了质疑，但我们回顾了强有力支持这个长期模型的科学证据，并提出了一个基于Correa级联的新进展模型。根除H. pylori是全球预防胃癌最重要的方法，但对于已形成的GIM来说，根除的效果有限，甚至可以忽略。因此，对于存在大范围胃体GIM的患者来说，内镜监测GIM可能是必要的。近期集成人工智能的图像增强内镜技术的进展，将有助于识别GIM和肿瘤性病变，这将对预防策略产生重要影响。版权所有 © 2023 AGA Institute. 由Elsevier Inc.发表。保留所有权利。

Gastric intestinal metaplasia (GIM), which denotes conversion of gastric mucosa into an intestinal phenotype, can occur in all regions of the stomach, including cardiac, fundic, and pyloric mucosa. Since the earliest description of GIM, its association with gastric cancer of the differentiated (intestinal) type, has been a well-recognized concern. Many epidemiological studies have confirmed GIM to be significantly associated with subsequent gastric cancer development. Helicobacter pylori (H. pylori), the principal etiological factor for gastric cancer, plays the most important role in predisposing to GIM. Although the role of GIM in the stepwise progression model of gastric carcinogenesis (the so-called "Correa cascade") has come into question recently, we review the scientific evidence that strongly support this long-standing model and propose a new progression model that builds upon the Correa cascade. Eradication of H. pylori is the most important method for preventing gastric cancer globally, but the effect of eradication on established GIM, is limited, if any. Endoscopic surveillance for GIM may therefore be necessary, especially when there is extensive corpus GIM. Recent advances in image-enhanced endoscopy with integrated artificial intelligence have facilitated the identification of GIM and neoplastic lesions, which will impact preventive strategies in the near future.Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.