<prompt> Which one of the following is the most significant risk factor for the development of gastric carcinoma?Paneth cell metaplasiaPyloric metaplasiaIntestinal metaplasiaCiliated metaplasia  <response>: The risk of tumor development is greatly increased in patients in whom mucosal inflammation progresses to multifocal mucosal atrophy and intestinal metaplasia- RobbinsSerial endoscopic examinations of the stomach in patients with atrophic gastritis have documented replacement of the usual gastric mucosa by intestinal-type cells. This process of intestinal metaplasia may lead to cellular atypia and eventual neoplasia - Harrison 