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Gastrointest Endosc. 2019 Aug 16. pii: S0016-5107(19)32136-4. doi: 10.1016/j.gie.2019.07.038. [Epub ahead of print]

Prevalence, Risk Factors, and Surveillance Patterns for Gastric Intestinal Metaplasia Among Patients Undergoing Upper Endoscopy with Biopsy.

Author information

1
Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA.
2
Division of Gastroenterology, University of Washington, Seattle, WA.
3
Fox Chase Cancer Center, Philadelphia, PA.
4
Department of Pathology, University of Washington, Seattle, WA.
5
Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA. Electronic address: jooha@stanford.edu.

Abstract

BACKGROUND AND AIMS:

Gastric intestinal metaplasia (GIM) is an important precursor lesion to gastric cancer (GC), the second leading cause of cancer deaths worldwide. There exist few data regarding the prevalence of, risk factors for, and clinical practice patterns regarding gastric intestinal metaplasia (GIM) in the United States. Furthermore, there are currently no U.S. guidelines regarding screening/surveillance for GIM.

METHODS:

All consecutive upper endoscopic procedures from 2 academic medical centers in Seattle between 1999 and 2014 are reviewed. Demographic, clinical, and endoscopic covariates are recorded at time of endoscopy. Procedures with gastric biopsy are matched to final histologic diagnoses, including presence of Helicobacter pylori. Cases of GIM and dysplasia are recorded and compared with non-GIM controls using univariate and multivariable regression. Surveillance patterns for cases of GIM are recorded.

RESULTS:

Data from 36,799 upper endoscopies, 17,710 gastric biopsies, 2,073 cases of GIM, 43 cases of dysplasia, and 78 cases of GC were captured. The point prevalence of GIM is 11.7% in patients who underwent gastric biopsy. Non-white race (P<0.001), increasing age (P<0.001), and presence of H pylori (P<0.001) associated with GIM. Once GIM is present, increasing age (P<0.001) and male gender (P<0.001) associate with progression, and presence of H pylori (P<0.001) inversely associates with progression to dysplasia/GC. Few cases of GIM/dysplasia/GC are made during procedures for GIM screening/surveillance. Only 16% of patients with a diagnosis of GIM received a recommendation for surveillance.

CONCLUSIONS:

There is a high prevalence of GIM among non-white and Hispanic Americans. Risk factors for development of GIM may be distinct from risk factors for progression to GC.

PMID:
31425693
DOI:
10.1016/j.gie.2019.07.038

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