Gastric intestinal metaplasia is associated with gastric dysplasia but is inversely correlated with esophageal dysplasia

Abstract

AIMTo determine which clinical factors might be associated with gastric intestinal metaplasia (IM) in a North American population.METHODSPathology and endoscopy databases at an academic medical center were reviewed to identify patients with and without gastric IM on biopsies for a retrospective cohort study. Patient demographics, insurance status, and other clinical factors were reviewed.RESULTSFour hundred and sixty-eight patients with gastric IM (mean age: 61.0 years ± 14.4 years, 55.5% female) and 171 without gastric IM (mean age: 48.8 years ± 20.8 years, 55.0% female) were compared. The endoscopic appearance of atrophic gastritis correlated with finding gastric IM on histopathology (OR = 2.05, P = 0.051). Gastric IM was associated with histologic findings of chronic gastritis (OR = 2.56, P < 0.001), gastric ulcer (OR = 6.97, P = 0.015), gastric dysplasia (OR = 6.11, P = 0.038), and gastric cancer (OR = 6.53, P = 0.027). Histologic findings of Barrett’s esophagus (OR = 0.28, P = 0.003) and esophageal dysplasia (OR = 0.11, P = 0.014) were inversely associated with gastric IM. Tobacco use (OR = 1.73, P = 0.005) was associated with gastric IM.CONCLUSIONPatients who smoke or have the endoscopic finding of atrophic gastritis are more likely to have gastric IM and should have screening gastric biopsies during esophagogastroduodenoscopy (EGD). Patients with gastric IM are at increased risk for having gastric dysplasia and cancer, and surveillance EGD with gastric biopsies in these patients might be reasonable.

Role of endoscopy in suspicion of atrophic gastritis with and without intestinal metaplasia in comparison to histopathology

“…Most of the studies estimated the incidence of IM in patients underwent EGD and had biopsies to be less than 10% (3). In our study, the incidence of IM reported 17.3% may be due to late detection and lack of routine cancer screening programs.…”

“…Atrophic gastritis (AG) and intestinal metaplasia (IM) are established premalignant gastric lesions (1). Incidence of gastric cancer (GC) is the 5th among cancers worldwide with more than 95% are adenocarcinomas (2) and the 3rd cause of cancer-related deaths worldwide (3). Recently, H. pylori infects more than half of the population in developing countries leading to a sequelae of chronic gastritis, AG, IM, and finally invasive gastric carcinoma in untreated patients (4,5).…”

“…Clinically, AG and IM are difficult to be detected as they have no specific symptoms or signs with most cases discovered endoscopically and or by histopathological assessment (3).…”

“…A systematic review reported recently a range of 0.53-15.24/1000 person/year with AG and 0.38-17.08/1000 person with IM lead to GC annually (6). A large study done on 61707 patients with gastric IM, revealed annual progression to GC by 0.25% (3). Moreover, IM increases the risk of GC by 6-folds (2).…”

“…Pathologically, IM can be identified by simple columnar epithelium containing paneth, absorptive, and goblet cells (3).…”