1235 Risk Factors for Advanced Gastric Intestinal Metaplasia in a Multi-Ethnic United States Cohort

Abstract

INTRODUCTION: Gastric intestinal metaplasia (GIM) is a precursor to gastric cancer (GC). The operative link for GIM (OLGIM) is a standardized histologic scoring system (ranging 0 to 4) used to evaluate severity of GIM; in prospective European studies, it has been shown to predict risk for progression onto GC. Use of OLGIM has not previously been described in North American populations. Risk factors for advanced GIM are poorly described in North America, and currently no screening recommendations exist for either GC or GIM. METHODS: We prospective enrolled patients between the ages of 30 and 84 scheduled to undergo outpatient endoscopy at Stanford University for the following indications 1) dyspepsia, 2) H. pylori assessment, 3) GC screening, or 4) GIM surveillance. At time of enrollment, all patients completed a standardized questionnaire inquiring about medical, family, dietary, and exposure history. Biopsies were performed from both antrum and body. Histologic scoring was performed according to a Standardized protocol, and OLGIM score assigned to each subject. We compared demographic, clinical, and environmental variables between subjects with GIM and subjects without GIM. We also compared subjects with advanced GIM (defined as OLGIM ≥ 2) with subjects without advanced GIM (OLGIM < 2). Continuous variables were analyzed using Student's T-test, and categorical variables were analyzed using the Chi-squared test. RESULTS: 38 subjects with GIM, and 41 subjects without GIM were enrolled. Of the GIM group, 20 subjects demonstrated advanced GIM. Subjects with GIM were older (P = 0.001), more likely to have a history of H. pylori treatment (P = 0.002), and more likely to be first-generation immigrants (P = 0.008) compared to subjects without GIM (Figure 1). Subjects with advanced GIM were more likely to be older (P = 0.02), and more likely to be first-generation immigrants (P = 0.04) compared to subjects without advanced GIM (Figure 2). Gender, presence of symptoms, presence of medical comorbidity, family history, smoking status, and dietary preferences did not demonstrate significant differences between groups in this cohort. CONCLUSION: Age and immigration status, known risk factors for GC, may also be risk factors for advanced GIM. As advanced GIM significantly increases risk for GC, detection of advanced GIM may improve GC morbidity and mortality. Additional research should be focused on non-invasive testing to detect advanced GIM in North American populations.