Association of Intestinal Metaplasia and Helicobacter pylori Infection in an Urban Minority Population

Abstract

Introduction: Intestinal metaplasia (IM) is regarded as a pre-malignant condition that may be related to Helicobacter pylori (HP) infection. Currently, no specific guidelines exist regarding management and follow up of patients with IM. The prevalence of HP has been reported to vary significantly according to geographic distribution. Studies from the United States (U.S.), Finland, and Korea have shown IM prevalence of 8%, 19%, and 29% respectively. A study from the Netherlands showed IM prevalence of 34% in HP positive patients compared to 15% IM prevalence in patients negative for HP infection. Similarly, a study from Japan showed prevalence rates of 37% and 2% respectively. We aimed to study the prevalence of IM in our urban hospital population and investigate potential association with HP infection. Methods: This is a retrospective study of patients who were screened with endoscopic biopsies for HP and IM in our urban community hospital from 2008 to 2015. Exclusion criteria: Patients under 18 years old. Results: 4421 patient charts were reviewed. 413/4421 (9.3%) patients had IM, consistent with a recent large U.S. study. 970/4421 (21.9%) patients were positive for HP. Of these, 123/970 (12.7%) patients had IM. Of the 3451 patients without HP infection, 290/3451 (8.4%) had IM. Chi-square analysis revealed that this difference was statistically significant (p < 0.001). Conclusion: IM is a common finding in endoscopic biopsies. We found a statistically significant difference in patients with IM and HP infection compared to patients with IM but HP negative. Major gastroenterology society guidelines are needed for management and follow up of patients with IM with or without concurrent HP infection.