Abstract
Background and Aims Gastric cancer is the 5th leading cause of cancer mortality worldwide and the leading infection-associated cancer. Helicobacter pylori is the most common chronic bacterial infection in humans and the major predisposing factor for the development of gastric intestinal metaplasia (GIM), the principal preneoplastic lesion in the gastric carcinogenesis pathway. GIM surveillance is now recommended for individuals among high-risk subgroups by three major gastroenterology societies in Europe, England, and U.S. Our objective was to provide the initial epidemiologic data for GIM among Hispanics in Puerto Rico. Methods Using a cross-sectional study design, we analyzed an extensive pathology database (n = 43,993) that captured approximately 50% of all endoscopy biopsies taken during 2012-2014 at academic, public, and private sectors in Puerto Rico. Prevalence estimates of GIM, GIM subgroups, and H. pylori status were estimated using logistic regression models. Results A total of 4,707 GIM cases were identified during the study period for a prevalence rate of 10.7%. H. pylori was detected in 26.9% (95% CI: 25.7-28.2) of the GIM cases. The majority of the pathology reports lacked information regarding the high-risk subtypes (99.6%) and extension (71.2%). Conclusions The prevalence of GIM among Hispanics living in Puerto Rico may be higher than in U.S. mainland non-Hispanic populations. The prevalence of H. pylori detected in our study population was comparable to the rates reported in the mainland U.S. Standardization of the endoscopy biopsy protocol and pathology reporting is needed to characterize and risk stratify GIM surveillance programs in Puerto Rico.
Highlights
Worldwide, gastric cancer is the 5th leading cause of cancer mortality and the leading infection-associated cancer [1]
Noncardia gastric cancer, arising from the antrum, incisura, body, and/or fundus, represents the majority of gastric cancers in the U.S [4]. This histologic subtype of gastric cancer arises through a stepwise progression starting with chronic gastritis followed by atrophic gastritis, gastric intestinal metaplasia (GIM), dysplasia, and adenocarcinoma [5]
We report the epidemiologic data for GIM among Hispanics living in Puerto Rico for the first time, a Hispanic subpopulation with high gastric burden [2, 3]
Summary
Gastric cancer is the 5th leading cause of cancer mortality and the leading infection-associated cancer [1]. In Puerto Rico, gastric cancer continues to be a commonly diagnosed malignancy It is the 15th most commonly diagnosed cancer on the island and is the 6th and 8th leading cause of cancer death among men and women, respectively [2, 3]. Noncardia gastric cancer, arising from the antrum, incisura, body, and/or fundus, represents the majority of gastric cancers in the U.S [4] This histologic subtype of gastric cancer arises through a stepwise progression starting with chronic gastritis followed by atrophic gastritis, gastric intestinal metaplasia (GIM), dysplasia, and adenocarcinoma [5]. The prevalence of H. pylori detected in our study population was comparable to the rates reported in the mainland U.S Standardization of the endoscopy biopsy protocol and pathology reporting is needed to characterize and risk stratify GIM surveillance programs in Puerto Rico
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