Gastric Intestinal Metaplasia in a U.S. Tertiary Care Population

Abstract

Introduction: Gastric cancer is the fifth most common cancer worldwide, though the prevalence in the U.S. remains low. Gastric intestinal metaplasia (GIM) is known to be a precancerous condition and significantly increases a patient's risk of gastric cancer. GIM in the U.S. has not been well studied, however, and consensus guidelines for screening and surveillance are lacking. Methods: This was a retrospective analysis of patients with gastric intestinal metaplasia, dysplasia and cancer in a large, tertiary care center between November, 1993 and August, 2014. IRB approval was obtained prior to the initiation of the study. Results: 64,570 upper endoscopies were performed in our health system between 11/93 and 8/14. Of these, roughly 2,810 (4.4%) had biopsies with gastric intestinal metaplasia, gastric dysplasia or gastric cancer. Charts were reviewed for 1,233 patients. Of these, 1,151 had intestinal metaplasia, 52 had gastric cancer, 17 had low-grade dysplasia and 13 had high-grade dysplasia. Of the patients with intestinal metaplasia, 573 were male and 578 were female. The age range was 17 to 106 (median 62). The most common racial group was Caucasian (43%), followed by Asian (22%). The most common indications for EGD were abdominal pain (21%), GERD (20%) and anemia (12%). 43 patients (3.7%) had EGD performed for either GIM screening or surveillance. 336 (29%) had biopsies positive for H Pylori. 196 patients had surveillance recommended for IM. Of these, 83 (42%) had the surveillance procedure performed. Conclusion: Gastric intestinal metaplasia may be more prevalent than previously recognized in certain groups of patients in the U.S. In our study, 22% of the patients with intestinal metaplasia were of Asian descent, though only 6.7% of all endoscopies over the study period were performed on Asian patients. Further study is needed to assess the prevalence of intestinal metaplasia and risk of progression to gastric cancer in this group. Furthermore, adherence to recommended surveillance was 42%, suggesting further patient and provider education and outreach are needed.