Tu1508 PREDICTORS FOR DEVELOPMENT OF COMPLETE AND INCOMPLETE INTESTINAL METAPLASIA (IM) ASSOCIATED WITH HELICOBACTER PYLORI INFECTION: A LARGE-SCALE STUDY FROM LOW PREVALENCE AREA OF GASTRIC CANCER (IM-HP TRIAL)

Abstract

Gastric intestinal metaplasia (IM) is a precancerous lesion of gastric cancer related to Helicobacter pylori (H. pylori) infection. Until now, there has been limited data about IM prevalence and associated risk factors in Thai people. This study aimed to determine risk factors related to the development of IM to guide proper management in Thailand. 1,117 dyspeptic patients undergoing upper gastrointestinal endoscopy in Thammasat University Hospital, Thailand were enrolled between April 2018 and August 2019. Patients’ data including baseline characteristics, laboratory results, and histopathology of gastric biopsies from medical database were extensively reviewed. 1,117 patients had overall H. pylori prevalence of 44.8% and the mean age was 60.6 years and 44.7% of whom were males. 862 (77.2%) patients demonstrated chronic gastritis, while 209 (18.7%) had IM. There were 180 (16.1%) patients with complete IM and 29 (2.6%) with incomplete IM. In groups of complete and incomplete IM, current H. pylori infection rates were 66.1%, and 58.6%, respectively (OR 0.73; 95% CI 0.33-1.62, p = 0.434). The mean body mass index (BMI) of incomplete IM group (27.3) was significantly higher than BMI of complete IM group (23.7) (OR 1.13; 95% CI 1.04-1.23, p = 0.003). Age >45 years, current H. pylori infection, and family history of gastric cancer were significantly higher in IM than chronic gastritis group with OR 1.90 (95% CI 1.04-3.45, p = 0.036), OR 2.94 (95% CI 2.10-4.11, p <0.001), and OR 5.36 (95% CI 1.11-26.01, p = 0.037), respectively, as demonstrated in table 1 and 2. There was no difference of laboratory result including complete blood count, plasma glucose, tumor markers (CEA and CA19-9) between complete and incomplete IM groups. During 16 months of study, there were 12 patients (1.1%) diagnosed with gastric cancer and 2 of them had history of prior IM along with adenocarcinoma on their gastric pathology. The 1-year survival rate of 12 gastric cancer patients was as low as 50%. Age >45 years, current H. pylori infection, and family history of gastric cancer are significant predictors for the presence of intestinal metaplasia. Body mass index might be beneficial for using as a predictive risk factor to reduce the development of incomplete intestinal metaplasia. H. pylori eradication could be an effective way to prevent the development of gastric precancerous lesions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)