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Factors associated with the progression of gastric intestinal metaplasia: a multicenter, prospective cohort study.

ABSTRACT: Background and study aims? Gastric cancer (GC) is usually preceded by premalignant gastric lesions (GPLs) such as gastric intestinal metaplasia (GIM). Information on risk factors associated with neoplastic progression of GIM are scarce. This study aimed to identify predictors for progression of GIM in areas with low GC incidence. Patients and methods? The Progression and Regression of Precancerous Gastric Lesions (PROREGAL) study includes patients with GPL. Patients underwent at least two upper endoscopies with random biopsy sampling. Progression of GIM means an increase in severity according to OLGIM (operative link on gastric intestinal metaplasia) during follow-up (FU). Family history and lifestyle factors were determined through questionnaires. Serum Helicobacter pylori infection, pepsinogens (PG), gastrin-17 and GC-associated single nucleotide polymorphisms (SNPs) were determined. Cox regression was performed for risk analysis and a chi-squared test for analysis of single nucleotide polymorphisms. Results? Three hundred and eight patients (median age at inclusion 61 years, interquartile range (IQR: 17; male 48.4?%; median FU 48 months, IQR: 24) were included. During FU, 116 patients (37.7?%) showed progression of IM and six patients (1.9?%) developed high-grade dysplasia or GC. The minor allele (C) on TLR4 (rs11536889) was inversely associated with progression of GIM (OR 0.6; 95?%CI 0.4-1.0). Family history (HR 1.5; 95?%CI 0.9-2.4) and smoking (HR 1.6; 95?%CI 0.9-2.7) showed trends towards progression of GIM. Alcohol use, body mass index, history of H. pylori infection, and serological markers were not associated with progression. Conclusions? Family history and smoking appear to be related to an increased risk of GIM progression in low GC incidence countries. TLR4 (rs11536889) showed a significant inverse association, suggesting that genetic information may play a role in GIM progression.

SUBMITTER: Nieuwenburg SAV

PROVIDER: S-EPMC7892268 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Factors associated with the progression of gastric intestinal metaplasia: a multicenter, prospective cohort study.

Nieuwenburg S A V SAV Mommersteeg M C MC Eikenboom E L EL Yu B B den Hollander W J WJ Holster I Lisanne IL den Hoed Caroline M CM Capelle L G LG Tang Thjon J TJ Anten Marie-Paule MP Prytz-Berset I I Witteman E M EM Ter Borg F F Burger Jordy P W JPW Bruno Marco J MJ Fuhler G M GM Peppelenbosch Maikel P MP Doukas Michael M Kuipers Ernst J EJ Spaander Manon C W MCW

Endoscopy international open 20210218 3

<b>Background and study aims </b> Gastric cancer (GC) is usually preceded by premalignant gastric lesions (GPLs) such as gastric intestinal metaplasia (GIM). Information on risk factors associated with neoplastic progression of GIM are scarce. This study aimed to identify predictors for progression of GIM in areas with low GC incidence. <b>Patients and methods </b> The Progression and Regression of Precancerous Gastric Lesions (PROREGAL) study includes patients with GPL. Patients underwent at le ...[more]

PMID: 33655025

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Project description:BackgroundAs a precursor to gastric cancer, gastric intestinal metaplasia (GIM) represents a target for surveillance. US-based guidelines recommend surveillance of racial/ethnic minorities and immigrants from high incidence gastric cancer regions, yet there is marked variability in prevalence amongst these subgroups and within groups from high incidence regions. There is a paucity of information regarding country of birth as a risk factor for GIM and we sought to determine the association between country of birth and GIM in an ethnically and racially diverse US population.MethodsThis was a retrospective cohort study of persons who underwent esophagogastroduodenoscopy (EGD) with gastric biopsy at University of Miami Hospital between 2011 and 2021. A natural language processing (NLP) algorithm was developed and implemented to extract diagnoses of GIM and Helicobacter pylori (HP) infection from endoscopic pathology reports. Multivariable logistic regression was performed to evaluate risk factors for GIM, accounting for important covariates, including country of birth.FindingsA total of 21,108 persons from 130 varying countries of birth were included in the study. A total of 1699 cases of GIM were identified yielding a prevalence of 8.0% (95% CI: 7.7-8.4%). Multivariable analysis was restricted to countries with at least 100 persons in the cohort, yielding 15 countries with 1208 cases of GIM. Country of birth (p < 0.0001), race/ethnicity (p = 0.026), active HP infection (p < 0.0001), and increasing age (p < 0.0001) were significantly associated with increased odds of GIM. Highest odds for GIM were among persons born in Ecuador (OR 2.34, 95% CI 1.56-3.50), Honduras (OR 2.34, 95% CI 1.65-3.34), and Peru (OR 2.17, 95% CI 1.58-2.99).InterpretationWe demonstrate that country of birth is a key risk factor for GIM. Not all countries that are thought to be in "high-risk" regions are associated with higher rates of GIM, underlining the importance of studying the under-investigated risk factor of country of birth. Guidelines should account for country of birth, in addition to other risk factors, to tailor screening/surveillance appropriately.FundingShida Haghighat, MD, MPH is supported by an NIH training grant T32 DK 11667805.

Dataset Information

Factors associated with the progression of gastric intestinal metaplasia: a multicenter, prospective cohort study.

Publications

Factors associated with the progression of gastric intestinal metaplasia: a multicenter, prospective cohort study.

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