Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2017; 9(2): 61-69
Published online Feb 16, 2017. doi: 10.4253/wjge.v9.i2.61
Gastric intestinal metaplasia is associated with gastric dysplasia but is inversely correlated with esophageal dysplasia
Justin M Gomez, James T Patrie, Wissam Bleibel, Jeanetta W Frye, Bryan G Sauer, Vanessa M Shami, Edward B Stelow, Christopher A Moskaluk, Andrew Y Wang
Justin M Gomez, Wissam Bleibel, Jeanetta W Frye, Bryan G Sauer, Vanessa M Shami, Andrew Y Wang, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA 22908, United States
James T Patrie, Division of Biostatistics and Epidemiology, University of Virginia, Charlottesville, VA 22908, United States
Edward B Stelow, Christopher A Moskaluk, Department of Pathology, University of Virginia, Charlottesville, VA 22908, United States
Author contributions: Gomez JM and Wang AY contributed equally to this work; Gomez JM, Bleibel W, Frye JW, Sauer BG, Shami VM, Moskaluk CA and Wang AY designed the research; Gomez JM, Patrie JT, Moskaluk CA and Wang AY performed the research; Patrie JT contributed statistical/analytic tools; Stelow EB and Moskaluk CA provided pathological analysis; Gomez JM, Patrie JT and Wang AY analyzed the data; Gomez JM, Patrie JT and Wang AY wrote the paper; Bleibel W, Frye JW, Sauer BG, Shami VM, Stelow EB, Moskaluk CA and Wang AY critically revised the paper for important intellectual content.
Institutional review board statement: This study was reviewed and approved by the University of Virginia Institutional Review Board for Health Sciences Research.
Informed consent statement: Informed consent was obtained prior to all endoscopic procedures as part of routine patient care. However, this was a retrospective cohort study that involved materials (data, documents, or records) that were collected solely for non-research purposes (such as medical diagnosis and treatment). Therefore, informed consent was not required for the purposes of this study given minimal risk to subjects.
Conflict-of-interest statement: The authors have no conflicts of interest, financial or otherwise, to report with respect to this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andrew Y Wang, MD, AGAF, FACG, FASGE, Associate Professor of Medicine, Section Chief of Interventional Endoscopy, Division of Gastroenterology and Hepatology, University of Virginia, PO Box 800708, Charlottesville, VA 22908, United States. ayw7d@virginia.edu
Telephone: +1-434-9241653 Fax: +1-434-2447590
Received: June 16, 2016
Peer-review started: June 17, 2016
First decision: July 27, 2016
Revised: October 13, 2016
Accepted: November 16, 2016
Article in press: November 17, 2016
Published online: February 16, 2017
Processing time: 243 Days and 10.6 Hours
Abstract
AIM

To determine which clinical factors might be associated with gastric intestinal metaplasia (IM) in a North American population.

METHODS

Pathology and endoscopy databases at an academic medical center were reviewed to identify patients with and without gastric IM on biopsies for a retrospective cohort study. Patient demographics, insurance status, and other clinical factors were reviewed.

RESULTS

Four hundred and sixty-eight patients with gastric IM (mean age: 61.0 years ± 14.4 years, 55.5% female) and 171 without gastric IM (mean age: 48.8 years ± 20.8 years, 55.0% female) were compared. The endoscopic appearance of atrophic gastritis correlated with finding gastric IM on histopathology (OR = 2.05, P = 0.051). Gastric IM was associated with histologic findings of chronic gastritis (OR = 2.56, P < 0.001), gastric ulcer (OR = 6.97, P = 0.015), gastric dysplasia (OR = 6.11, P = 0.038), and gastric cancer (OR = 6.53, P = 0.027). Histologic findings of Barrett’s esophagus (OR = 0.28, P = 0.003) and esophageal dysplasia (OR = 0.11, P = 0.014) were inversely associated with gastric IM. Tobacco use (OR = 1.73, P = 0.005) was associated with gastric IM.

CONCLUSION

Patients who smoke or have the endoscopic finding of atrophic gastritis are more likely to have gastric IM and should have screening gastric biopsies during esophagogastroduodenoscopy (EGD). Patients with gastric IM are at increased risk for having gastric dysplasia and cancer, and surveillance EGD with gastric biopsies in these patients might be reasonable.

Keywords: Gastric; Intestinal metaplasia; Atrophic gastritis; Biopsies; Esophagogastroduodenoscopy

Core tip: Gastric intestinal metaplasia (IM) is a precursor to gastric adenocarcinoma. There are no North American consensus recommendations as to which patients might benefit from esophagogastroduodenoscopy (EGD) with biopsy for screening or surveillance for gastric IM. Patients who smoke or have the endoscopic finding of atrophic gastritis are more likely to have gastric IM and should have screening gastric biopsies during EGD. Patients with gastric IM are at increased risk for developing gastric dysplasia and cancer, and surveillance EGD with gastric biopsies in these patients might be reasonable.