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Gastric intestinal metaplasia more common in US than previously thought

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HONOLULU — In a retrospective analysis, researchers found gastric intestinal metaplasia to be more prevalent among the U.S. population than previously thought, according to an oral presentation at ACG 2015.

“Gastric cancer is the third leading cause of cancer deaths worldwide, though the prevalence in the U.S. remains low,” Joo Ha Hwang, MD, PhD, associate professor and section chief of gastroenterology at Harborview Medical Center, University of Washington, Seattle, Washington, said during his presentation. “There will be approximately 24,590 new cases of gastric cancer in the U.S. in 2015, compared to 16,980 new cases of esophageal cancer. … The goal was to determine the prevalence of gastric intestinal metaplasia, dysplasia and gastric cancer among patients who had endoscopy and evaluate the prevalence of [gastric intestinal metaplasia], dysplasia and gastric cancer by race in patients who had endoscopy.”

Joo Ha Hwang

Hwang and colleagues analyzed data of 1,233 patients with either gastric intestinal metaplasia (GIM; n = 1,151), low- or high-grade dysplasia (n = 30) or gastric cancer (n = 52) who had endoscopy performed at Harborview Medical Center and University of Washington Medical Center between November 1993 and August 2014.

Overall, 573 patients with GIM were male and 578 were female. The median age of all the patients was 62 years. A majority of the patients who had GIM were Caucasian (43%) and Asian (22%).

Among Asian patients who had endoscopy, 13.5% had GIM compared with 2.6% of Caucasian patients with GIM.

The most common indications for esophagogastroduodenoscopy (EGD) were abdominal pain (21%), GERD (20%) and anemia (12%). 

Forty-three patients had EGD performed for either gastric cancer screening or GIM surveillance (3.7%); 336 had positive biopsies for Helicobacter pylori (29%); and 196 patients were recommended to undergo surveillance for GIM. Of the 196 patients, 83 had the surveillance procedure actually performed (42%).

Hwang stated that providers should be aware of where their patients have immigrated to be able to implement proper screening procedures and know if they are from high-risk areas.

“If you have a patient who is an immigrant, you need to be aware; do they come from a demographic that is high risk?” he said.

Hwang concluded: “Further study is needed to assess the prevalence of intestinal metaplasia and risk of progression to gastric cancer in this group. Adherence to recommended follow-up was low [and] … we are suggesting further patient and provider education and outreach are needed.” – by Melinda Stevens 

Reference:

Higa J, et al. Abstract 15. Presented at: ACG; Oct. 16-21, 2015; Honolulu.

Disclosures: The researchers report no relevant financial disclosures.