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Prevalence of Extensive and Limited Gastric Intestinal Metaplasia and Progression to Dysplasia and Gastric Cancer

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Abstract

Background and Aims

Guidelines cite extensive gastric intestinal metaplasia (GIM) as a bigger risk factor for gastric cancer (GC) than limited GIM and an indication for endoscopic surveillance. Data on progression of extensive GIM to GC in the USA are limited. This study aimed to estimate the prevalence and progression rates of extensive GIM in a US cohort.

Methods

This retrospective study assessed the prevalence of extensive GIM between 1/1/1990 and 8/1/2019 at a large academic medical center. Multivariable regression was used to identify predictors of extensive GIM. Incidence of GC on follow-up was calculated as number of new diagnoses divided by person-years of follow-up. Presence of GIM on subsequent follow-up endoscopy was assessed.

Results

Of 1256 individuals with GIM, 352 (28%) had extensive GIM and 904 (72%) had limited GIM. On multivariable analysis, older age (OR 1.01, 95% CI 1.00–1.02) and Hispanic ethnicity (OR 1.55, 95% CI 1.11–2.16) were predictive of extensive GIM. The annual incidence of GC for GIM overall was 0.09%. There was no difference in progression to GC between extensive or limited GIM (IRR 0, 95% CI 0–2.6), or to advanced lesions overall (IRR 0.37, 95% CI 0.04–1.62). 70% of individuals had persistent GIM on follow-up biopsy, and 22% with limited GIM had extensive GIM on follow-up biopsy.

Conclusions

28% of individuals with GIM have the extensive subtype, and are more likely to be older and of Hispanic ethnicity. There was no difference in progression to GC between extensive and limited GIM. Further research is needed to better assess risk of GIM in the US context.

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Abbreviations

US:

United States

GIM:

Gastric intestinal metaplasia

GC:

Gastric cancer

LGD:

Low grade dysplasia

HGD:

High grade dysplasia

AGA:

American Gastroenterological Association

MAPS:

Management of Epithelial Precancerous Conditions in the Stomach

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Funding

ML—NIH K08 DK125876-01A1 and MSKCC Department of Subspecialty Medicine Award. ASF—NIH T32DK083256.

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Authors and Affiliations

  1. Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Monika Laszkowska, Adam S. Faye, Judith Kim, Julian A. Abrams & Chin Hur

  2. Department of Subspecialty Medicine, Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA

    Monika Laszkowska

  3. Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA

    Han Truong, Sarah **nhui Tan, Francesca Lim & Chin Hur

  4. Division of Gastroenterology, New York University Langone Health, New York, NY, USA

    Adam S. Faye

  5. Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA

    Julian A. Abrams & Chin Hur

Authors
  1. Monika Laszkowska
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  2. Han Truong
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  3. Adam S. Faye
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  4. Judith Kim
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  5. Sarah **nhui Tan
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  6. Francesca Lim
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  7. Julian A. Abrams
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  8. Chin Hur
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Contributions

Study concept and design: ML, HT, JK, JAA, CH. Acquisition of data: ML, HT, ST, FL. Analysis and interpretation of data: ML, HT, ASF, JK, JAA, CH. Drafting of the manuscript: ML. Critical revision of the manuscript for important intellectual content: ML, HT, ASF, JK, ST, FL, JAA, CH.

Corresponding author

Correspondence to Monika Laszkowska.

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The authors declare that they have no conflict of interest.

Ethical statement

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Columbia University Irving Medical Center approved this study.

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Laszkowska, M., Truong, H., Faye, A.S. et al. Prevalence of Extensive and Limited Gastric Intestinal Metaplasia and Progression to Dysplasia and Gastric Cancer. Dig Dis Sci 67, 3693–3701 (2022). https://doi.org/10.1007/s10620-021-07276-9

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  • DOI: https://doi.org/10.1007/s10620-021-07276-9

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