Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Gastric intestinal metaplasia development in African American predominant United States population
Akram I Ahmad, Arielle Lee, Claire Caplan, Colin Wikholm, Ioannis Pothoulakis, Zaynab Almothafer, Nishtha Raval, Samantha Marshall, Ankit Mishra, Nicole Hodgins, In Guk Kang, Raymond K Chang, Zachary Dailey, Arvin Daneshmand, Anjani Kapadia, Jae Hak Oh, Brittney Rodriguez, Abhinav Sehgal, Matthew Sweeney, Christopher B Swisher, Daniel F Childers, Corinne O'Connor, Lynette M Sequeira, Won Cho
Akram I Ahmad, Ioannis Pothoulakis, Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20010, United States
Arielle Lee, Claire Caplan, Colin Wikholm, Zaynab Almothafer, Nishtha Raval, Samantha Marshall, Ankit Mishra, Nicole Hodgins, In Guk Kang, Raymond K Chang, Zachary Dailey, Arvin Daneshmand, Anjani Kapadia, Jae Hak Oh, Brittney Rodriguez, Abhinav Sehgal, Matthew Sweeney, Christopher B Swisher, Daniel F Childers, Corinne O'Connor, Lynette M Sequeira, Won Cho, Department of Internal Medicine, Georgetown University School of Medicine, Washington, DC 20007, United States
Won Cho, Department of Gastroenterology and Hepatology, INOVA Medical System, Leesburg, VA 20176, United States
Author contributions: Ahmad AI and Cho W contributed to the study designing and wrote the manuscript; Ahmad AI, Cho W, Lee A and Pothoulakis I contributed to the manuscript edit; Lee A, Caplan C, Wikholm C performed the project coordinator; Lee A, Caplan C, Almothafer Z, Raval N, Marshall S, Hodgins N, Kang IG, Chang RK, Dailey Z, Daneshmand A, Kapadia A, Oh JH, Rodriguez B, Sehgal A, Sweeney M, Swisher CB, Childers DF, Mishra A, O'Connor C and Sequeira LM contributed to the data collection.
Institutional review board statement: The study was reviewed and approved by the Medstar Health Research Institute and Georgetown University Hospital Institutional Review Board.
Informed consent statement: The study was exempt from informed consent based on the MedStar Health Research Institute IRB committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Akram.i.ahmad@medstar.net.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Akram I Ahmad, MBBS, Doctor, Department of Internal Medicine, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, United States. akram.i.ahmad@medstar.net
Received: July 17, 2022
Peer-review started: July 17, 2022
First decision: August 19, 2022
Revised: September 1, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: October 16, 2022
BACKGROUND
Gastric cancer significantly contributes to cancer mortality globally. Gastric intestinal metaplasia (GIM) is a stage in the Correa cascade and a premalignant lesion of gastric cancer. The natural history of GIM formation and progression over time is not fully understood. Currently, there are no clear guidelines on GIM surveillance or management in the United States.
AIM
To investigate factors associated with GIM development over time in African American-predominant study population.
METHODS
This is a retrospective longitudinal study in a single tertiary hospital in Washington DC. We retrieved upper esophagogastroduodenoscopies (EGDs) with gastric biopsies from the pathology department database from January 2015 to December 2020. Patients included in the study had undergone two or more EGDs with gastric biopsy. Patients with no GIM at baseline were followed up until they developed GIM or until the last available EGD. Exclusion criteria consisted of patients age < 18, pregnancy, previous diagnosis of gastric cancer, and missing data including pathology results or endoscopy reports. The study population was divided into two groups based on GIM status. Univariate and multivariate Cox regression was used to estimate the hazard induced by patient demographics, EGD findings, and Helicobacter pylori (H. pylori) status on the GIM status.
RESULTS
Of 2375 patients who had at least 1 EGD with gastric biopsy, 579 patients were included in the study. 138 patients developed GIM during the study follow-up period of 1087 d on average, compared to 857 d in patients without GIM (P = 0.247). The average age of GIM group was 64 years compared to 56 years in the non-GIM group (P < 0.001). In the GIM group, adding one year to the age increases the risk for GIM formation by 4% (P < 0.001). Over time, African Americans, Hispanic, and other ethnicities/races had an increased risk of GIM compared to Caucasians with a hazard ratio (HR) of 2.12 (1.16, 3.87), 2.79 (1.09, 7.13), and 3.19 (1.5, 6.76) respectively. No gender difference was observed between the study populations. Gastritis was associated with an increased risk for GIM development with an HR of 1.62 (1.07, 2.44). On the other hand, H. pylori infection did not increase the risk for GIM.
CONCLUSION
An increase in age and non-Caucasian race/ethnicity are associated with an increased risk of GIM formation. The effect of H. pylori on GIM is limited in low prevalence areas.
Core Tip: Gastric intestinal metaplasia (GIM) is a precancerous lesion, and previous literature showed a higher rate in the United States minorities. Our study highlighted the natural history of GIM over time. It was observed in the study that irrespective of being minorities, Non-Caucasian races/ethnicities have a higher risk for GIM. Gastritis and older age contribute to GIM formation. The effect of Helicobacter pylori infection was not significant in our population.
