Gastric intestinal metaplasia development in African American predominant United States population

doi:10.4253/wjge.v14.i10.597

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Oct 16, 2022 (publication date) through Apr 25, 2024

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World Journal of Gastrointestinal Endoscopy

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1948-5190

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Endosc. Oct 16, 2022; 14(10): 597-607
Published online Oct 16, 2022. doi: 10.4253/wjge.v14.i10.597

Table 1 Data summary and comparison between patients with and without gastric intestinal metaplasia

Level		Baseline no GIM
Level		Overall	No GIM	GIM	P value
		579	441	138
Follow-up days [median (IQR)]		885.0 (257.5, 1901.5)	857.0 (259.0, 1834.0)	1087.0 (260.5, 2307.3)	0.247
Age baseline [median (IQR)]		58.0 (49.0, 67.8)	56.0 (46.8, 65.0)	64.00 (54.0, 72.0)	< 0.001
Sex (%)	Male	227 (39.3)	166 (37.7)	61 (44.2)	0.208
Sex (%)	Female	351 (60.7)	274 (62.3)	77 (55.8)
Ethnicity/Race (%)	Caucasian	85 (15.9)	73 (18.1)	12 ( 9.3)	0.032
	AA	381 (71.5)	287 (71.0)	94 (72.9)
	Hispanic	18 ( 3.4)	11 ( 2.7)	7 ( 5.4)
	Other	49 ( 9.2)	33 ( 8.2)	16 (12.4)
Obesity (%)	BMI < 30	261 (56.7)	191 (53.5)	70 (68.0)	0.013
Obesity (%)	BMI > 30	199 (43.3)	166 (46.5)	33 (32.0)
Smoking status (%)	Never	269 (54.8)	207 (55.3)	62 (53.0)	0.198
	Previous	119 (24.2)	84 (22.5)	35 (29.9)
	Current	103 (21.0)	83 (22.2)	20 (17.1)
Biopsy site (%)	≤ 2	227 (39.2)	190 (43.1)	37 (26.8)	0.001
Biopsy site (%)	> 3	352 (60.8)	251 (56.9)	101 (73.2)
H. pylori at Baseline (%)	No	499 (86.2)	382 (86.6)	117 (84.8)	0.686
H. pylori at Baseline (%)	Yes	80 (13.8)	59 (13.4)	21 (15.2)
H. pylori at follow-up (%)	No	536 (92.6)	413 (93.7)	123 (89.1)	0.114
H. pylori at follow-up (%)	Yes	43 ( 7.4)	28 ( 6.3)	15 (10.9)
n		80	59	21
H. pylori at follow up with positive Baseline (%)	No	65 (81.2)	48 (81.4)	17 (81.0)	1
H. pylori at follow up with positive Baseline (%)	Yes	15 (18.8)	11 (18.6)	4 (19.0)
Gastritis (%)	No	209 (36.1)	180 (40.8)	29 (21.0)	< 0.001
Gastritis (%)	Yes	370 (63.9)	261 (59.2)	109 (79.0)
Ulcer (%)	No	534 (92.2)	408 (92.5)	126 (91.3)	0.778
Ulcer (%)	Yes	45 ( 7.8)	33 ( 7.5)	12 ( 8.7)
81 mg Aspirin Use at Baseline (%)	No	450 (77.7)	347 (78.7)	103 (74.6)	0.379
81 mg Aspirin Use at Baseline (%)	Yes	129 (22.3)	94 (21.3)	35 (25.4)
81 mg Aspirin use at follow up (%)	No	453 (78.2)	359 (81.4)	94 (68.1)	0.001
81 mg Aspirin use at follow up (%)	Yes	126 (21.8)	82 (18.6)	44 (31.9)
PPI usage at baseline (%)	No	392 (67.7)	285 (64.6)	107 (77.5)	0.006
PPI usage at baseline (%)	Yes	187 (32.3)	156 (35.4)	31 (22.5)
PPI usage at follow up (%)	No	318 (54.9)	233 (52.8)	85 (61.6)	0.088
PPI usage at follow up (%)	Yes	261 (45.1)	208 (47.2)	53 (38.4)
Blood type (%)	A	72 (31.2)	47 (28.7)	25 (37.3)	0.317
	B	42 (18.2)	28 (17.1)	14 (20.9)
	O	109 (47.2)	82 (50.0)	27 (40.3)
	AB	8 ( 3.5)	7 ( 4.3)	1 ( 1.5)
Hemoglobin [median (IQR)]		11.2 (9.2, 12.8)	11.5 (9.5, 13.0)	10.5 (9.0, 12.2)	0.075
Hemoglobin Baseline [median (IQR)]		10.8 (9.2, 12.8)	11.8 (9.7, 13.1)	9.60 (8.40, 11.00)	< 0.001

GIM: Gastric intestinal metaplasia; IQR: Interquartile range; AA: African Americans; BMI: Body mass index; PPI: Proton pump inhibitors.

Table 2 Univariate Cox proportional hazards regression model results for gastric intestinal metaplasia formation over time

Predictor	GIM
Predictor	HR (95%CI)	P value
Age	1.04 (1.02, 1.05)	< 0.001
Age (ref: ≤ 45)
46-55	2.13 (1.08, 4.19)	0.028
56-65	2.09 (1.08, 4.03)	0.029
> 65	4.03 (2.17, 7.48)	< 0.001
Female	0.81 (0.58, 1.14)	0.229
Race/Ethnicity (ref: Caucasians)
African American	2.12 (1.16, 3.87)	0.015
Hispanic	2.79 (1.09, 7.13)	0.032
Other	3.19 (1.50, 6.76)	0.003
Obesity (BMI > 30)	0.58 (0.38, 0.88)	0.010
Gastritis	1.62 (1.07, 2.44)	0.022
*H. pylori* (ref: Baseline: Neg, follow-up: Neg)
Baseline: Neg, follow-up: Pos	0.88 (0.45, 1.7)	0.695
Baseline: Pos, follow-up: Neg	1.16 (0.7, 1.94)	0.563
Baseline: Pos, follow-up: Pos	1.02 (0.37, 2.8)	0.966
PPI Usage at follow-up	0.81 (0.57, 1.14)	0.225
PPI Usage Baseline	0.80 (0.54, 1.20)	0.280
Aspirin Use at follow-up (81 mg)	1.49 (1.04, 2.14)	0.031
Aspirin Use Baseline (81 mg)	1.45 (0.98, 2.13)	0.063
Smoking status (ref: Never)
Previous smoker	1.35 (0.89, 2.04)	0.161
Current smoker	1.01 (0.61, 1.68)	0.972
Blood group (ref: Group A)
Blood group B	1.07 (0.56, 2.07)	0.835
Blood group O	0.66 (0.38, 1.14)	0.135
Blood group AB	0.24 (0.03, 1.77)	0.161
Haemoglobin level at follow-up	1.00 (0.92, 1.09)	0.962
Haemoglobin level at baseline	0.83 (0.74, 0.93)	0.001

GIM: Gastric intestinal metaplasia; HR: Hazard ratio; BMI: Body mass index; PPI: Proton pump inhibitors; Neg: Negative; Pos: Positive.

Table 3 Multivariate Cox proportional hazards regression model results for gastric intestinal metaplasia formation over time

	HR (95%CI)	P value
Age at baseline (ref: ≤ 45)
46-55	1.75 (0.67, 4.58)	0.255
56-65	1.44 (0.56, 3.68)	0.445
> 65	3.01 (1.25, 7.26)	0.014
Female	0.8 (0.48, 1.33)	0.384
Race/Ethnicity (ref: Caucasians)
African American	3.4 (1.16, 9.95)	0.026
Hispanic	1.64 (0.28, 9.47)	0.582
Other	7.46 (2.26, 24.67)	0.001
Obesity (BMI > 30)	0.71 (0.42, 1.2)	0.201
Gastritis	1.65 (0.97, 2.81)	0.065
*H. pylori* (ref: Baseline: Neg, follow-up: Neg)
Baseline: Neg, follow-up: Pos	1.26 (0.53, 2.98)	0.602
Baseline: Pos, follow-up: Neg	0.6 (0.26, 1.37)	0.223
Baseline: Pos, follow-up: Pos	1.13 (0.34, 3.76)	0.847
Smoking (ref: Never)
Previous	0.96 (0.56, 1.65)	0.876
Current	0.74 (0.38, 1.47)	0.398

HR: Hazard ratio; BMI: Body mass index; Neg: Negative; Pos: Positive.

Citation: Ahmad AI, Lee A, Caplan C, Wikholm C, Pothoulakis I, Almothafer Z, Raval N, Marshall S, Mishra A, Hodgins N, Kang IG, Chang RK, Dailey Z, Daneshmand A, Kapadia A, Oh JH, Rodriguez B, Sehgal A, Sweeney M, Swisher CB, Childers DF, O'Connor C, Sequeira LM, Cho W. Gastric intestinal metaplasia development in African American predominant United States population. World J Gastrointest Endosc 2022; 14(10): 597-607
URL: https://www.wjgnet.com/1948-5190/full/v14/i10/597.htm
DOI: https://dx.doi.org/10.4253/wjge.v14.i10.597