The Presence of Gastric Intestinal Metaplasia in Patients Undergoing EGD with Biopsy is Associated with a Family History of Gastric Cancer in the United States

Abstract

AIM: Gastric intestinal metaplasia (IM) is a pre-malignant lesion that can develop into adenocarcinoma through a sequential cascade involving non-atrophic gastritis, atrophic gastritis, IM, gastric dysplasia, and ultimately carcinoma. To estimate the prevalence of gastric IM in patients undergoing EGD with biopsy at an academic medical center; To determine what clinical factors might be associated with gastric IM. METHODS: Three hundred consecutive patients presenting for EGD with biopsy at a tertiary-care medical center were enrolled in a retrospective single-center cohort study. RESULTS: Gastric biopsies found H. pylori infection in 2% (n=6), chronic gastritis in 20% (n=61), and gastric IM in 5% (n=15)of patients. A first-degree family history of gastric cancer was a risk factor for having gastric IM (OR 8.51, 95% CI: 1.52-40.22, P=0.018) on age-adjusted multivariate analysis. Uninsured patients (OR 5.1, 95% CI: 2.4-11.2, P<0.001) and those with Medicaid (OR 3.6, 95% CI: 1.3-9.7, P=0.014) were more likely to have chronic gastritis as compared to those with private insurance on age-adjusted multivariate analysis. CONCLUSION: A family history of gastric cancer significantly increased the odds of having gastric IM. Uninsured patients and those with Medicaid were at increased risk of having chronic gastritis and trended towards having IM on gastric biopsies. As guidelines regarding the screening and surveillance of premalignant gastric lesions emerge, attention should be paid to patients with a family history of gastric cancer, and possibly those with lower socioeconomic status who might be at increased risk for gastric IM.