Parbhu Sheeva K, Shah Shailja C, Sossenheimer Michael J, Fang John C, Peterson Kathryn A, Gawron Andrew J
Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA.
Division of Gastroenterology, University of California San Diego, San Diego, CA, USA Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
Therap Adv Gastroenterol. 2022 Sep 3;15:17562848221117640. doi: 10.1177/17562848221117640. eCollection 2022.
Gastric intestinal metaplasia (GIM) is a premalignant gastric mucosal change that is often incidentally detected during esophagogastroduodenoscopy (EGD). Despite the established higher risk of gastric cancer associated with GIM, the incidence, prevalence, and outcomes data for GIM are limited in the United States (US), and practice patterns are highly variable.
Our primary objectives were to accurately identify incident histology-confirmed GIM cases and determine patient characteristics, endoscopy findings, (HP) detection, and eradication treatment outcomes, as well as surveillance and follow-up recommendations.
We conducted a retrospective cohort study using administrative data.
We first developed and validated a rule-based natural language processing tool to identify the patients with GIM on gastrointestinal pathology reports between 2011 and 2016. We then performed a manual chart review of all EGD procedures and associated pathology notes to confirm cases and obtain clinically relevant data.
In all, 414 patients with an index diagnosis of GIM were confirmed (prevalence = 2.5% of patients undergoing any EGD). A majority (52.4%) of patients were non-Hispanic white. The most common indication for EGD was abdominal pain (46.9%). A majority (55%) did not receive specific follow-up recommendations or were asked to see their primary care provider. HP testing was documented in 86% of patients, and detected in 94 patients (prevalence = 26.4%). Treatment was documented in 94.7% of cases, and eradication confirmed in only 34.8% of these cases.
A large group of US patients with an index diagnosis of GIM was accurately identified. There was wide variability in clinical practice patterns including biopsy practice, HP treatment and eradication confirmation testing, and surveillance recommendations. This work demonstrates that there is a major unmet need for quality improvement efforts to standardize care for patients with GIM, a premalignant condition, and inform future prospective studies in a US population.
胃黏膜肠化生（GIM）是一种胃癌前胃黏膜改变，常在食管胃十二指肠镜检查（EGD）时偶然发现。尽管已确定GIM与胃癌风险较高相关，但在美国，GIM的发病率、患病率和转归数据有限，且实践模式差异很大。
我们的主要目标是准确识别经组织学证实的新发GIM病例，并确定患者特征、内镜检查结果、幽门螺杆菌（HP）检测及根除治疗效果，以及监测和随访建议。
我们使用管理数据进行了一项回顾性队列研究。
我们首先开发并验证了一种基于规则的自然语言处理工具，以识别2011年至2016年间胃肠道病理报告中患有GIM的患者。然后，我们对所有EGD程序及相关病理记录进行了人工图表审查，以确认病例并获取临床相关数据。
总共确认了414例初诊为GIM的患者（患病率=接受任何EGD检查患者的2.5%）。大多数（52.4%）患者为非西班牙裔白人。EGD最常见的指征是腹痛（46.9%）。大多数（55%）患者未收到具体的随访建议，或被要求去看他们的初级保健医生。86%的患者记录了HP检测，其中94例检测到HP（患病率=26.4%）。94.7%的病例记录了治疗情况，但其中只有34.8%的病例确认根除。
准确识别出一大组初诊为GIM的美国患者。临床实践模式差异很大，包括活检操作、HP治疗及根除确认检测，以及监测建议。这项工作表明，对于改善GIM（一种癌前疾病）患者的护理质量，存在重大未满足需求，这可为美国人群未来的前瞻性研究提供信息。
