Akpoigbe Kesiena, Culpepper-Morgan Joan, Nwankwo Obinna, Genao Alvaro
Division of Gastroenterology, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA.
Division of Internal Medicine, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, USA.
Cureus. 2022 Nov 14;14(11):e31502. doi: 10.7759/cureus.31502. eCollection 2022 Nov.
Gastric intestinal metaplasia (GIM) is a precancerous lesion. It has a low prevalence rate in the United States. However, GIM is more common among non-White and immigrant populations. Harlem Hospital serves a community that includes predominantly African Americans, Hispanics, and immigrants from West Africa and Spanish-speaking Caribbean countries. This study aims to define the factors predicting GIM in this high-risk group as well as help define screening strategies for vulnerable populations.
A total of 1351 patients who underwent endoscopic gastroduodenoscopy (EGD) and biopsy in 2018 and 2019 for any indication at Harlem Hospital were included in this study. Gastric biopsy specimens taken during the procedure were assessed for GIM by histopathology. Baseline demographics were collected, including age, sex, and ethnicity. Other information collected included risk factors for GIM such as infection, smoking status, and the use of alcohol. Descriptive analysis was done and the Wilcoxon rank sum test and chi-squared test were used to test for associations. Multiple logistic regressions were used to assess the odds of independent factors associated with increased risk of GIM.
Of the 1351 patients reviewed, 106 had GIM for a prevalence of 8.0% (CI: 6.7%-9.6%, p < 0.001). Univariate analysis revealed older patients, males, history of smoking, alcohol, and infection were significantly associated with GIM. Using multiple logistic regressions and adjusting for underlying risk factors, smoking (OR: 1.61, 95% CI: 1.00-2.570) and infection (OR: 3.35, 95% CI: 2.18-5.15) continued to be significantly associated with increased risk of GIM; however, alcohol use was not significant after adjusting for other risk factors (OR: 1.10, 95% CI: 0.68-1.78). Hispanic risk for GIM was slightly higher than African Americans (OR: 1.17, 95% CI: 0.74-1.83). The predicted marginal effect of age on the odds of GIM was significant from age 40 and increased exponentially at age 50. By age 70, the odds of GIM were as high as 11% (95% CI: 8.3-13.6).
The prevalence of GIM in our population is significantly higher compared to reported cases in the United States. Age, male gender, infection, and smoking significantly increase the risk of GIM. Given the high prevalence of GIM in our population, early endoscopic screening would play an important role in evaluating dyspepsia to diagnose GIM with or without infection. We propose screening all at-risk ethnicities from age 40 years with EGD according to the Sydney System biopsy protocol. We believe this will ultimately decrease the incidence of gastric cancer death in these vulnerable populations of color.
胃黏膜肠化生（GIM）是一种癌前病变。在美国，其患病率较低。然而，GIM在非白人和移民人群中更为常见。哈莱姆医院服务的社区主要包括非裔美国人、西班牙裔以及来自西非和讲西班牙语的加勒比国家的移民。本研究旨在确定该高危人群中预测GIM的因素，并帮助确定针对易感人群的筛查策略。
本研究纳入了2018年和2019年在哈莱姆医院因任何指征接受内镜下胃十二指肠镜检查（EGD）和活检的1351例患者。对手术过程中采集的胃活检标本进行组织病理学评估以确定是否存在GIM。收集了基线人口统计学数据，包括年龄、性别和种族。收集的其他信息包括GIM的危险因素，如感染、吸烟状况和饮酒情况。进行了描述性分析，并使用Wilcoxon秩和检验和卡方检验来检验相关性。使用多因素逻辑回归来评估与GIM风险增加相关的独立因素的比值比。
在审查的1351例患者中，106例患有GIM，患病率为8.0%（置信区间：6.7%-9.6%，p<0.001）。单因素分析显示，老年患者、男性、吸烟史、饮酒和感染与GIM显著相关。使用多因素逻辑回归并调整潜在危险因素后，吸烟（比值比：1.61，95%置信区间：1.00-2.570）和感染（比值比：3.35，95%置信区间：2.18-5.15）继续与GIM风险增加显著相关；然而，在调整其他危险因素后，饮酒情况不显著（比值比：1.10，95%置信区间：0.68-1.78）。西班牙裔患GIM的风险略高于非裔美国人（比值比：1.17，95%置信区间：0.74-1.83）。年龄对GIM比值比的预测边际效应从40岁开始显著，并在50岁时呈指数增长。到70岁时，GIM的比值比高达11%（95%置信区间：8.3-13.6）。
与美国报告的病例相比，我们人群中GIM的患病率显著更高。年龄、男性、感染和吸烟显著增加GIM的风险。鉴于我们人群中GIM的高患病率，早期内镜筛查在评估消化不良以诊断有无感染的GIM方面将发挥重要作用。我们建议根据悉尼系统活检方案，对所有40岁及以上的高危种族进行EGD筛查。我们相信这最终将降低这些有色易感人群中胃癌死亡的发生率。
