Yoon Ji Yoon, Katcher Erik, Cohen Ella, Ward Stephen C, Rouphael Carol, Itzkowitz Steven H, Wang Christina P, Kim Michelle K, Shah Shailja C
Departments of Gastroenterology.
Sackler School of Medicine at Tel Aviv University, Tel Aviv, Israel.
J Clin Gastroenterol. 2024 Jul 17. doi: 10.1097/MCG.0000000000002039.
Gastric intestinal metaplasia (GIM) is a precancerous condition. Limited data exist on real-world clinical practice relative to guidelines.
The aim of this study was to evaluate adherence to GIM risk stratification and identify factors associated with follow-up endoscopy.
We conducted manual chart review of patients with histologically confirmed GIM at an urban, tertiary medical center were identified retrospectively and details of their demographics, Helicobacter pylori, biopsy protocol, endoscopic/histologic findings, and postendoscopy follow-up were recorded. Multivariable logistic regression was used to identify factors independently associated with follow-up endoscopy.
Among 253 patients, 59% were female, 37% non-Hispanic White (NHW), 26% Hispanic, 16% non-Hispanic Black (NHB). The median age at index endoscopy was 63.4 years (IQR: 55.9 to 70.0), with median follow-up of 65.1 months (IQR: 44.0 to 72.3). H. pylori was detected in 21.6% patients at index EGD. GIM extent and subtype data were frequently missing (22.9% and 32.8%, respectively). Based on available data, 26% had corpus-extended GIM and 28% had incomplete/mixed-type GIM. Compared with NHW, Hispanic patients had higher odds of follow-up EGD (OR=2.48, 95% CI: 1.23-5.01), while NHB patients had 59% lower odds of follow-up EGD (OR=0.41, 95% CI: 0.18-0.96). Corpus-extended GIM versus limited GIM (OR=2.27, 95% CI: 1.13-4.59) was associated with follow-up EGD, but GIM subtype and family history of gastric cancer were not.
We observed suboptimal risk stratification among patients with GIM and notable race and ethnic disparities with respect to endoscopic surveillance. Targeted interventions are needed to improve practice patterns and mitigate observed disparities.
胃黏膜肠化生（GIM）是一种癌前状态。关于实际临床实践与指南相关的数据有限。
本研究的目的是评估对GIM风险分层的依从性，并确定与随访内镜检查相关的因素。
我们对一家城市三级医疗中心经组织学确诊为GIM的患者进行了人工病历审查，回顾性确定患者，并记录其人口统计学、幽门螺杆菌、活检方案、内镜/组织学检查结果以及内镜检查后随访的详细信息。采用多变量逻辑回归分析确定与随访内镜检查独立相关的因素。
253例患者中，59%为女性，37%为非西班牙裔白人（NHW），26%为西班牙裔，16%为非西班牙裔黑人（NHB）。首次内镜检查时的中位年龄为63.4岁（四分位间距：55.9至70.0岁），中位随访时间为65.1个月（四分位间距：44.0至72.3个月）。首次胃镜检查时，21.6%的患者检测到幽门螺杆菌。GIM范围和亚型数据经常缺失（分别为22.9%和32.8%）。根据现有数据，26%的患者有胃体扩展型GIM，28%的患者有不完全/混合型GIM。与NHW相比，西班牙裔患者进行随访胃镜检查的几率更高（比值比=2.48，95%置信区间：1.23 - 5.01），而NHB患者进行随访胃镜检查的几率低59%（比值比=0.41，95%置信区间：0.18 - 0.96）。胃体扩展型GIM与局限性GIM相比（比值比=2.27，95%置信区间：1.13 - 4.59）与随访胃镜检查相关，但GIM亚型和胃癌家族史则不然。
我们观察到GIM患者的风险分层欠佳，且在内镜监测方面存在显著的种族和族裔差异。需要有针对性的干预措施来改善实践模式并减轻观察到的差异。
