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Increased Risk of Progression to Gastric Adenocarcinoma in Patients with Non-dysplastic Gastric Intestinal Metaplasia Versus a Control Population

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Abstract

Aim

In previous studies, the 5-year progression rate of gastric intestinal metaplasia to gastric adenocarcinoma has varied substantially. We investigated the incidence rate of dysplasia and gastric adenocarcinoma and the rate of progression among a cohort of patients with non-dysplastic gastric intestinal metaplasia.

Methods

This is a single-center, single-cohort retrospective study. Patients who had undergone an EGD with biopsies from 01/01/1993 to 12/31/2013 were included. The primary outcome of interest was the composite of low-grade dysplasia, high-grade dysplasia, or adenocarcinoma. Time to progression and risk factor subgroup analyses were performed.

Results

A total of 1628 subjects were screened, of whom 358 met the inclusion criteria. A total of 21 first-time events were recorded. The annual incidence rate of low-grade dysplasia was 2.1 (95% CI 1.3–3.5) cases per 1000 person-years, 0.5 (95% 0.2–1.3) per 1000 person-years for high-grade dysplasia, and 0.8 (95% CI 0.3–1.6) cases per 1000 person-years for gastric adenocarcinoma. The historical control group had an annual adenocarcinoma incidence rate of 0.07 per 1000 person-years. The event rate in Asians was also noted to be significantly higher between years 0–8 as compared with patients of non-Asian race, and extensive intestinal metaplasia was an independent risk factor (HR = 4.06 (95% CI 1.45–11.34), p = 0.007).

Conclusions

Patients with non-dysplastic gastric intestinal metaplasia may progress to dysplasia and gastric adenocarcinoma. The incidence rate of gastric adenocarcinoma is higher than that of the historical control population (0.07 per 1000 person-years). The presence of extensive intestinal metaplasia was a risk factor for progression of disease. Triennial EGD may be warranted in patients with non-dysplastic gastric intestinal metaplasia.

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Funding

Statistical analysis supported by unrestricted Grant from Allergan Pharmaceuticals.

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Authors and Affiliations

  1. Department of Internal Medicine, Tufts Medical Center, Boston, MA, USA

    Rohit Dhingra & Yazan Daaboul

  2. Division of Gastroenterology/Hepatology, Tufts Medical Center, Boston, MA, USA

    Nikola S. Natov, Moises Guelrud & Mark J. Sterling

  3. Tufts University School of Medicine, Boston, MA, USA

    Abraham Cherukara & Pu Fang Hung

Authors
  1. Rohit Dhingra
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  2. Nikola S. Natov
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  3. Yazan Daaboul
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  4. Moises Guelrud
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  5. Abraham Cherukara
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  6. Pu Fang Hung
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  7. Mark J. Sterling
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Contributions

RD and NSN were involved in conception and design, acquisition of data, drafting of the manuscript, and critical revision of the article for important intellectual content. YD performed statistical analysis and drafting of the manuscript. MG contributed to conception and design. AC and PFH performed acquisition of data. MJS obtained funding and helped in conception and design, administrative support, and study supervision.

Corresponding author

Correspondence to Nikola S. Natov.

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All authors declare no conflicts of interest related to this article.

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This study was reviewed and approved by the Tufts Health Sciences Campus Institutional Review Board.

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Dhingra, R., Natov, N.S., Daaboul, Y. et al. Increased Risk of Progression to Gastric Adenocarcinoma in Patients with Non-dysplastic Gastric Intestinal Metaplasia Versus a Control Population. Dig Dis Sci 65, 3316–3323 (2020). https://doi.org/10.1007/s10620-019-06031-5

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  • DOI: https://doi.org/10.1007/s10620-019-06031-5

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