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Risk of Progression of Gastric Intestinal Metaplasia Is Significantly Greater When Detected in Both Antrum and Body

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Abstract

Background

Gastric cancer (GC) is the fifth leading cause of cancer-related death worldwide. GC is usually preceded by a cascade of well-defined precursor lesions, set in place by an environmental trigger (H. pylori) including intestinal metaplasia (GIM) and dysplasia.

Aims

To investigate the rates of progression of GIM to dysplasia and GC in a region of low gastric cancer incidence.

Methods

We identified all patients diagnosed with GIM between January 1, 2008, and June 30, 2012. Any repeat upper endoscopy more than 1 year after index diagnosis and before December 31, 2018, was considered follow-up. Carcinomas the bulk of which were macroscopically located below the OGJ were considered primary gastric cancer.

Results

Progression to more advanced lesions was observed in six patients (0.6%). Four patients (three male) developed GC at median age 74 years (SD 6). Two patients progressed to dysplasia (one male) at median age 71 years (SD 4). Patients with GIM in both gastric antrum and body were significantly more likely to progress than those with GIM in only one location (3.1% vs. 0.4%) (p value 0.017). Fifty-eight patients who had H. pylori eradicated were followed up. No progression to dysplasia or GC was noted in this group, with 28 patients having persistent GIM at follow-up.

Conclusion

Patients with GIM in both antrum and body had a significantly increased risk of progression and warrant close attention. This is comparable to routinely followed premalignant conditions such as Barrett’s esophagus and Colonic Polyps, and appropriate surveillance protocols should be followed in this group.

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Authors and Affiliations

  1. Gastroenterology Department, Trinity College Dublin, Tallaght University Hospital, Belgard Avenue, Tallaght, Dublin, D24 NR0A, Ireland

    Anthony O’Connor, Adam Bowden, Eoin Farrell, Joshua Weininger, Deirdre McNamara & Colm O’Morain

  2. Histopathology Department, Trinity College Dublin, Tallaght University Hospital, Dublin, Ireland

    Stephen Crowther

  3. Upper Gastrointestinal Surgery Department, Trinity College Dublin, Tallaght University Hospital, Dublin, Ireland

    Paul Ridgway

Authors
  1. Anthony O’Connor
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  2. Adam Bowden
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  3. Eoin Farrell
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  4. Joshua Weininger
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  5. Stephen Crowther
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  6. Deirdre McNamara
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  7. Paul Ridgway
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  8. Colm O’Morain
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Contributions

AOC, AB, EF, JW, SC, DMcN, PR and COM conceived and drafted the study. AB, EF, JW and SC collected all data. AOC, DMcN and COM analyzed and interpreted the data. AOC drafted the manuscript. AOC, SC, DMcN, PR and COM commented on drafts of the paper. All authors have approved the final draft of the manuscript.

Corresponding author

Correspondence to Anthony O’Connor.

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Conflict of interest

Anthony O’Connor: none to declare. Adam Bowden: none to declare. Eoin Farrell: none to declare. Joshua Weininger: none to declare. Deirdre McNamara: none to declare. Colm O’Morain: none to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As this is a retrospective study formal consent is not required.

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O’Connor, A., Bowden, A., Farrell, E. et al. Risk of Progression of Gastric Intestinal Metaplasia Is Significantly Greater When Detected in Both Antrum and Body. Dig Dis Sci 66, 3470–3475 (2021). https://doi.org/10.1007/s10620-020-06659-8

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  • DOI: https://doi.org/10.1007/s10620-020-06659-8

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