Prevalence of Gastric Intestinal Metaplasia in a Multi-Ethnic United States Veterans Population

Abstract Background There is a need to identify individuals with gastric intestinal metaplasia, a precursor to gastric cancer, so they can be offered screening and surveillance. We examined the prevalence of gastric intestinal metaplasia, detected by upper endoscopy biopsy analysis, in different race and ethnic sub-groups. We also investigated the extent to which Helicobacter pylori infection, with or without acute and chronic gastritis, accounts for observed associations between race or ethnicity and risk of gastric intestinal metaplasia. Methods We used data from a cross-sectional study of consecutively recruited patients at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas from February 2008 to August 2013. All participants completed a study questionnaire on sociodemographic and clinical characteristics and underwent upper endoscopy with gastric mapping (7 biopsy sites). Cases were classified as having gastric intestinal metaplasia if intestinal metaplasia was detected in 1 or more non-cardia gastric biopsy; non-cases were participants without evidence of gastric intestinal metaplasia. We used logistic regression models to estimate odds ratios (OR) and 95% CI values to examine the association between race or ethnicity and gastric intestinal metaplasia and performed a mediation analysis to determine whether H pylori and gastritis affected observed associations. Results We included 415 cases with gastric intestinal metaplasia and 1764 non-cases. The prevalence of gastric intestinal metaplasia was highest among Hispanic patients (29.5%; 95% CI, 23.7%–36.1%), followed by African-American (25.5%; 22.4%–28.9%) and non-Hispanic white patients (13.7%; 11.9%–15.7%). After we adjusted for age, sex, and smoking, African-American (OR, 1.87; 1.44–2.44) and Hispanic race or ethnicity (OR, 2.32; 1.61–3.34) and H pylori infection (OR, 3.65; 2.79–4.55) were associated with increased risk of gastric intestinal metaplasia. H pylori infection alone accounted for 33.6% of the association of race or ethnicity with gastric intestinal metaplasia, and 55.5% of the association when combined with acute and chronic gastritis. Conclusions Hispanic and African-American patients have an increased risk for gastric intestinal metaplasia, determined by upper endoscopy biopsy analysis, compared with non-Hispanic white patients. This increase in risk was partially independent of H pylori infection.