Volume 82, February 2023, 102309Author links open overlay panelAbstractBackground

Atrophic gastritis (AG) and intestinal metaplasia (IM) play an essential role in gastric carcinogenesis. This study aimed to determine the prevalence of AG and IM and their associated factors.

Methods

Subjects who underwent upper endoscopy at Chiang Mai University Hospital from January 2018 to Dec 2021 were included. All participants were interviewed using a structured questionnaire to collect their personal histories. In addition, clinical and histological data and associated factors of AG and IM were analyzed.

Results

A total of 947 subjects (mean age, 53.61 ± 9.73 years; 60% male) were included. The prevalence of AG and IM, diagnosed by histopathology, was 39% and 19%. Prevalence of AG and IM increased from 28% and 9% in those under 50 years to 43% and 30% in those above 60 (p < 0.05). In a multivariate analysis, Helicobacter pylori (H. pylori) infection, age 50–59 and over 60 years were significantly associated with higher odds of AG (odds ratio (OR), 2.07, 2.06, and 1.98) and IM (OR, 2.07, 2.18, and 4.46), respectively. Conversely, ingestion of spicy food was significantly associated with lower odds of AG and IM (OR, 0.75, and 0.62).

Conclusions

This study confirms that age and H. pylori infection are risk factors, whereas spicy food intake is a protective factor against AG and IM, which are common in patients over 50. Therefore, upper endoscopy and gastric mapping sampling are recommended for patients with chronic dyspepsia older than 50 to reduce gastric cancer risk.

Introduction

Gastric cancer (GC) is a global health problem, with more than 1 million people being diagnosed yearly [1]. Despite its decline in incidence and mortality over the past five decades, GC remains the fourth leading cause of cancer-related death worldwide [1]. GC incidence and mortality are highly variable by region and highly dependent on diet and Helicobacter pylori (H. pylori) infection [2]. Most GC arise after long-term H. pylori infection via a multi-step histopathological cascade known as the Correa pathway, which involves the following steps: gastritis, atrophic gastritis (AG), intestinal metaplasia (IM), dysplasia, and finally, GC [3]. H. pylori-infected individuals with AG and IM were found to have a 4.9 and 6.4-fold higher risk of developing GC, respectively [4]. These suggest that AG and IM were precancerous lesions of the stomach. For this reason, knowledge of epidemiology and associated factors for AG and IM is essential for the physician to make personalized decisions about risk stratification, screening, and prevention of GC.

Up to 60% of patients with chronic dyspepsia had histopathological features of chronic gastritis, which some may find concomitant to AG or IM [5]. This multi-step process could be related to individual and environmental factors [6]. However, few detailed reports regarding the prevalence of AG and IM and few comprehensive analyses have been conducted on their associated factors. From this background, the present study was conducted to assess the prevalence of AG and IM and to investigate independent risk factors predicting the development of these precancerous lesions among patients with dyspepsia.

Section snippetsStudy population and design

We used clinical and histological data from a hospital-based cross-sectional study of patients with dyspepsia to evaluate the prevalence and associated factors of AG and IM. We recruited consecutive patients who underwent elective upper endoscopy and gastric mapping sampling as indicated for diagnostic evaluation of dyspepsia at Chiang Mai University Hospital, Chiang Mai, Thailand, from January 2018 to December 2021. Dyspepsia was defined as predominant epigastric pain, including other upper

Characteristics of participating subjects

During the study period, a total of 947 subjects were recruited. There were 572 (60%) females and 375 (40%) males with a mean age of 53.61 ± 9.73 years (range 37–87 years). H. pylori infection was demonstrated in 357 participants (38%). Demographic data and clinical characteristics of subjects were described in Table 1.

Prevalence of AG and IM

The prevalence of AG and IM, diagnosed by histopathology, were 39% (365 of 947) and 19% (179 of 947) (Table 1). The prevalence of AG and IM was not different between males and

Discussion

Atrophic gastritis (AG) and intestinal metaplasia (IM) are precancerous conditions of GC. Therefore, understanding the epidemiological characteristic and the detection of these precancerous lesions may enable the prevention of GC. This cross-sectional study showed that the prevalence of AG and IM in subjects undergoing endoscopy as indicated for diagnostic evaluation of dyspepsia was 39% and 19%. Furthermore, the prevalence of AG and IM increased with age, especially in people over 50. Our

Conclusions

This study confirmed that AG and IM were associated with age and H. pylori infection, whereas they were inversely associated with ingesting spicy food. According to the high prevalence of precancerous lesions in patients with chronic dyspepsia older than 50, upper endoscopy and gastric mapping sampling are recommended for patients requiring endoscopy to manage dyspepsia.

Funding

This work was supported by the Faculty of Medicine, Chiang Mai University, under grant number 07016. The sponsors had no role in the design or conduct of the study, interpretation of results, or approval of the manuscript. The researchers acted independently from the study sponsors in all aspects of the work.

Ethics approval

This study was approved by the Institutional Review Board for Chiang Mai University (MED-2564–07915).

CRediT authorship contribution statement

Taned Chitapanarux: Contributed to the study conception and design; acquisition, analysis, and interpretation of data; drafted the manuscript and revised it critically for valuable intellectual content; gave the final approval for publication; undertook the endoscopic assessments and performed data collection and statistical analysis. Patumrat Sripan: Performed data collection and statistical analysis. Sarawut Kongkarnka: helped with the pathologic evaluations. Komson Wannasai: helped with the

Acknowledgments

We would like to thank all participants for contributing data to this study.

Author contribution statement

All authors have made: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND Drafting the work or revising it critically for important intellectual content; AND Final approval of the version to be published, AND Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of

References (31)M.F. Dixon et al.Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of gastritis, Houston 1994

Am. J. Surg. Pathol.

(1996)

Y.H. Park et al.Review of atrophic gastritis and intestinal metaplasia as a premalignant lesion of gastric cancer

J. Cancer Prev.

(2015)

S.C. Shah et al.AGA clinical practice update on the diagnosis and management of atrophic gastritis: expert review

Gastroenterology

(2021)

L. Marques-Silva et al.Prevalence of gastric precancerous conditions: a systematic review and meta-analysis

Eur. J. Gastroenterol. Hepatol.

(2014)

G.D.Y. Asaka M et al.Atrophic gastritis and intestinal metaplasia in Japan: results of a large multicenter study

Helicobacter

(2001)

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