Clinical Characteristics of Gastrointestinal Metaplasia in a Predominantly African American Population

Introduction: Gastrointestinal metaplasia (GIM) is a poorly understood precursor to gastric adenocarcinoma that has been studied in various East Asian countries, but poorly studied in the United States (US). We performed a retrospective study to evaluate demographic and clinical characteristics of patients with GIM in a predominantly African American US population. Methods: Upper endoscopies (EGDs) with gastric biopsies during 2015-2020 were retrieved from the pathology department database. EGD results, biopsy results, and patient information was collected from electronic medical records. Data from the initial EGD of patients with a GIM diagnosis (GIM group) was collected and compared against patients who did not have GIM (non-GIM group) using univariate and multivariable statistical methods. Results: Patients in the GIM group were significantly older than patients in the non-GIM group (P < 0.05), with a mean age of 64.7 years (SE = 0.6) compared to 55.7 years (SE = 0.7), respectively (Table 1). Relative to the non-GIM group, patients with GIM were more likely to be male than female (P = 0.005). Race differed significantly between GIM and non-GIM patients (P < 0.001). Relative to African Americans and when comparing between groups, white patients made up a lower proportion of GIM cases (P < 0.001), and Hispanic patients constituted a greater proportion of GIM cases (p < 0.001). A significantly higher proportion of GIM patients had pre-existing gastritis (P < 0.001) or positive H. pylori on biopsy (P < 0.039) compared to non-GIM patients, and had higher rates of aspirin use (p = 0.005). Other medication use and blood type did not significantly differ between GIM and non-GIM groups (P > 0.05). In the multivariable logistic model, only age and race were significant predictors of GIM: patients were at an increased risk of GIM if they were older (OR = 1.05, 95% CI 1.04-1.07) or Hispanic (OR = 3.95, 95% CI 1.51-10.36), and less likely to have GIM if they were white (OR = 0.54, 95% CI 0.31-0.95). Conclusion: In our retrospective study, we found that patients from the GIM group were older, with a higher male proportion, and higher aspirin use. The Hispanic population had the highest relative risk of GIM, which is consistent with previous literature findings. Older age and Hispanic ethnicity were the strongest independent risk factors for GIM. Further studies are necessary to better understand GIM in the United States, particularly the role of race and ethnicity on risk of progression to gastric adenocarcinoma.Table 1.: Characteristics, demographics, Co-existing diagnosis, and medication use in the gastrointestinal metaplasia group in comparison with the non-gastrointestinal metaplasia group. footnote: GIM: gastrointestinal metaplasia, PUD: Peptic Ulcer disease, SE: standard error.Figure 1.: title: ethnicity distribution in Gastrointestinal metaplasia group in comparison with non-Gastrointestinal metaplasia group footnote: GIM: Gastrointestinal metaplasia.