Background & Aims

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 subgroups. 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 noncardia gastric biopsies; noncases were participants without evidence of gastric intestinal metaplasia. We used logistic regression models to estimate odds ratios (ORs) 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 noncases. 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%; 95% CI, 22.4%–28.9%) and non-Hispanic white patients (13.7%; 95% CI, 11.9%–15.7%). After we adjusted for age, sex, and smoking, African American (OR, 1.87; 95% CI, 1.44–2.44) and Hispanic race or ethnicity (OR, 2.32; 95% CI, 1.61–3.34) and H pylori infection (OR, 3.65; 95% CI, 2.79–4.55) were associated with an 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.

中文翻译：

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美国多种族退伍军人群体中胃肠化生的患病率。

 背景与目标

有必要识别患有胃肠化生（胃癌前兆）的个体，以便对他们进行筛查和监测。我们通过上消化道内窥镜活检分析检测不同种族和民族亚组中胃肠化生的患病率。我们还调查了幽门螺杆菌感染（无论是否患有急性和慢性胃炎）在多大程度上解释了种族或民族与胃肠化生风险之间观察到的关联。

 方法

我们使用的数据来自 2008 年 2 月至 2013 年 8 月在德克萨斯州休斯顿 Michael E. DeBakey 退伍军人事务医疗中心连续招募的患者的横断面研究。所有参与者都完成了一份有关社会人口学和临床特征的研究问卷，并接受了上消化道内窥镜检查胃标测（7 个活检部位）。如果1次或多次非贲门胃活检检出肠化生，则病例被归类为胃肠化生；非病例是指没有胃肠化生证据的参与者。我们使用逻辑回归模型来估计比值比 (OR) 和 95% CI 值，以检查种族或民族与胃肠化生之间的关联，并进行中介分析以确定幽门螺杆菌和胃炎是否影响观察到的关联。

 结果

我们纳入了 415 例胃肠化生病例和 1764 例非病例。西班牙裔患者胃肠化生患病率最高（29.5%；95% CI，23.7%–36.1%），其次是非洲裔美国人（25.5%；95% CI，22.4%–28.9%）和非西班牙裔白人患者（13.7%；95% CI，11.9%–15.7%）。在我们调整年龄、性别和吸烟情况后，非裔美国人（OR，1.87；95% CI，1.44–2.44）和西班牙裔人种或民族（OR，2.32；95% CI，1.61–3.34）和幽门螺杆菌感染（OR， ，3.65；95% CI，2.79-4.55）与胃肠化生风险增加相关。幽门螺杆菌单独感染占种族或民族与胃肠化生关联的33.6%，与急慢性胃炎合并时占55.5%。

 结论

根据上消化道内窥镜活检分析确定，与非西班牙裔白人患者相比，西班牙裔和非裔美国患者发生胃肠化生的风险增加。这种风险的增加部分独立于幽门螺杆菌感染。