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.
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.
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).
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.
- • Atrophic gastritis (AG) and intestinal metaplasia (IM) are precancerous lesions in the stomach.
- • There is a need to identify patients with AG and IM for screening and surveillance to reduce gastric cancer risk.
- • Age and Helicobacter pylori (H. pylori) infection have an increased risk for AG and gastric IM.
- • Spicy food has a protective effect against the development of AG and IM.
- • Patients over 50 should be screened for gastric precancerous lesions and H. pylori infection by endoscopy and gastric mapping.
Gastric cancer (GC) is a global health problem, with more than 1 million people being diagnosed yearly . Despite its decline in incidence and mortality over the past five decades, GC remains the fourth leading cause of cancer-related death worldwide . GC incidence and mortality are highly variable by region and highly dependent on diet and Helicobacter pylori (H. pylori) infection . 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 . 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 . 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 . This multi-step process could be related to individual and environmental factors . 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.