P2035 - Clinical Characteristics of Gastrointestinal Metaplasia in a Predominantly African American Population

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Akram I. Ahmad, MBBS

Medstar Washington Hospital Center
Washington, DC, United States

Akram I. Ahmad, MBBS¹, Ioannis Pothoulakis, MD², Colin Wikholm, BS³, Claire Caplan, MS, BA⁴, LOVELEEN BHOGAL, MBBS⁵, Harshkumar Patel, MBBS⁶, Nicole E. Hodgins, ⁷, In Guk Kang, BS³, Raymond K. Chang, BS³, Zachary Dailey, BA³, Arvin Daneshmand, BA⁸, Anjani Kapadia, BA³, Samantha Marshall, BA³, Jae Hak Oh, BS⁹, Brittney Rodriguez, BS³, Abhinav Sehgal, ³, Matthew Sweeney, BS, MS³, Christopher B. Swisher, BS³, Zuby Syed, MS³, Ehab A. Bahrun, BS³, Zaynab Almothafer, ³, Daniel F. Childers, BS³, Arielle J. Lee, BS³, Ankit Mishra, MS³, Corinne E. O'Connor, BA³, Nishtha Raval, BS³, Lynette Sequeira, BS³, Won Cho, MD⁵
¹Medstar Washington Hospital Center, Washington, DC; ²MedStar Washington Hospital Center, Washington, DC; ³Georgetown University School of Medicine, Washington, DC; ⁴Georgetown University School of Medicine, McLean, VA; ⁵MedStar Washington Hospital Cetner, Washington, DC; ⁶Georgetown University, MedStar Health Washington Hospital Center, Washington, DC; ⁷Georgetown University, Grosse Ile Township, MI; ⁸Georgetown University, Centreville, VA; ⁹Georgetown University School of Medicine, Centreville, VA

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).

Discussion: 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.

Figure: title: ethnicity distribution in Gastrointestinal metaplasia group in comparison with non-Gastrointestinal metaplasia group
footnote: GIM: Gastrointestinal metaplasia

Patient Characteristic (n = 943)	GIM (n = 450)	No GIM (n = 493)	p-value
GENDER	n (%)	n (%)	0.005
Male (n (%))	197 (46.8%)	164 (37.4%)
Female (n (%))	224 (53.2%)	275 (62.6%)
AGE (mean years [SE])	64.7 (0.6)	55.7 (0.7)	< 0.001
RACE OR ETHNICITY	n (%)	n (%)	< 0.001
Black	288 (75.2%)	283 (70.9%)	—
White	29 (7.6%)	78 (19.5%)	< 0.001
Hispanic	28 (7.3%)	7 (1.8%)	< 0.001
Asian or Pacific Islander	9 (2.3%)	3 (0.8%)	0.143
Other	29 (7.6%)	28 (7.0%)	0.950

CO-EXISTING DIAGNOSES	n (%)	n (%)
H. pylori status (positive)	86 (19.2%)	51 (13.8%)	0.039
Presence of Gastritis (n (%))	367 (82.8%)	274 (73.1%)	< 0.001
History of PUD (n (%))	34 (8.5%)	32 (8.2%)	0.847
Presence of Peptic Ulcer (n (%))	60 (13.6%)	44 (10.2%)	0.119
Presence of Gastric Polyps (n (%))	30 (6.7%)	24 (5.5%)	0.46
Presence of Gastric Malignancy (n (%))	12 (2.7%)	6 (1.6%)	0.256

SMOKING STATUS
Ever Smoker	n (%)	n (%)	0.219
Current (2)	91 (22.2%)	87 (23.0%)
Previous (1)	118 (28.9%)	89 (23.5%)
Never (3)	200 (48.9%)	203 (53.6%)

MEDICATIONS	n (%)	n (%)
Proton Pump Inhibitor (chronic use)	172 (41.8%)	160 (43.4%)	0.670
Aspirin	142 (34.8%)	95 (25.6%)	0.005
Celecoxib	2 (0.5%)	2 (0.5%)	1.000
Other NSAID	48 (11.8%)	32 (8.6%)	0.153
Blood Type	n (%)	n (%)	0.965
A+	47(30.3%)	37(24.2%)
A-	3(1.9%)	3(2.0%)
B+	21(13.5%)	23(15.0%)
B-	2(1.3%)	2(1.3%)
O+	71(45.8%)	75(49.0%)
O-	5(3.2%)	7(4.6%)
AB+	5(3.2%)	6(3.9%)
AB-	1(0.6%)	0(0.0%)

Table: title: 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,

Disclosures:
Akram Ahmad indicated no relevant financial relationships.
Ioannis Pothoulakis indicated no relevant financial relationships.
Colin Wikholm indicated no relevant financial relationships.
Claire Caplan indicated no relevant financial relationships.
LOVELEEN BHOGAL indicated no relevant financial relationships.
Harshkumar Patel indicated no relevant financial relationships.
Nicole Hodgins indicated no relevant financial relationships.
In Guk Kang: Abbott Laboratories – Stockholder/Ownership Interest (excluding diversified mutual funds). Anthem Inc. – Stockholder/Ownership Interest (excluding diversified mutual funds). Cerner Corp. – Stockholder/Ownership Interest (excluding diversified mutual funds). Danaher Corp. – Stockholder/Ownership Interest (excluding diversified mutual funds). Illumina Inc. – Stockholder/Ownership Interest (excluding diversified mutual funds). Intuitive Surgical Inc. – Stockholder/Ownership Interest (excluding diversified mutual funds). Novartis AG – Stockholder/Ownership Interest (excluding diversified mutual funds). Novo Nordisk A/S – Stockholder/Ownership Interest (excluding diversified mutual funds). Regeneron Pharmaceuticals Inc. – Stockholder/Ownership Interest (excluding diversified mutual funds). Roche Holding AG – Stockholder/Ownership Interest (excluding diversified mutual funds). ThermoFisher Scientific Inc. – Stockholder/Ownership Interest (excluding diversified mutual funds). Zoetis Inc. – Stockholder/Ownership Interest (excluding diversified mutual funds).
Raymond Chang indicated no relevant financial relationships.
Zachary Dailey indicated no relevant financial relationships.
Arvin Daneshmand indicated no relevant financial relationships.
Anjani Kapadia indicated no relevant financial relationships.
Samantha Marshall indicated no relevant financial relationships.
Jae Hak Oh indicated no relevant financial relationships.
Brittney Rodriguez indicated no relevant financial relationships.
Abhinav Sehgal indicated no relevant financial relationships.
Matthew Sweeney indicated no relevant financial relationships.
Christopher Swisher indicated no relevant financial relationships.
Zuby Syed indicated no relevant financial relationships.
Ehab Bahrun indicated no relevant financial relationships.
Zaynab Almothafer indicated no relevant financial relationships.
Daniel Childers indicated no relevant financial relationships.
Arielle Lee indicated no relevant financial relationships.
Ankit Mishra indicated no relevant financial relationships.
Corinne O''Connor indicated no relevant financial relationships.
Nishtha Raval indicated no relevant financial relationships.
Lynette Sequeira indicated no relevant financial relationships.
Won Cho indicated no relevant financial relationships.

Akram I. Ahmad, MBBS¹, Ioannis Pothoulakis, MD², Colin Wikholm, BS³, Claire Caplan, MS, BA⁴, LOVELEEN BHOGAL, MBBS⁵, Harshkumar Patel, MBBS⁶, Nicole E. Hodgins, ⁷, In Guk Kang, BS³, Raymond K. Chang, BS³, Zachary Dailey, BA³, Arvin Daneshmand, BA⁸, Anjani Kapadia, BA³, Samantha Marshall, BA³, Jae Hak Oh, BS⁹, Brittney Rodriguez, BS³, Abhinav Sehgal, ³, Matthew Sweeney, BS, MS³, Christopher B. Swisher, BS³, Zuby Syed, MS³, Ehab A. Bahrun, BS³, Zaynab Almothafer, ³, Daniel F. Childers, BS³, Arielle J. Lee, BS³, Ankit Mishra, MS³, Corinne E. O'Connor, BA³, Nishtha Raval, BS³, Lynette Sequeira, BS³, Won Cho, MD⁵. P2035 - Clinical Characteristics of Gastrointestinal Metaplasia in a Predominantly African American Population, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.