IDDF2022-ABS-0213 Gastric intestinal metaplasia may attenuate reflux symptoms – analysis of a large observational prospective cohort

• Published in: Gut Vol. 71; no. Suppl 2; p. A59
• Main Authors: Tang, Si-Ying, Lee, Jonathan, Koh, Calvin J, Zhu, Feng, So, Jimmy, Ho, Khek-Yu, Srivastava, Supriya, Tsao, Stephen, Khor, Christopher, Fock, Kwong-Ming, Lim, Wee-Chian, Ling, Khoon-Lin, Ang, Tiing-Leong, Teh, Ming
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 02.09.2022; BMJ Publishing Group LTD
• Subjects: Acids; Appetite loss; Basic Gastroenterology; Coffee; Dyspepsia; Dysphagia; Dysplasia; Endoscopy; Gastric cancer; Gastric mucosa; Gastritis; Gastroesophageal reflux; Heart; Helicobacter pylori; Intestine; Metaplasia; Nausea; Patients; Satiety; Statistical analysis; Vomiting
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2022-IDDF.67

BackgroundGastric intestinal metaplasia (GIM) is a precancerous lesion associated with dysplasia and gastric cancer (GC). Annually, 1.8%, 10% and 73% of patients with atrophic gastritis, GIM and dysplasia progress to GC. While dyspepsia is associated with Helicobacter Pylori and active gastritis, GIM is not thought to be associated with specific symptoms. The aim of the study is to evaluate the correlation between GIM and pre-endoscopy symptoms.Methods2874 participants underwent 7480 gastroscopies with updated Sydney System gastric mucosal sampling from January 2004 – December 2010 with GIM graded using the Operative Link in Gastric Intestinal Metaplasia (OLGIM) staging. Prior to each endoscopy, the participants completed a medical history interview reporting symptoms of dyspepsia, acid brash, heartburn, dysphagia, nausea, vomiting, early satiety, indigestion, loss of weight, loss of appetite, coffee ground vomitus and melena. Results were compiled and statistics calculated using R for chi-square and logistic regression analysis.ResultsGIM was present in 53.3% (n=3992) of the gastroscopies. One-third of the patients (37.1%, n=2781) were symptomatic prior to the endoscopy, with the most common symptoms being dyspepsia (n=1860, 24.9%), acid brash (n=838, 11.2%) and heartburn (n=520, 7%).Compared to controls, patients with GIM have lower proportions of symptoms (34.2% vs 39.8%, p<0.01). Of note, patients with GIM reported significantly less acid brash (9.5% vs 12.7%, p<0.01) and heartburn (5.2% vs 8.5%, p<0.01) (IDDF2022-ABS-0213 Table1), whereby H. pylori status was not significantly different in these subgroups.Abstract IDDF2022-ABS-0213 Table 1Symptoms in patients with or without GIM Symptoms No GIM (%) GIM (%) Total (%) P-value Odds ratio (CI) Acid brash No 3484 (87.3) 3158 (90.5) 6642 (88.8) <0.001 0.72 (0.62–0.83) Yes 508 (12.7) 330 (9.5) 838 (11.2) Heartburn No 3653 (91.5) 3307 (94.8) 6960 (93.0) <0.001 0.59 (0.49 - 0.71) Yes 339 (8.5) 181 (5.2) 520 (7.0) Dysphagia No 3939 (98.7) 3462 (99.3) 7401 (98.9) 0.019 0.56 (0.35 - 0.89) Yes 53 (1.3) 26 (0.7) 79 (1.1) Nausea No 3868 (96.9) 3418 (98.0) 7286 (97.4) 0.004 0.64 (0.47 - 0.86) Yes 124 (3.1) 70 (2.0) 194 (2.6) Vomiting No 3963 (99.3) 3463 (99.3) 7426 (99.3) 1.000 0.99 (0.58 - 1.69) Yes 29 (0.7) 25 (0.7) 54 (0.7) Dyspepsia No 2932 (73.4) 2688 (77.1) 5620 (75.1) <0.001 0.82 (0.74 - 0.91) Yes 1060 (26.6) 800 (22.9) 1860 (24.9) Satiety No 3829 (95.9) 3365 (96.5) 7194 (96.2) 0.233 0.86 (0.68 - 1.09) Yes 163 (4.1) 123 (3.5) 286 (3.8) Indigestion No 3878 (97.1) 3420 (98.1) 7298 (97.6) 0.014 0.68 (0.50 - 0.92) Yes 114 (2.9) 68 (1.9) 182 (2.4) LOA No 3941 (98.7) 3463 (99.3) 7404 (99.0) 0.022 0.56 (0.34 - 0.92) Yes 51 (1.3) 25 (0.7) 76 (1.0) LOW No 3889 (97.4) 3425 (98.2) 7314 (97.8) 0.029 0.69 (0.51 - 0.95) Yes 103 (2.6) 63 (1.8) 166 (2.2) Coffeeground No 3986 (99.8) 3485 (99.9) 7471 (99.9) 0.641 0.57 (0.14 – 2.29) Yes 6 (0.2) 3 (0.1) 9 (0.1) Melena No 3967 (99.4) 3470 (99.5) 7437 (99.4) 0.634 0.82 (0.45 – 1.51) Yes 25 (0.6) 18 (0.5) 43 (0.6) Symptomatic No 2404 (60.2) 2295 (65.8) 4699 (62.8) <0.001 0.79 (0.72 -0.86) Yes 1588 (39.8) 1193 (34.2) 2781 (37.2) ConclusionsWe hypothesize that patients with intestinal metaplasia and atrophic gastritis may have less acid secretion, and correspondingly fewer reflux symptoms. Although many patients in clinical practice, are scoped for dyspepsia and reflux symptoms, our data suggest that patients with GIM are less likely to have these symptoms and yet harbour this pre-malignant condition of the stomach.