Gastric intestinal metaplasia is generally considered to be a precancerous lesion in the gastric carcinogenesis cascade.
In this study, physicians from Hong Kong, China, identified the risk factors associated with progression of intestinal metaplasia.
The team randomized 587 Helicobacter pylori-infected subjects to receive a 1 week course of either omeprazole, amoxicillin, and clarithromycin (OAC) or placebo.
The subjects all underwent endoscopy with biopsy at baseline and at 5 years.
|Progression of intestinal metaplasia was found in 53% of subjects.|
The team graded the severity of intestinal metaplasia according to the updated Sydney classification. They defined progression as the worsening of intestinal metaplasia scores at 5 years in either the antrum or corpus, or development of neoplasia.
The physicians found that 435 subjects, 10 developed gastric cancer and 3 had dysplasia.
They found progression of intestinal metaplasia in 53% of subjects.
The team determined that persistent H. pylori infection, age >45 years, male sex, alcohol use, and drinking water from a well were significantly associated with progression.
However, duodenal ulcer and OAC treatment were associated with a reduced risk of histological progression.
They also established that progression of metaplasia was more frequent in those with more extensive and severe intestinal metaplasia at baseline.
Multivariate analysis found that duodenal ulcer (OR 0.23) was an independent protective factor against intestinal metaplasia progression.
However, persistent H. pylori infection (OR 2.13), age >45 years (OR 1.92), alcohol use (OR 1.67), and drinking water from a well (OR 1.74) were independent risk factors associated with progression.
Dr Leung and colleagues concluded, "Eradication of H. pylori is protective against progression of premalignant gastric lesions".