Prevalence of Gastric Intestinal Metaplasia Among Patients with Active Helicobacter Pylori Infection Served by a Safety-Net Healthcare System

Gastric intestinal metaplasia (GIM) is a precursor of gastric cancer. Prior estimates of GIM prevalence in retrospective studies of U.S. populations may not be representative of true prevalence because gastric biopsies are not routinely performed for screening in the general population. Participants from a cross-sectional screening study of a safety-net patient population in Houston, Texas, who were Helicobacter pylori seropositive underwent endoscopy with systematic gastric mapping biopsies per Sydney protocol. Among participants with histopathologic evidence of active H. pylori , we calculated the prevalence of GIM overall and within subgroups. We additionally examined the prevalence of extensive (body involvement) and severe (Operative Link on GIM Assessment [OLGIM] stage III/IV) GIM. We included data from 273 patients with mean age 47.4 years. Most patients were female (75.1%), Hispanic (92.3%), and first-generation immigrants (90.5%). Overall, 28.9% (95% confidence interval [CI] 23.6%–34.7%) of patients with active H. pylori had GIM, including 8.1% (95% CI 5.1%–11.9%) with extensive GIM. All participants with GIM had OLGIM stage I/II. Prevalence of GIM did not vary between sociodemographic groups. Prevalence of GIM was 29.0% (95% CI 23.4%–35.0%) among Hispanic patients and 28.6% (95% CI 11.3%–52.2%) among non-Hispanic patients. GIM prevalence among first-generation immigrants (28.7%; 95% CI 23.2%–34.4%) was similar to among second- and third-generation immigrants (30.8%; 95% CI 14.3%–51.8%). In a safety-net U.S. population, 28.9% of patients with active H. pylori infection had GIM. While GIM may improve after H. pylori eradication, prevalence of GIM is high in all sociodemographic subgroups in the setting of active H. pylori infection.