Risk factors and correlation of intestinal metaplasia: A case- control study in Wuwei

Abstract

Background

Intestinal metaplasia (IM) is a significant gastric mucosal change that warrants attention due to its potential role in the pathogenesis of gastric cancer. IM is often triggered by Helicobacter pylori (H. pylori) infection and some risk factors.

Patients and methods

This study examined H. pylori infection and related risk factors in 7,096 participants, identifying 2,200 cases of IM linked to H. pylori and 4,896 controls without the infection in Wuwei, Gansu Province, China. The Operative Link on Gastritis/Intestinal Metaplasia (OLGIM) and (Operative Link on Gastritis Assessment (OLGA) classifications tools were used for identifying participants at high risk for gastric cancer by evaluating the severity and extent of H. pylori infection and IM.

Results

The study found that IM and H. pylori prevalence were gender-related, with males representing 41.09 % of cases compared to 33.92 % of controls, a significant difference (P < 0.0001). Conversely, females were more prevalent in the control group (66.07 %) compared to the case group (58.91 %). Age analysis showed higher proportions of IM cases in the 40–49 years group (46.95 %) compared to controls (43.40 %), with significant differences across age groups (P < 0.0001). IM showed significant positive correlations with smoking , alcohol consumption , and drinking water sources . H. pylori infection was detected in 238 (10.81 %) of the case group and 542 (11.07 %) of the control group. Using the OLGIM classification, which incorporates IM into gastric cancer risk assessment, stage 0 (no IM) was observed in 1,189 (24.28 %) of the control group and 530 (24.09 %) of the case group. Stage 1 (mild IM) was found in 3,165 (64.62 %) of the controls and 1,432 (65.09 %) of the cases. Stage 2 (moderate IM) was present in 520 (10.62 %) of the controls and 220 (10 %) of the cases, while stage 3 (severe IM) was observed in 24 (0.49 %) of the controls and 18 (0.82 %) of the cases. For OLGA staging, the case group had a higher percentage of individuals in higher stages (III and IV) compared to the control group. Specifically, 50.84 % of the cases were classified as stage 0, 19.75 % , stage I, 14.71 %, stage II, 8.40 %, stage III, and IV, 6.30 %. In the control group, 54.43 % were classified as stage 0, 24.17 %, stage I, 18.45 %, stage II, 1.66 %, stage III, and IV, 1.29 % respectively.

Conclusions

These findings suggest that older individuals, males, smokers, drinkers, and those using certain drinking water sources are more likely to develop IM. The study highlights the combined impact of H. pylori and risk factors on IM development, emphasizing the need for comprehensive public health strategies to address these risks. The higher proportion of advanced OLGA stages in the case group suggests more severe gastric atrophy, potentially indicating a higher risk for gastric cancer development.