title: Risks and Predictors of Gastric Adenocarcinoma in Patients with Gastric Intestinal Metaplasia and Dysplasia: A Population-Based Study.
abstract: Gastric intestinal metaplasia and dysplasia are precursor lesions for adenocarcinoma. The risks of progression to malignancy from these lesions are not well characterized, particularly in the US populations.
  
  
  
  We identified 4,331 Kaiser Permanente Northern California members who were diagnosed with gastric intestinal metaplasia or dysplasia between 1997 and 2006 and followed them through December 2013. The incident rates of gastric adenocarcinoma, relative risks in comparison with the Kaiser Permanente general population, and predictors of progression to malignancy were investigated.
  
  
  
  Among 4,146 individuals with gastric intestinal metaplasia and 141 with low-grade dysplasia with 24,440 person-years follow-up, 17 and 6 cases of gastric adenocarcinoma were diagnosed, respectively, after 1 year from the index endoscopy. The incidence rate of gastric adenocarcinoma was 0.72/1,000 person-years in patients with intestinal metaplasia, with a relative risk of 2.56 (95% confidence interval (CI) 1.49-4.10) compared with the Kaiser Permanente member population, and 7.7/1,000 person-years for low-grade dysplasia, with a relative risk of 25.6 (95% CI, 9.4-55.7). The median time for gastric intestinal metaplasia to progress to adenocarcinoma was 6.1 years, and for low-grade dysplasia, 2.6 years. Hispanic race/ethnicity and history of dysplasia were associated with significantly higher risk of progression to gastric adenocarcinoma.
  
  
  
  Gastric intestinal metaplasia and dysplasia are significant predictors for gastric adenocarcinoma. The low risk for malignancy associated with intestinal metaplasia does not support routine endoscopic surveillance. However, surveillance should be considered in patients at higher risks, including those with suspicious endoscopic features, presence of dysplasia, and Hispanic race/ethnicity.
authors.affiliation: Department of Medicine and Gastroenterology, Kaiser Permanente Northern California, Santa Clara, California, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Medicine and Gastroenterology, Kaiser Permanente Northern California, Santa Clara, California, USA.
authors.forename: Marita C
authors.initials: MC
authors.lastname: Bautista
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Sheng-Fang
authors.initials: SF
authors.lastname: Jiang
authors.affiliation: Department of Medicine and Gastroenterology, Kaiser Permanente Northern California, Santa Clara, California, USA.
authors.forename: Paras
authors.initials: P
authors.lastname: Daryani
authors.affiliation: Department of Pathology, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Brackett
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Armstrong
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Yun-Yi
authors.initials: YY
authors.lastname: Hung
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Debbie
authors.initials: D
authors.lastname: Postlethwaite
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Uri
authors.initials: U
authors.lastname: Ladabaum
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology*; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D008297:Male; D008679:Metaplasia / Q000453:epidemiology; D008875:Middle Aged; D011230:Precancerous Conditions / Q000453:epidemiology*; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology*; D013272:Stomach Diseases / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000453:epidemiology*