BACKGROUBD: EGD is not routinely recommended in the initial evaluation of dyspepsia although gastric cancer may be the underlying etiology. Heliobacter pylori (Hp) infection, gastric ulceration, atrophic gastritis, intestinal metaplasia (IM), and dysplasia are pre-malignant lesions of the stomach associated with progression to gastric cancer and may present with dyspepsia. The purpose of this study was to prospectively analyze the utility of EGD in detecting gastric cancer and pre-malignant lesions in the initial evaluation of high risk East Asian subjects with dyspepsia.
METHODS: From October 1998 to June 2000, East Asian subjects > 45 years old with dyspepsia were recruited from the local community for an IRB approved gastric cancer screening protocol. We have previously identified this population as having an increased risk of gastric cancer. 109 individuals completing history, physical exam, EGD with biopsies, and pathologic review were included. Pre-malignant lesions were analyzed according to the status of associated chronic gastritis (active vs. inactive).
RESULTS: The median age was 48 years. 49% were male. All were immigrants; 81% from China, 7% Korea, 6% Vietnam, 6% elsewhere. 85% did not speak English. 23% were in the U.S. <5 years, 32% 6-10 years, 45% >10 years. Gross endoscopic findings were as follows: 20% normal, 74% gastritis, 6% ulcer, 5% esophagitis, 1 subject with esophageal cancer. Histologic findings were as follows: Of 54 (49.5%) subjects with chronic active gastritis, all were Hp (+), 37% had atrophic gastritis, 50% had IM, none had dysplasia, 81% had healed gastric ulceration or active regenerative mucosa. Of 54 (49.5%) subjects with chronic inactive gastritis, 63% were Hp (+), 63% had atrophic gastritis, 37% had IM, 4% had dysplasia, 94% had healed gastric ulceration or active regenerative mucosa. 1 subject without chronic gastritis had atrophy and IM. History, physical exam, and status of chronic gastritis were not predictive of pre-malignant changes.
CONCLUSIONS: Pre-malignant changes of the stomach are prevalent in this high risk immigrant population. Detailed histologic analysis of EGD biopsies is the only reliable indicator of pre-malignant changes. To identify those high risk dyspeptic patients with the greatest threat of progression to gastric cancer, EGD with biopsies is recommended as an initial test in these individuals. Long term follow-up, including repeat EGD, will determine the clinical implications of these pre-malignant changes.