TY - JOUR
T1 - Prevalence of Gastric Precursor Lesions in Countries With Differential Gastric Cancer Burden
T2 - A Systematic Review and Meta-analysis
AU - Mülder, Duco T.
AU - Hahn, Anne I.
AU - Huang, Robert J.
AU - Zhou, Margaret J.
AU - Blake, Benjamin
AU - Omofuma, Omonefe
AU - Murphy, John D.
AU - Gutiérrez-Torres, Daniela S.
AU - Zauber, Ann G.
AU - O'Mahony, James F.
AU - Camargo, M. Constanza
AU - Ladabaum, Uri
AU - Yeh, Jennifer M.
AU - Hur, Chin
AU - Lansdorp-Vogelaar, Iris
AU - Meester, Reinier
AU - Laszkowska, Monika
N1 - Publisher Copyright:
© 2024 AGA Institute
PY - 2024/3/2
Y1 - 2024/3/2
N2 - Background & Aims: The prevalence of precursor lesions for gastric cancer (GC) and the differential burden between countries of varying GC risk is not well-understood. We conducted a systematic review and meta-analysis to estimate the global prevalence of precursor lesions. Methods: We estimated the prevalence of atrophic gastritis (AG), gastric intestinal metaplasia (IM), and dysplasia in regions with low, medium, and high GC incidence. Because IM is an advanced manifestation of AG, we assessed the prevalence of less advanced precursors, regardless of the presence of more advanced lesions. Prevalence was sub-stratified by Helicobacter pylori infection, symptomatology, and period (<2000, 2000–2010, and >2010). Results: Among the 582 articles that underwent full-text review, 166 studies met inclusion criteria. The global prevalence estimates of AG, IM, and dysplasia were 25.4%, 16.2%, and 2.0%, respectively, on the basis of 126 studies that reported the prevalence of less advanced precursors, regardless of the presence of more advanced lesions. The prevalence of all precursor lesions was higher in high and medium compared with low GC incidence countries (P < .01). Prevalence of AG and IM was significantly higher among H pylori–infected individuals (P < .01) but not statistically different between symptomatic and asymptomatic individuals (P > .17). All precursors demonstrated a secular decrease in prevalence over time. Conclusions: Gastric precursor lesions have differences in prevalence in regions with differential GC incidence and are associated with H pylori infection. Because of the substantial prevalence of precursor lesions in both symptomatic and asymptomatic individuals, symptomatic evaluation may not be sufficient to identify individuals at risk. These estimates provide important insights for tailoring GC prevention strategies.
AB - Background & Aims: The prevalence of precursor lesions for gastric cancer (GC) and the differential burden between countries of varying GC risk is not well-understood. We conducted a systematic review and meta-analysis to estimate the global prevalence of precursor lesions. Methods: We estimated the prevalence of atrophic gastritis (AG), gastric intestinal metaplasia (IM), and dysplasia in regions with low, medium, and high GC incidence. Because IM is an advanced manifestation of AG, we assessed the prevalence of less advanced precursors, regardless of the presence of more advanced lesions. Prevalence was sub-stratified by Helicobacter pylori infection, symptomatology, and period (<2000, 2000–2010, and >2010). Results: Among the 582 articles that underwent full-text review, 166 studies met inclusion criteria. The global prevalence estimates of AG, IM, and dysplasia were 25.4%, 16.2%, and 2.0%, respectively, on the basis of 126 studies that reported the prevalence of less advanced precursors, regardless of the presence of more advanced lesions. The prevalence of all precursor lesions was higher in high and medium compared with low GC incidence countries (P < .01). Prevalence of AG and IM was significantly higher among H pylori–infected individuals (P < .01) but not statistically different between symptomatic and asymptomatic individuals (P > .17). All precursors demonstrated a secular decrease in prevalence over time. Conclusions: Gastric precursor lesions have differences in prevalence in regions with differential GC incidence and are associated with H pylori infection. Because of the substantial prevalence of precursor lesions in both symptomatic and asymptomatic individuals, symptomatic evaluation may not be sufficient to identify individuals at risk. These estimates provide important insights for tailoring GC prevention strategies.
UR - http://www.scopus.com/inward/record.url?scp=85190131261&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2024.02.023
DO - 10.1016/j.cgh.2024.02.023
M3 - Article
C2 - 38438000
AN - SCOPUS:85190131261
SN - 1542-3565
VL - 22
SP - 1605-1617.e46
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 8
ER -
