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Meta-Analysis
. 2024 Aug;22(8):1605-1617.e46.
doi: 10.1016/j.cgh.2024.02.023. Epub 2024 Mar 2.

Prevalence of Gastric Precursor Lesions in Countries With Differential Gastric Cancer Burden: A Systematic Review and Meta-analysis

Duco T Mülder  1 , Anne I Hahn  2 , Robert J Huang  3 , Margaret J Zhou  3 , Benjamin Blake  4 , Omonefe Omofuma  5 , John D Murphy  5 , Daniela S Gutiérrez-Torres  5 , Ann G Zauber  2 , James F O'Mahony  6 , M Constanza Camargo  5 , Uri Ladabaum  3 , Jennifer M Yeh  7 , Chin Hur  8 , Iris Lansdorp-Vogelaar  1 , Reinier Meester  9 , Monika Laszkowska  10
Affiliations
Meta-Analysis

Prevalence of Gastric Precursor Lesions in Countries With Differential Gastric Cancer Burden: A Systematic Review and Meta-analysis

Duco T Mülder et al. Clin Gastroenterol Hepatol. 2024 Aug.

Abstract

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.

Keywords: Dysplasia; Gastric Cancer; Gastric Precursor Lesions; Gastrointestinal Endoscopy; Global Burden Atrophic Gastritis; Helicobacter Pylori; Intestinal Metaplasia; Meta-analyses; Prevalence; Systematic Review.

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Conflict of interest statement

Dr. Uri Ladabaum is a medical consultant to Medtronic, Clinical Genomics, Guardant Health, Freenome, and ChekCap and an advisor to Universal Dx, Vivante Health, Kohler Ventures and Lean Medical. Dr. Reinier Meester is an employee of Freenome Holdings Inc. Dr. Monika Laszkowska reports research funding from AI Medical Service Inc. The remaining authors disclose no conflicts.

Figures

Figure 1.
Figure 1.
Flow diagram of systematic review selection criteria * There may be overlap of studies when multiple lesions are reported or when one study reports on cohorts in different geographic regions. These estimates include n=734,892 observations related to atrophic gastritis, n=1,521,386 observations related to intestinal metaplasia, and n=480,262 observations related to dysplasia.
Figure 2.
Figure 2.
Estimated prevalence of atrophic gastritis, gastric intestinal metaplasia, and dysplasia in countries with a low (A), medium (B) and high (C) gastric cancer incidence
Figure 3.
Figure 3.
Meta-regression of the precursor prevalence on the level of gastric cancer incidence (A) and H.-pylori prevalence (B)
Figure 4.
Figure 4.
Estimated prevalence of atrophic gastritis (A) and intestinal metaplasia (B) among H.-pylori negative and positive individuals in countries with a low, medium, and high gastric cancer incidence
Figure 5.
Figure 5.
Estimated prevalence of atrophic gastritis (A), intestinal metaplasia (B), and dysplasia (C) based on symptomatology in countries with a low, medium, and high gastric cancer incidence
Figure 6.
Figure 6.
Pooled estimated prevalence of atrophic gastritis, intestinal metaplasia, and dysplasia over time from 2000–2010+
See this image and copyright information in PMC

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