TY - JOUR
T1 - Prevalence and temporal trend of gastric preneoplastic lesions in Asia
T2 - A systematic review with meta-analysis
AU - Li, Yunhao
AU - Jiang, Fang
AU - Wu, Chun Ying
AU - Leung, Wai K.
N1 - Publisher Copyright:
© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.
PY - 2024/2
Y1 - 2024/2
N2 - Background: Gastric cancer is the fifth most common cancer globally, with about 75% of cases occurring in Asia. While chronic atrophic gastritis (CAG) and intestinal metaplasia (IM) are well-recognized preneoplastic gastric lesions, we determined the prevalence and temporal trend of CAG and IM in Asia over the past 50 years. Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, MEDLINE, Scopus, and Web of Science for studies reporting the prevalence of CAG and IM in Asia (according to the United Nations geoscheme) published between 1970 and 2022. Heterogeneity was assessed by the I2 index and Cochran Q test. We adopted the random effects model to estimate the pooled prevalence and 95% confidence interval (CI). The slope of prevalence was estimated as a function of time in simple linear regression and weighted meta-regression models to demonstrate the temporal trend. Studies that reported the odds ratio (OR) of Helicobacter pylori infection and CAG/IM were analyzed separately to compile a pooled OR with a 95% CI. This study was registered in INPLASY2022120028. Results: Of the 81 studies from 19 Asian countries identified, the pooled prevalence for CAG and IM in Asia was 26.1% (95%CI: 22.7–30.0) and 22.9% (95%CI: 19.7–26.6), respectively. Over the past 5 decades, there was a significant decline in the prevalence of IM (slope in adjusted meta-regression models: −0.79 [95%CI: −1.28 to −0.26], P = 0.003), but there was no significant change in the pooled prevalence of CAG. Within Asia, the prevalence varied significantly among different regions. Southern Asia reported the highest pooled prevalence of CAG (42.9%, 95%CI: 27.5%–67.1%), while Western Asia reported the lowest level (12.7%, 95%CI: 5.0%–32.3%). For IM, Eastern Asia reported the highest prevalence (27.1%, 95%CI: 21.1–34.9), with the lowest prevalence reported in Western Asia (3.1%; 95% CI 1.2%–8.0%). H. pylori infection was linked to CAG and IM with OR of 2.16 (95%CI: 2.09–2.22) and 1.64 (95%CI: 1.57–1.72), respectively. Conclusion: This updated meta-analysis showed that up to 26% of study individuals in Asia harbored preneoplastic gastric lesions. There was a declining temporal trend in the prevalence of IM, but not for CAG, in Asia.
AB - Background: Gastric cancer is the fifth most common cancer globally, with about 75% of cases occurring in Asia. While chronic atrophic gastritis (CAG) and intestinal metaplasia (IM) are well-recognized preneoplastic gastric lesions, we determined the prevalence and temporal trend of CAG and IM in Asia over the past 50 years. Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, MEDLINE, Scopus, and Web of Science for studies reporting the prevalence of CAG and IM in Asia (according to the United Nations geoscheme) published between 1970 and 2022. Heterogeneity was assessed by the I2 index and Cochran Q test. We adopted the random effects model to estimate the pooled prevalence and 95% confidence interval (CI). The slope of prevalence was estimated as a function of time in simple linear regression and weighted meta-regression models to demonstrate the temporal trend. Studies that reported the odds ratio (OR) of Helicobacter pylori infection and CAG/IM were analyzed separately to compile a pooled OR with a 95% CI. This study was registered in INPLASY2022120028. Results: Of the 81 studies from 19 Asian countries identified, the pooled prevalence for CAG and IM in Asia was 26.1% (95%CI: 22.7–30.0) and 22.9% (95%CI: 19.7–26.6), respectively. Over the past 5 decades, there was a significant decline in the prevalence of IM (slope in adjusted meta-regression models: −0.79 [95%CI: −1.28 to −0.26], P = 0.003), but there was no significant change in the pooled prevalence of CAG. Within Asia, the prevalence varied significantly among different regions. Southern Asia reported the highest pooled prevalence of CAG (42.9%, 95%CI: 27.5%–67.1%), while Western Asia reported the lowest level (12.7%, 95%CI: 5.0%–32.3%). For IM, Eastern Asia reported the highest prevalence (27.1%, 95%CI: 21.1–34.9), with the lowest prevalence reported in Western Asia (3.1%; 95% CI 1.2%–8.0%). H. pylori infection was linked to CAG and IM with OR of 2.16 (95%CI: 2.09–2.22) and 1.64 (95%CI: 1.57–1.72), respectively. Conclusion: This updated meta-analysis showed that up to 26% of study individuals in Asia harbored preneoplastic gastric lesions. There was a declining temporal trend in the prevalence of IM, but not for CAG, in Asia.
KW - epidemiology
KW - gastric atrophy
KW - gastric cancer
KW - gastric preneoplastic lesion
KW - intestinal metaplasia
KW - prevalence
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85179323762&partnerID=8YFLogxK
U2 - 10.1002/ueg2.12507
DO - 10.1002/ueg2.12507
M3 - Article
C2 - 38084663
AN - SCOPUS:85179323762
SN - 2050-6406
VL - 12
SP - 139
EP - 151
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
IS - 1
ER -