Practice Trends among US Gastroenterologists following the 2020 American Gastroenterological Association Guidelines on Gastric Intestinal Metaplasia

Author:

Rouphael Carol1,Elkin Baila2,El Dahdah Joseph3,Moufawad Michelle4,Yang Qijun5,Bena James5,Shah Shailja67,K. Kim Michelle1

Affiliation:

1. Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease Institute

2. Department of Internal Medicine

3. Department of Cardiovascular Medicine

4. Central Michigan University College of Medicine, Mount Pleasant, MI

5. Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, OH

6. Department of Gastroenterology, University of California San Diego

7. Jennifer Moreno Department of Veterans Affairs Medical Center, Gastroenterology Section, San Diego, CA

Abstract

Background and Aims: Studies show variability in gastroenterologists’ management of gastric intestinal metaplasia (GIM) in the United States. In 2020, the American Gastroenterological Association published GIM guidelines, recommending physician-patient shared decision-making on GIM surveillance based on risk factors. We compared gastroenterologists’ communication trends of a GIM finding and surveillance recommendations before and after 2020 and evaluated patient and provider factors associated with a surveillance recommendation. Methods: A sample of patients diagnosed with GIM on biopsies from upper endoscopies performed in 2018 (cohort A) and 2021 (cohort B) were included. Logistic regression analysis assessed the association between patient/provider characteristics and surveillance recommendations in the overall cohort and over time. Materials: In all, 347 patients were included: 175 in cohort A and 172 in B. Median age was 65.7 (56.0, 73.4), and 54.5% were females. Communication to patients about GIM findings and surveillance recommendations increased from 24.6% <2020 to 50% >2020 (P<0.001) and 20% <2020 to 41.3% >2020 (P<0.001), respectively. Overall, endoscopy >2020, family history of gastric cancer, autoimmune gastritis, female providers, and gastroenterologists with 10 to 20 years of experience were associated with a surveillance recommendation. The effect of family history of gastric cancer and the effect of the patient’s female sex on surveillance was significantly different between both cohorts [Odds ratio (OR): 0.13, 95% (Confidence interval) CI: 0.02, 0.97 and OR 3.39, 95% CI: 1.12, 10.2, respectively). Conclusions: Despite a 2-fold increase in surveillance recommendations after 2020, there was no meaningful effect of any of the patients’ factors on a recommendation for surveillance over time, which raises the question as to whether surveillance is being offered to both average and high-risk patients without thorough risk stratification.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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