Effect of lifestyle, smoking, and diet on development of intestinal metaplasia in H-pylori-positive subjects

OBJECTIVES: This study aimed to evaluate the influence of environmental and sociodemographic factors and the effect of smoking, alcohol, and dietary h abits on the risk of gastric intestinal metaplasia (IM) in Helicobacter pyl ori-infected subjects. METHODS: The investigation was based on 2598 consecutive volunteer blood do nors tested for the presence of antibodies against H. pylori from March 199 5 to March 1997. Endoscopy with multiple biopsies was offered to all H. pyl ori-positive, symptomatic subjects. The presence or absence of IM was diagn osed by gastric biopsies. A serologically H. pylori-positive subject with g astric IM was defined as a case, whereas serologically H. pylori-positive s ubjects without IM were used as controls. All patients answered a detailed questionnaire collecting sociodemographic characteristics and smoking, alco hol drinking, and dietary habits. Odds ratios (ORs) and their 95% CIs were estimated by unconditional logistic regression, including terms for age and sex, to assess the association between the data collected and IM. RESULTS: Three hundred forty-four subjects with serological H. pylori infec tion and upper-GI symptoms underwent GI endoscopy, during which biopsies we re taken fur histological diagnosis. Histology revealed metaplasia in 74 su bjects (21.5%). Incomplete IM was found in 37.8% of these cases. No signifi cant associations were found between IM and anthropometric or sociodemograp hic factors. There was a significant association between age and IM (chi (2 ) for trend, 6.67; p value, 0.009). Current smokers of over 20 cigarettes p er day had a 4-fold risk of IM (OR, 4.75, 95% CI, 1.33-16.99). A 2-fold inc reased risk was found for high butter consumers (OR, 2.17; 95% CI, 1.14-4.1 1). No significant specific associations were found between the variables s tudied and complete or incomplete IM. CONCLUSIONS: This study found that smoking and high butter consumption may increase the risk of having gastric IM in H. pylori-positive subjects. (C) 2001 by Am. Cell. of Gastroenterology.