Routine clinical variables do not support pre-endoscopic triage for gastric intestinal metaplasia in H. pylori-seropositive safety-net patients
Abstract
Purpose Gastric intestinal metaplasia (GIM) is a precursor to gastric adenocarcinoma and an actionable target for prevention. Pre-endoscopic risk scores may help prioritize endoscopy in heterogenous populations, but their additional value over H. pylori seropositivity alone remains uncertain. We evaluated whether routinely available clinical and demographic variables could identify GIM among H. pylori -seropositive adults in a safety-net setting. Methods We analyzed 273 asymptomatic H. pylori -seropositive patients (GIM prevalence 28.9%) recruited from primary care clinics in a safety-net health system. Random forest (RF) and Least Absolute Shrinkage and Selection Operator (LASSO) models were developed using 8 pre-endoscopic predictors spanning demographics, clinical, lifestyle, and medical history factors. Performance was assessed in a held-out test set using area under the receiver operating characteristic curve (AUROC), classification metrics, and decision curve analysis (DCA). Results Participants were predominantly Hispanic (92.3%), first-generation immigrants (90.5%), and low-income (72.9% with annual household income <$25,000). Age was the only candidate predictor associated with GIM (p = 0.033). RF and LASSO achieved held-out AUROCs of 0.558 (95% CI: 0.422–0.707) and 0.500 (95% CI: 0.371–0.643), respectively. Neither model provided clinically meaningful net benefit compared with endoscopic evaluation of all H. pylori -seropositive participants. Conclusion In this high-risk safety-net population, routinely available pre-endoscopic variables did not meaningfully discriminate GIM after H. pylori seropositivity was established. Findings suggest risk-score-based triage may be insufficient to determine which seropositive patients should undergo endoscopy. Systematic endoscopic evaluation may be more appropriate in similar high-risk settings, while future prediction models may require biologic markers that better capture residual GIM risk.
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BibTeX
@misc{thrift2026routine,
title = {{Routine clinical variables do not support pre-endoscopic triage for gastric intestinal metaplasia in H. pylori-seropositive safety-net patients}},
author = {Aaron Thrift and Nicholas Weaver and Neda Zarrin-Khameh and Ava Melmed and Tuesday Haynes and Jourdan Brown and Jennifer Mistica Zafiro Garcia-Villanueva and Lisa Danek and Hammad Mahmood and Thomas Porter and Noreen Pirzada and Jaime J. Rueda and Jay Orr and Fred Sutton and Jordan Sparkman and Maya Balakrishnan and Milena Suarez and Richa Shukla and Robert J. Sealock and Yanyan Chen and David Graham and Hashem El-Serag and Mimi Tan},
howpublished = {Research Square},
year = {2026},
month = oct,
doi = {10.21203/rs.3.rs-11322056/v1},
url = {https://doi.org/10.21203/rs.3.rs-11322056/v1},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - Routine clinical variables do not support pre-endoscopic triage for gastric intestinal metaplasia in H. pylori-seropositive safety-net patients
AU - Aaron Thrift
AU - Nicholas Weaver
AU - Neda Zarrin-Khameh
AU - Ava Melmed
AU - Tuesday Haynes
AU - Jourdan Brown
AU - Jennifer Mistica Zafiro Garcia-Villanueva
AU - Lisa Danek
AU - Hammad Mahmood
AU - Thomas Porter
AU - Noreen Pirzada
AU - Jaime J. Rueda
AU - Jay Orr
AU - Fred Sutton
AU - Jordan Sparkman
AU - Maya Balakrishnan
AU - Milena Suarez
AU - Richa Shukla
AU - Robert J. Sealock
AU - Yanyan Chen
AU - David Graham
AU - Hashem El-Serag
AU - Mimi Tan
PY - 2026
DA - 2026/10/27
PB - Research Square
DO - 10.21203/rs.3.rs-11322056/v1
UR - https://doi.org/10.21203/rs.3.rs-11322056/v1
AB - Purpose Gastric intestinal metaplasia (GIM) is a precursor to gastric adenocarcinoma and an actionable target for prevention. Pre-endoscopic risk scores may help prioritize endoscopy in heterogenous populations, but their additional value over H. pylori seropositivity alone remains uncertain. We evaluated whether routinely available clinical and demographic variables could identify GIM among H. pylori -seropositive adults in a safety-net setting. Methods We analyzed 273 asymptomatic H. pylori -seropositive patients (GIM prevalence 28.9%) recruited from primary care clinics in a safety-net health system. Random forest (RF) and Least Absolute Shrinkage and Selection Operator (LASSO) models were developed using 8 pre-endoscopic predictors spanning demographics, clinical, lifestyle, and medical history factors. Performance was assessed in a held-out test set using area under the receiver operating characteristic curve (AUROC), classification metrics, and decision curve analysis (DCA). Results Participants were predominantly Hispanic (92.3%), first-generation immigrants (90.5%), and low-income (72.9% with annual household income <$25,000). Age was the only candidate predictor associated with GIM (p = 0.033). RF and LASSO achieved held-out AUROCs of 0.558 (95% CI: 0.422–0.707) and 0.500 (95% CI: 0.371–0.643), respectively. Neither model provided clinically meaningful net benefit compared with endoscopic evaluation of all H. pylori -seropositive participants. Conclusion In this high-risk safety-net population, routinely available pre-endoscopic variables did not meaningfully discriminate GIM after H. pylori seropositivity was established. Findings suggest risk-score-based triage may be insufficient to determine which seropositive patients should undergo endoscopy. Systematic endoscopic evaluation may be more appropriate in similar high-risk settings, while future prediction models may require biologic markers that better capture residual GIM risk.
SN - 2693-5015
ER -