Abstract: Objective  To retrospectively analyze the clinical characteristics of patients with gastric xanthoma (GX) combined with intestinal metaplasia. Methods  Totally 68 391 patients who underwent initial gastroscopy in the digestive endoscopy center of Xuanwu Hospital, Capital Medical University between January 2012 and January 2022 were selected and 1 346 cases were diagnosed with GX, with a GX detection rate of 1.97% and a mean age of (55.4 ± 12.1) years old. GX cases were divided into two groups according to the presence or absence of intestinal metaplasia: GX with intestinal metaplasia (n=901) and GX without intestinal metaplasia (n=445). The two groups were compared with respect to age, gender，Helicobacter pylori (HP)，degree of gastric mucosal atrophy and the presence or absence of concomitant gastric cancer. The GX with intestinal metaplasia group was further divided into three subgroups according to the degree of intestinal metaplasia: GX with mild intestinal metaplasia (n=412), GX with moderate intestinal metaplasia (n=291) and GX with severe intestinal metaplasia (n=198), and the clinical characteristics of different subgroups of GX with intestinal metaplasia were analyzed comparatively. Results  There were significant differences between GX with and without intestinal metaplasia in terms of age (P=0.012), HP infection(P<0.001） and gastric cancer (P=0.014); GX with intestinal metaplasia was associated with a higher incidence of elderly patients, a higher HP infection and a higher detection rate of concomitant gastric cancer. Univariate and multivariate analysis showed that there were significant differences in age (P<0.001), HP infection (P<0.001), gastric mucosa atrophy (P<0.001) and intestinal metaplasia (P=0.014) between GX group and non-gastric cancer group. All three subgroups showed significant differences in age (P <0.001), gender (P=0.004), degree of gastric mucosal atrophy (P<0.001) and gastric cancer (P<0.001). The GX group with moderate or severe intestinal metaplasia had a higher proportion of elderly subjects (P=0.002, P=0.008). Gastric mucosal atrophy of various degrees was the mildest in the GX with mild enteropathy group (P<0.001), and the GX with severe intestinal metaplasia group had the highest degree of combined severe gastric mucosal atrophy (P<0.001) and a higher proportion of combined gastric cancer (P<0.001). Conclusion  The occurrence of GX with intestinal changes is associated with gastric cancer and atrophic gastritis, which needs to be further demonstrated by multicenter and large sample studies.

Key words: gastric xanthoma, intestinal metaplasia, atrophic gastritis, gastric neoplasia