Background and AimAtrophic gastritis (AG) and gastric intestinal metaplasia (GIM) are early changes in the stepwise progression to gastric adenocarcinoma. There is heterogeneity in international guidelines regarding the endoscopic diagnosis and surveillance of AG and GIM. This study aims to determine the prevalence of GIM in an Australian center and assess the approach of Australian endoscopists for these two conditions.MethodsWe conducted a single-center retrospective study of adult patients between January 2015 and December 2020 diagnosed with GIM on gastric biopsy following upper gastric endoscopy. A web-based, 25-question, investigator-designed, multiple-choice survey was distributed among all registered endoscopists in Australia.ResultsThe overall prevalence of GIM within a single Australian center was 11.7% over 5 years. Of the 1026 patients identified, only 58.7% underwent mapping biopsies using the modified Sydney protocol. Among the cohort, 1.6% had low-grade dysplasia, 0.9% had high-grade dysplasia, and 1.8% had malignancy on initial gastroscopy. Two hundred and sixty-seven (7.2%) endoscopists completed the survey, 44.2% indicated they would perform mapping for all patients, and 36% only for high-risk patients. Only 1.5% (n = 4) of respondents were able to correctly identify all six endoscopic photos of GIM/AG.ConclusionThis study demonstrates that in a large tertiary center, GIM is a prevalent endoscopic finding, but the associated rates of dysplasia and cancer were low. Additionally, among a small proportion of surveyed Australian endoscopists, there is notable variability in the endoscopic approach for AG and GIM and significant knowledge gaps. More training is required to increase the recognition of GIM and compliance with histological mapping. This retrospective study in a large Australian tertiary center revealed a gastric intestinal metaplasia (GIM) prevalence of 11.7% over 5 years, with low rates of associated dysplasia and malignancy. The survey of Australian endoscopists showed significant variability in approaches, emphasizing the need for standardized practices and increased awareness in the diagnosis and management of GIM and atrophic gastritis. image

A lack of geographic and racial diversity in clinical trial populations may arise from a disproportionate focus on trial conduct in the US and Europe. We sought to assess the proportion of leaders and collaborators from seminal cardiometabolic trials from the Asia-Pacific (APAC) region.

Background:A lack of geographic and racial diversity in clinical trial populations may arise from a disproportionate focus on the United States and Europe for trial leadership and conduct. Inadequate diversity may compromise the external validity to the Asia-Pacific (APAC) region, where 60% of global cardiometabolic disease exists. Objectives:This study aimed to assess the proportion and trends of Asian race participants and APAC authorship in cardiometabolic trials. Methods:We performed a systematic review of all cardiovascular, diabetes and obesity-related randomized controlled trials (phase ≥2, n = ≥100) published in these major medical journals: the New England Journal of Medicine, the Lancet, and the Journal of the American Medical Association between January 1, 2011, and December 31, 2020. Trial leadership was defined by first authorship, and any listed author was considered a trial collaborator. Temporal trends were evaluated using the Jonckheere-Terpstra proportion test and correlations using Pearson's correlation coefficient. Participant-to-prevalence ratios (PPR) were determined using Global Health Data Exchange registry data. Results:A total of 8.3% (218,613 of 2,619,710) participants identified as being of Asian race and 7.7% of total enrollment occurred in APAC. APAC lead authorship occurred in 52 of 656 (7.9%) trials and collaboration in 10.1% (1312 of 13,000 of authors), which correlated with Asian enrollment (r = 0.63 and r = 0.76, respectively). A marginal increase in the proportion of Asian race (Δ1.40% ± 6.95%/year, P = 0.003) and APAC regional (Δ1.46% ± 8.67%/year, P = 0.003) enrollment was observed; however, severe regional underrepresentation persisted (PPR <0.30). Conclusions:Despite a favorable trend over the past decade, Asian participants and authors from APAC remain significantly underrepresented in seminal cardiometabolic trials; barriers to trial conduct and leadership in this region must be addressed.

Imogen Hartley: YES financial relationship with a commercial interest;Pzifer:Other Activities Not in List (use freeform entry below) | Declan Connoley: NO financial relationship with a commercial interest | Nikhita Sane: NO financial relationship with a commercial interest | Ryan Hirsch: NO financial relationship with a commercial interest | Dilini Abeywickrama: NO financial relationship with a commercial interest | Nicholle YW Sim: NO financial relationship with a commercial interest | Vinny Ea: NO financial relationship with a commercial interest | Robert Azzopardi: NO financial relationship with a commercial interest | Ian Simpson: NO financial relationship with a commercial interest | Simon Hew: NO financial relationship with a commercial interest