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Establishment and Evaluation of a Risk Prediction Model for Pathological Escalation of Gastric Low-Grade Intraepithelial Neoplasia
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Factors Associated with Malignant Gastric Ulcers: A 10-year Retrospective Cohort Study
Anas Zayad1, Yousef Yahia2, Prem Chandra3
1Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar.
International Journal of General Medicine
|June 4, 2026
Summary
Gastric ulcer size is a key indicator of malignancy risk. Larger ulcers require prompt biopsy and follow-up to detect potential cancer early.
Area of Science:
- Gastroenterology
- Oncology
- Epidemiology
Background:
- Gastric ulcers are associated with malignancy, but regional data, especially from the Middle East with high Helicobacter pylori prevalence and low gastric cancer rates, is limited.
- This study addresses the gap by evaluating malignant gastric ulcer prevalence and identifying predictors in the Middle East.
Purpose of the Study:
- To determine the prevalence of malignant gastric ulcers.
- To identify clinical and endoscopic predictors of malignancy in gastric ulcers.
- To assess the performance of ulcer size in predicting malignancy.
Main Methods:
- Retrospective cohort analysis of 473 patients diagnosed with gastric ulcers between 2014 and 2024.
- Data collection included demographics, ulcer morphology, Helicobacter pylori status, and clinical exposures.
- Logistic regression and ROC analyses were employed to identify predictors and model performance, categorizing ulcer size as small, medium, or large.
Main Results:
- A total of 39 (8.2%) malignant gastric ulcers were identified.
- Ulcer size was the strongest predictor of malignancy, with medium and large ulcers showing significantly increased odds.
- Age, sex, smoking, alcohol use, H. pylori status, and ulcer location were not independent predictors. The multivariable model achieved an AUC of 0.868.
Conclusions:
- Malignant gastric ulcers represent a significant minority of ulcer presentations.
- Ulcer size is the primary predictor of malignancy, outperforming demographic, lifestyle, and microbial factors.
- Emphasizing ulcer size in risk stratification and ensuring universal biopsy for all gastric ulcers, particularly medium and large ones, is recommended.
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