AIM To determine which clinical factors might be associated with gastric intestinal metaplasia(IM) in a North American population.METHODS Pathology and endoscopy databases at an academicmedical center were reviewed to identify patients with and without gastric IM on biopsies for a retrospective cohort study. Patient demographics, insurance status, and other clinical factors were reviewed.RESULTS Four hundred and sixty-eight patients with gastric IM(mean age: 61.0 years ± 14.4 years, 55.5% female) and 171 without gastric IM(mean age: 48.8 years ± 20.8 years, 55.0% female) were compared. The endoscopic appearance of atrophic gastritis correlated with finding gastric IM on histopathology(OR = 2.05, P = 0.051). Gastric IM was associated with histologic findings of chronic gastritis(OR = 2.56, P < 0.001), gastric ulcer(OR = 6.97, P = 0.015), gastric dysplasia(OR = 6.11, P = 0.038), and gastric cancer(OR = 6.53, P = 0.027). Histologic findings of Barrett’s esophagus(OR = 0.28, P = 0.003) and esophageal dysplasia(OR = 0.11, P = 0.014) were inversely associated with gastric IM. Tobacco use(OR = 1.73, P = 0.005) was associated with gastric IM.CONCLUSION Patients who smoke or have the endoscopic finding of atrophic gastritis are more likely to have gastric IM and should have screening gastric biopsies during esophagogastroduodenoscopy(EGD). Patients with gastric IM are at increased risk for having gastric dysplasia and cancer, and surveillance EGD with gastric biopsies in these patients might be reasonable. AIM To determine which clinical factors might be associated with gastric intestinal metaplasia (IM) in a North American population. METHODS Pathology and endoscopy databases at an academic center of were reviewed to identify patients with and without gastric IM on biopsies for a retrospective cohort study. Patient demographics, insurance status, and other clinical factors were compared .RESULTS Four hundred and sixty-eight patients with gastric IM (mean age: 61.0 years ± 14.4 years, 55.5% female) and 171 without gastric IM (mean age: 48.8 years ± 20.8 years, 55.0% female) were compared. The endoscopic appearance of atrophic gastritis correlated with finding gastric IM on histopathology (OR = 2.05, P = 0.051). Gastric IM was associated with histologic findings of chronic gastritis , gastric ulcer (OR = 6.97, P = 0.015), gastric dysplasia (OR = 6.11, P = 0.038), and gastric cancer = 0.003) a Tobacco use (OR = 1.73, P = 0.005) was associated with gastric IM. CONCLUSION Patients who smoke or have the endoscopic finding of atrophic gastritis are more likely to have gastric IM and should have screening gastric biopsies during esophagogastroduodenoscopy (EGD). Patients with gastric IM are at increased risk for having gastric dysplasia and cancer, and surveillance EGD with gastric biopsies in these patients might be reasonable.