[Public screening for early carcinoma of gastric cardia: rule of carcinogenetic development observed by endoscopy]

OBJECTIVE

To study the rule of development of early cancer of gastric cardia in vivo in public screening.

METHODS

A prospective cohort study on gastric cardiac cancer was held in the high incidence area of cancer of esophagus and stomach in China. 106 subjects had been examined regularly by endoscopy to observe the change of mucosa in high incidence area of gastric cardiac carcinoma developing at the root of gastric cardiac ridge by taking serial biopsy specimens. All specimens were diagnosed through the normal pathological processes to study the prognosis of pre-cancerous lesion of gastric cardia.

RESULTS

The result of 106 subjects who had been observed for four years were: 1. Of 8 normal persons, 3 stayed normal, 4 turned to chronic gastritis, 1 developed early gastric cardiac cancer. 2. Of 61 persons chronic gastritis, 11 was observed to have glandular atrophy, 4 with mild atypical hyperplasia, and 2 with highly atypical hyperplasia. 3. Of 9 subjects showing atrophic chronic gastritis, 5 revealed no change, and 4 became chronic gastritis. 4. Of 22 subjects who revealed mild atypical hyperplasia, 17 resolved, 4 showed no change, and 1 advanced to highly atypical hyperplasia. 5. One person with highly atypical hyperplasia reverted to mild atypical hyperplasia. 6. Of 5 subjects with early gastric cardiac cancer without any treatment, 1 became advanced cancer, 1 still stayed in early stage, and 3 turned to atypical hyperplasia.

CONCLUSION

1. The development of early cancer of gastric cardia would proceed through the stages of chronic gastritis, glandular atrophy, and atypical hyperplasia. 2. The early cancer and pre-cancerous lesion of gastric cardia is reversible, though possessing malignant possibility.

Lack of specific association between gastric autoimmunity hallmarks and clinical presentations of atrophic body gastritis

AIM: To investigate the possible relationships between gastric autoimmune phenomena and clinical presentations of this disorder, in consecutive atrophic body gastritis patients.

METHODS: A total of 140 atrophic body gastritis patients, diagnosed as consecutive outpatients presenting with macrocytic or iron deficiency anemia, or longstanding dyspepsia underwent gastroscopy with antral and body biopsies, assay of intrinsic factor, parietal cells and Helicobacter pylori (H pylori) antibodies. Gastritis was assessed according to Sydney System.

RESULTS: Parietal cell antibodies were equally distributed in all clinical presentations, whereas the positivity of intrinsic factor antibodies (49/140, 35%) was significantly higher in pernicious anemia patients (49.2%) than in iron deficiency (21.1%) and dyspeptic patients (27.8%). No specific pattern of autoantibodies was related to the clinical presentations of atrophic body gastritis. A positive correlation was obtained between the body atrophy score and the intrinsic factor antibody levels (r = 0.2216, P = 0.0085). Associated autoimmune diseases were present in 25/140 (17.9%) patients, but the prevalence of autoimmune diseases was comparable, irrespective of the clinical presentations.

CONCLUSION: The so-called hallmarks of gastric autoimmunity, particularly in intrinsic factor antibody cannot be usefully employed in defining an autoimmune pattern in the clinical presentations of ABG.

[Risk factors of gastric cancer in Wuwei City---an endemic region of gastric cancer]

BACKGROUND & OBJECTIVE

Researches show that epidemiologic factors of gastric cancer include living habit, eating moldy food and pickles, dystrophy, lack of microelements, and inherit, etc. This study was to explore universalities of these factors in Wuwei, a city in northwest China with high incidence of gastric cancer, and provide evidences for the first-prevention of gastric cancer.

METHODS

Family histories of the residents in Wuwei City were investigated with case-control method. Separating ratio and heredity degree of gastric cancer were calculated with Li-Mantel-Cart method and Falconer's regression method. Chronic gastritis patients were followed-up by home-visit, gastroscopy, and pathology. Cancerigenic fungi and volatility N-nitrosate compounds in residents' meal, Helicobacter pylori (Hp) in gastric mucosa, and total content of vitamin C in 293 healthy adults' serum were detected by culture, authentication, and laboratory examinations.

RESULTS

In Wuwei City, the separating ratio of gastric cancer was 0.077; the heredity degree of first-degree relatives was 22.91%u cancerization rate of year in person of atrophic gastritis crowd was 1.09%. Eight kinds of nitrosamine and 14 kinds of cancerigenic fungi were detected from residents' meal. Total content of vitamin C in serum of the 293 healthy adults in summer was (5.74+2.79) mg/L. Positive rate of Hp in gastric mucosa of the residents was 67%.

CONCLUSION

The major extrinsic factors of gastric cancer in Wuwei City include various strong carcinogens existing in residents' meal and lack of vitamin Cu its intrinsic factors include infection of Hp, atrophic gastritis (especially atypical hyperplasia), and heritage susceptibility.

Differences in clinical characteristics between patients with endoscopy-negative reflux disease and erosive esophagitis in Japan

OBJECTIVE

Helicobacter pylori infection and atrophic gastritis are inversely related to erosive esophagitis. Whether these factors affect the pathogenesis of endoscopy-negative reflux disease is not clear. We aimed to elucidate the differences in clinical characteristics between endoscopy-negative erosive disease and erosive esophagitis.

METHODS

253 subjects (89 with endoscopy-negative reflux disease and 164 with erosive esophagitis) were studied. Gastric atrophy was assessed by measurement of serum pepsinogen. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (CI) of endoscopy-negative reflux disease compared with erosive esophagitis.

RESULTS

Among GERD patients, female gender (OR = 2.27, 95% CI, 1.25-4.10), smoking (OR = 0.45, 95% CI, 0.22-0.91), and the presence of hiatal hernia (OR = 0.30, 95% CI, 0.17-0.56) were significantly associated with endoscopy-negative reflux disease compared with male gender, not smoking, and absence of hiatal hernia, respectively. Body mass index (BMI) was also significantly associated with a decreased OR for endoscopy-negative reflux disease. Although H. pylori infection and gastric atrophy were significantly more common in patients with endoscopy-negative reflux disease, these associations did not persist in a multiple-adjustment model. After adjustment for gender, BMI, smoking, and hiatal hernia, a decrease in serum pepsinogen I/II ratio was significantly associated with an increased OR for endoscopy-negative reflux disease (p for trend = 0.018).

CONCLUSIONS

Female gender, low BMI, not smoking, absence of hiatal hernia, and severity of gastric atrophy were positively associated with endoscopy-negative reflux disease compared with erosive esophagitis among Japanese patients.

Broccoli consumption and chronic atrophic gastritis among Japanese males: an epidemiological investigation

Previous in vitro and animal experiments have shown that sulforaphane, which is abundant in broccoli, inhibits Helicobacter pylori (H. pylori) infection and blocks gastric tumor formation. This suggests that broccoli consumption prevents chronic atrophic gastritis (CAG) introduced by H. pylori infection and, therefore, gastric cancer. For an epidemiological investigation of the relationship between the broccoli consumption and CAG, a cross-sectional study of 438 male employees, aged 39 to 60 years, of a Japanese steel company was conducted. CAG was serologically determined with serum cut-off values set at pepsinogen I < or = 70 ng/ml and a ratio of serum pepsinogen I/pepsinogen II < or = 3.0. Broccoli consumption (weekly frequency) and diet were monitored by using a 31-item food frequency questionnaire. The prevalence of CAG among men who ate broccoli once or more weekly was twice as high as that among men who consumed a negligible amount (P < 0.05). Multiple logistic regression analysis indicated that broccoli consumption once or more weekly significantly increased the risk for CAG (odds ratio, 3.06; 95% confidence interval, 1.12-8.38; P < 0.05), after controlling for age, education, cigarette smoking, and alcohol consumption. The present study failed to show an expected association between frequent broccoli consumption and a low prevalence of CAG.

Type III intestinal metaplasia, Helicobacter pylori infection and gastric carcinoma risk index in an Italian series of 1750 patients

BACKGROUND/AIMS

To evaluate the utility of 2 biopsies of antrum and gastric body on routine endoscopy for the assessment of type III intestinal metaplasia (IM-3) and Helicobacter pylori (Hp), 1750 patients (pts) (895 males; 855 females) were considered from June'98 to June'00.

METHODOLOGY

Specimens were graded 0 to 3 for atrophy, IM-3 and Hp. 610 pts treated previously with antibiotics or not eligible for biopsy were excluded from initial 2360 pts.

RESULTS

IM-3 was found in 118 pts (6.7%), 100 pts (5.7%) only in the antrum. 10 of 355 pts (2.8%) with normal endoscopy and 47 of 702 (6.6%) with non-erosive endoscopic gastritis resulted IM-3 positive in the antrum. 709 pts (40.5%) were positive for Hp in antrum and/or corpus. The presence of Hp and IM-3 in the antrum was not correlated (p=0.99; Spearman test). A positive correlation (p=0.000) between duodenal ulcer and Hp was found when antral Hp positivity was taken into account. The gastric carcinoma risk index (GCRI) was found in 358 pts (20.4%); in this group 131 pts (36.6%) were Hp positive, 81 pts (22.65%) had IM-3 only in the antrum, 184 pts (51.4%) had atrophy.

CONCLUSIONS

The incidence of IM-3 is low (6.7%) in routine endoscopy. Normal endoscopy doesn't exclude the presence of IM-3. Biopsy is necessary to discover IM-3 in the antrum in 5.3% of pts with normal or aspecific endoscopic gastritis. Application of the GCRI might be useful for identifying a group of patients carrying a higher risk for gastric carcinoma.

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

OBJECTIVE

To determine the serum vitamin B(12) status of older New Zealanders and to assess the impact of atrophic gastritis on vitamin B(12) status.

DESIGN

A cross-sectional nationally representative population-based survey.

METHOD

Serum vitamin B(12) concentrations were used to assess vitamin B(12) status. The presence and severity of atrophic gastritis was classified using serum pepsinogen I and II.

SUBJECTS

A total of 466 noninstitutionalized urban and rural dwelling New Zealanders aged 65 y or older who participated in the 1997 National Nutrition Survey.

RESULTS

The prevalence of deficient (<148 pmol/l) and marginal (148-221 pmol/l) serum vitamin B(12) concentrations was 12 and 28%, respectively. The prevalence of atrophic gastritis was 6.7% (severe 3.1%, mild-moderate 3.6%). While atrophic gastritis increased the relative risk (RR, 95% CI) of having a deficient or marginal serum vitamin B(12) concentration by 21-fold (6-67) and five-fold (1-17), respectively, those who had atrophic gastritis made up only 33 and 6% of the participants with deficient or marginal serum vitamin B(12) concentrations. An intake of vitamin B(12) from food that exceeded the recommended dietary allowance (2.4 mug/day) did not protect against deficient (RR 0.5; 95% CI: 0.2, 1.2) or marginal (RR 0.9; 95% CI: 0.5, 1.7) serum vitamin B(12) status. Vitamin B(12) supplement users had a reduced risk of having deficient and marginal vitamin B(12) status (RR 0.3; 95% CI: 0.1, 0.8).

CONCLUSIONS

There is a relatively high prevalence of deficient and marginal serum vitamin B(12) concentrations among older New Zealanders. However, the prevalence of atrophic gastritis was low in the New Zealand elderly compared with other surveys. Although atrophic gastritis was a risk factor for low vitamin B(12) status, it did not fully explain the prevalence of low serum vitamin B(12).

Possible association of interleukin 1B C-31T polymorphism among Helicobacter pylori seropositive Japanese Brazilians with susceptibility to atrophic gastritis

Associations between anti-Helicobacter pylori seropositivity (HP+) and interleukin 1B (IL-1B) C-31T polymorphism have been reported and little is known about the host factors involved in the development of atrophic gastritis (AG) among infected individuals. This study aimed to examine the IL-1B C-31T polymorphism among anti-HP antibody seropositive Japanese descendants with AG in Brazil and to investigate the interactions with lifestyle factors. Subjects were 455 seropositive from four cities in Brazil, aged 33-69 years. Sex-age-adjusted odds ratio (OR) of AG for 61 current smokers was 1.29, 95% confidence interval (CI): 0.18-9.26 for T/T, while that for 325 never smokers was 0.52, 95% CI: 0.27-0.98. A negative association for AG and never alcohol drinking, every day fruit consumption and milk drinking, and less frequently coffee drinking in individuals with C/T or T/T genotype was observed. This study suggested that host genetic constitution and lifestyle factors may influence the protective effect for AG development.

[Reflux esophagitis--Japan and Western countries]

Although reflux esophagitis (RE) is a common disease of the upper gastrointestinal tract in Western countries, its prevalence is still low in Asian countries, including Japan. On the other hand, the prevalence of H. pylori infection and atrophic gastritis are very high in Japan in comparison to that of other developed countries. Atrophic gastritis decreases gastric acid secretion, which is much lower in the Japanese compared to that in Western persons. The main mechanism of RE is reflux of gastric acid into the esophagus from the stomach. A decrease in gastric acid secretion induced by atrophic gastritis might prevent this acid reflux. This may be the reason RE is an uncommon disease in Japan.

Improvement of complete blood count in patients with iron deficiency anemia and Helicobacter pylori infection after the eradication of Helicobacter pylori

BACKGROUND/AIMS

Recent reports support the possible association between Hp infection and iron deficiency anemia. In the present study, the effects of the eradication therapy on iron deficiency anemia were investigated.

METHODOLOGY

Fourteen women with iron deficiency anemia were enrolled (mean age: 36.4 years; range: 20-52 years old). None of the patients received iron supplementation. Several examinations including upper and lower gastrointestinal endoscopy were performed to reveal any gastrointestinal bleeding sites in all patients. Gastric biopsies during endoscopy were taken from the subjects except one whose serum anti-Hp IgG was positive. After diagnosing the Hp infection by means of microbiology, histology and Gram stain, a combination therapy consisting of lansoprosol, clarithromycin and amoxicillin was administered to each patient. Hematologic examinations and the body iron status were evaluated periodically, following the eradication therapy.

RESULTS

Endoscopic findings were as follows: Seven patients with antral gastritis, two patients with pangastritis, whereas five patients were found to be endoscopically normal. None of the subjects were found to have gastrointestinal bleeding of any type. Serum hemoglobin, iron and transferrin saturations of the patients were found to be increased at 20-24 weeks of follow-up after the eradication therapy. Serum ferritin levels were not found to be increased.

CONCLUSIONS

Hp infection may be involved in cases of iron deficiency anemia of unknown origin, and the eradication of the infection may improve blood parameters other than serum ferritin levels.

Helicobacter pylori-associated chronic gastritis and unexplained iron deficiency anemia: a reliable association?

BACKGROUND AND AIM

About 35% of iron deficiency anemia cases remain unexplained after a gastrointestinal evaluation. An association between Helicobacter pylori and iron malabsorption has been suggested. The aim of this study was to determine whether H. pylori-associated chronic gastritis is linked to unexplained iron deficiency anemia in adults.

METHODS

From 1996 to 2001, we identified 105 patients with unexplained iron deficiency anemia after upper endoscopy, colonoscopy, small bowel radiographic examination and duodenal biopsies. Two biopsies were obtained from the gastric antrum and two from the corpus of each patient. Gastritis status was described according to the Sydney System and H. pylori infection was assessed by an immunohistochemical test on biopsy specimens. This group was compared to a control group matched for sex and age.

RESULTS

There were 76 women and 29 men (mean age 57.4 +/- 21.4 years) examined in the study. A H. pylori-associated chronic gastritis was identified in 63 cases (60%) vs. 45 cases (43%) cases in the control group (p <.01). Atrophic gastritis was significantly associated with iron deficiency anemia compared with the control group [16 (15%) vs. 6 (6%); p <.03]. In the unexplained iron deficiency anemia group, (1) patients with chronic gastritis were significantly younger (52 +/- 22 vs. 64 +/- 20 years; p <.005), and (2) chronic gastritis was not linked to sex [sex ratio (male/female): 0.5 vs. 0.34, p =.34]. The prevalence of H. pylori infection was similar between premenopausal and postmenopausal women [28 (27%) vs. 26 (25%); p =.7] with iron deficiency anemia.

CONCLUSION

H. pylori infection and chronic gastritis, especially atrophic gastritis, are significantly associated with unexplained iron deficiency anemia. Relationships between H. pylori-associated chronic gastritis and unexplained iron deficiency anemia should be considered.

Helicobacter pylori infection and gastric autoimmune diseases: is there a link?

BACKGROUND

Helicobacter pylori is thought to be involved in atrophic body gastritis. We explored the prevalence of H. pylori infection in asymptomatic subjects with gastric parietal cell antibodies, as well as in patients with pernicious anemia, to evaluate a possible role of H. pylori gastric infection in gastric autoimmunity.

PATIENTS AND METHODS

We studied 79 consecutive asymptomatic subjects with parietal cell antibodies, 24 patients with pernicious anemia, and 66 parietal cell antibody-negative controls. All patients underwent gastric biopsies for histology and detection of H. pylori. Red blood cell count and volume, serum levels of gastrin, pepsinogen I, iron, folic acid, vitamin B12, and circulating antibodies to H. pylori and to intrinsic factor were also determined.

RESULTS

We found an atrophic body gastritis in 14 of the 79 asymptomatic subjects with parietal cell antibodies (18%) and in 2 of the 66 controls (3%) (p =.01). Mean levels of gastrin were increased (p <.0001), while those of pepsinogen were reduced (p <.001) compared with controls. H. pylori was identified at the gastric level and/or circulating anti-H. pylori antibodies were detected in 46 parietal cell antibody-positive subjects (58%) compared with 26 controls (39%) (p =.03). In patients with pernicious anemia we found an atrophic body gastritis in 18 of 24 cases (75%) (p <.001 vs. controls). Mean levels of gastrin were markedly increased (p <.0001) and those of pepsinogen I decreased (p <.0001) relative to controls. Only five of these patients (21%) had evidence of H. pylori infection compared with 46 of the parietal cell antibody-positive subjects (58%) (p =.003) and 26 of the controls (39%). Considering all patients with gastric autoimmunity (i.e. with parietal cell antibodies and/or with pernicious anemia), H. pylori was found in 44 of 72 of those without atrophy (61%) but in 6 of 31 with gastric body atrophy (19%) (p <.001), indicating that H. pylori infection is greatly reduced when gastric acid secretion decreases.

CONCLUSIONS

The frequent detection of H. pylori infection in subjects with early gastric autoimmunity, indicated by the presence of parietal cell antibodies, suggests that H. pylori could have a crucial role in the induction and/or the maintenance of autoimmunity at the gastric level.

Lifestyle factors associated with atrophic gastritis among Helicobacter pylori-seropositive Japanese-Brazilians in S�o Paulo

BACKGROUND

Studies of lifestyle factors related to gastric atrophy development in Helicobacter pylori-infected individuals are limited. The present cross-sectional study aimed to examine the associations between lifestyle factors and serum pepsinogens (PGs) among anti- H. pylori antibody-seropositive Japanese in Brazil, where gastric cancer mortality was reported to be as high as in Japanese in Japan, and seropositive individuals were still frequently detected.

METHODS

The subjects were 291 seropositive individuals (129 males and 162 females; age, 30 to 69 years) out of 656 Japanese-Brazilian volunteers in São Paulo city. Information on lifestyle factors was obtained using a self-administered questionnaire. Atrophic gastritis was defined as a PG1 serum level less than 70 ng/ml and PG1/PG2 ratio less than 3.

RESULTS

The prevalence of atrophic gastritis was 31.9% (95% confidence intervals, 26.6%-37.6%). The proportion of subjects with atrophic gastritis increased with age, but there were no significantly marked differences in the proportions of subjects with atrophic gastritis among the three generations studied (first generation [Issei], second generation [Nisei], and third generation [Sansei]) for any 10-year age group. The associations with smoking and alcohol drinking were not significant. Length of education was inversely associated with gastric atrophy, while infrequent rice intake was preventive; the odds ratio relative to everyday rice intake was 0.13 (95% confidence intervals, 0.39-0.46) on multivariate analysis.

CONCLUSIONS

The present study demonstrated that frequent rice intake was a risk factor for atrophic gastritis among the H. pylori-infected Japanese-Brazilians, suggesting that diet including rice plays a role in the step from H. pylori infection to gastric atrophy.

Food/nutrient intake and risk of atrophic gastritis among the Helicobacter pylori-infected population of northeastern Japan

Although Helicobacter pylori (H. pylori ) infection is considered a key risk factor for atrophic gastritis, along with other environmental factors, it is still unclear which factor is involved in the development of atrophic gastritis among H. pylori-infected subjects. In the present cross-sectional study, therefore, we analyzed various dietary factors in relation to the presence of atrophic gastritis among H. pylori-infected subjects who participated in a health check-up program in a town in northeastern Japan. One thousand and seventy-one subjects (362 males and 709 females) who provided both self-administered validated food frequency questionnaires and blood samples were the basis for the study, and all of them were serologically positive for H. pylori immunoglobulin G (IgG) antibody. Among them, 663 (223 males and 440 females) were diagnosed as having atrophic gastritis on the basis of serum pepsinogen levels. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated based on tertile categories of subjects without atrophic gastritis, using logistic regression analysis. Among females, high consumptions of rice (OR = 1.6, 95% CI: 1.1-2.3), cod roe (OR = 1.5, 95% CI: 1.0-2.2) and cuttlefish (OR = 1.5, 95% CI: 1.0-2.3) were associated with a moderately increased risk of atrophic gastritis after adjustment for age (P for trend = 0.02 for these items). Among males, high consumptions of rice and miso soup showed a tendency toward an increased risk (P for trend = 0.12 and 0.13, respectively). Vegetables and fruits showed no association among either males or females. From these results, it is suggested that the dietary habits of consumers of traditional Japanese foods may play a role in the development of atrophic gastritis after H. pylori infection.

Histology of gastritis and Helicobacter pylori infection in Thailand: a nationwide study of 3776 cases

BACKGROUND

Dyspepsia is a very common problem in Thailand. Etiology of gastritis, incidence of Helicobacter pylori and mode of transmission of Helicobacter pylori infection in the country was proposed.

METHODS

A nation-wide study of gastric biopsy in 3776 dyspeptic patients from six different geographic regions for incidence of gastritis, type of gastritis, incidence of H. pylori infection, gastric atrophic change and intestinal metaplasia in three age-groups of each region was done.

RESULTS

58.7% of dyspeptic patients had histological gastritis. Pangastritis was the most common type (77.3%) with mostly mild active inflammation (60.6%) and was found most commonly in the age group 31-60 years. Incidence of gastritis was slightly lower in the coastal and peninsular community compared with the mountain, jungle, semiarid plateau and fertile plain communities. Geographic factor, socioeconomic status and dietary habit were proposed to be important factors in inducing gastritis. H. pylori infection was found in 48.2% of dyspeptic patients with high incidence in the age-group 31-60 years (63.7%) and 98.2% of H. pylori infection was found to be associated with gastritis. Semi-arid plateau, mountain, jungle and fertile plain communities had high incidences of H. pylori infection varying from 54.0 to 67.1% while the coastal and peninsular communities had low incidences of 32%. Oral to oral spread is proposed to be the mode of bacterial transmission. Incidences of gastric atrophic change and intestinal metaplasia were low in this country and were found in 11.6% and 8.2% of subjects, respectively, with no significantly different distribution in geographic regions. Type I or intestinal type was found to be the most common type of intestinal metaplasia.

Predictors of vitamin B12 deficiency: age and Helicobacter pylori load of antral mucosa

BACKGROUND/AIMS

The aim of this study was to assess the frequency of vitamin B12 deficiency in patients with non atrophic gastric mucosa and any relationship between the presence of vitamin B12 deficiency and demographic, hematologic, and histopathologic parameters.

METHODS

Three hundred and ten patients with no gastric mucosal atrophy on histologic evaluation were included in the study. Chronic inflammation, neutrophil activity and H. pylori load were scored using the Sydney classification system. Variables that might influence or predict the presence of vitamin B12 deficiency (age, gender, hemoglobin, mean corpuscular volume, serum folate level, scores of histologic parameters) were evaluated by univariate/multivariate analysis.

RESULTS

The percentages of patients with vitamin B12 concentrations of < 250 pg/mL, < 200 pg/mL, and =100 pg/mL were 67.4%, 46.8% and 6.5% respectively. Patient age and all three histologic were inversely related to vitamin B12 deficiency (p<0.05). By multivariate analysis, factors independently associated with serum vitamin B12 deficiency were age and antral H. pylori load (p<0.05).

CONCLUSIONS

The higher frequency of vitamin B12 deficiency in this study compared with a western study may be a reflection of the effect of H. pylori infection on serum vitamin B12 level. In addition, age was shown to be an independent risk factor for vitamin B12 deficiency irrespective of gastric atrophy. It is already known that the presence of H. pylori on gastric mucosa influence serum vitamin B12 levels. Hematologic parameters are not useful in predicting the deficiency of this vitamin.

BGP expression in gastric biopsies may predict the development of new lesions after local treatment for early gastric cancer

BACKGROUND

Our previous studies have demonstrated the significant role of the generative cells of intestinal metaplasia (IM) expressing brain (fetal)-type glycogen phosphorylase (BGP) (BGP-IM) as a premalignant lesion of intestinal-type adenocarcinoma. The aims of the present study were to investigate the incidence of BGP-IM in gastric biopsy specimens and to establish BGP-IM as a predictor of the coexistence of accessory carcinoma and/or metachronous cancers before and after local treatment for early gastric carcinoma.

METHODS

We studied the incidence of BGP-IM in eight endoscopic biopsy specimens of methylene blue-positive mucosa of the stomach obtained from patients with multiple gastric carcinomas (n = 14), a single carcinoma (n = 25), and atrophic gastritis (n = 20).

RESULTS

BGP positivity was 93.3% in the multiple carcinomas and 80.0% in the single carcinomas. The incidences of BGP-IM (mean percentage +/- SD) in the stomachs with multiple carcinomas, single carcinoma, and atrophic gastritis were 83.2% +/- 22.8%, 36.5% +/- 41.3%, and 7.1% +/- 18.0%, respectively. The incidence was significantly higher in the stomachs with multiple carcinomas than in those with a single carcinoma or those with atrophic gastritis (P < 0.001).

CONCLUSION

It is suggested that the frequent appearance of BGP-IM reflects the high potential of carcinogenesis of intestinal-type gastric cancer, and that the involvement of BGP-IM in more than 50% of the eight biopsies may be a predictor of the coexistence of accessory and/or metachronous carcinoma before and after local treatment for early gastric carcinoma.

Long-term Helicobacter pylori infection and the development of atrophic gastritis and gastric cancer in Japan

The incidence of gastric cancer and the prevalence of Helicobacter pylori are high in Japan, so it is an important issue whether long-term H. pylori infection leads to chronic atrophic gastritis, considered one of the precursors of gastric cancer. We have reported that the grade of atrophy was higher in H. pylori-positive subjects than in H. pylori-negative subjects. It has also been reported that the atrophy of gastric mucosa increased in H. pylori-infected monkeys compared with control monkeys in a 5-year follow-up study. Most H. pylori infections occur in children, and atrophy of the gastric mucosa progresses during aging. Long-term data show that H. pylori infection can lead to gastric atrophy and may play an important role in the development of gastric cancer. Interestingly, there was no difference in the prevalence of H. pylori between patients with chronic gastritis and gastric cancer in Japan, but the prevalence of H. pylori in young Japanese gastric cancer patients was significantly higher than in the control group. These data clearly show that H. pylori infection is one of the risk factors of gastric cancer in young Japanese people, There is no answer to whether curing H. pylori infection can reverse the atrophy of the gastric mucosa and decrease the risk of gastric cancer development. To clarify this issue, an intervention study must be done. A large clinical trial called the Japanese Intervention Trial of H. pylori is in progress.

Autoimmune gastropathy in type 1 diabetic patients with parietal cell antibodies: histological and clinical findings

OBJECTIVE

Approximately 15-20% of type 1 diabetic patients exhibit parietal cell antibodies (PCAs) targeting gastric H+/K+ATPase. We examined whether iron deficiency anemia, pernicious anemia, and autoimmune gastritis, which may predispose to gastric tumors, were more frequent in PCA+ than in PCA- patients.

RESEARCH DESIGN AND METHODS

Gastric biopsies from 88 consecutively recruited type 1 diabetic patients (51 men and 37 women, 47 PCA+ and 41 PCA-, aged 42 +/- 13 years) were evaluated using the updated Sydney system. Immunostaining was done for parietal cells, B- and T-cells, enterochromaffin-like (ECL) cells, and Helicobacter pylori (HP). PCAs were assayed by indirect immunofluorescence, H+/K+ATPase antibodies by enzyme immunoassay, and HP by serology, urea breath test, and histology. Pentagastrin tests were performed in 42 subjects.

RESULTS

Autoimmune gastritis (AG) was present in 57% of PCA+ and 10% of PCA- cases (OR 12.5, P < 0.0001). PCA positivity (beta = 1.44; P = 0.04) and hypergastrinemia (beta = 0.01; P = 0.026), but not HP, age, diabetes duration, sex, and HLA-DQ type were risk factors for AG. Iron deficiency anemia (OR 3.9, P = 0.015), pernicious anemia (OR = 4.6, P = 0.022), and hypochlorhydria (OR = 20.0, P = 0.0002) were more frequent in AG+ individuals. HP infection was present in 47 patients but did not influence corpus histology or gastrinemia. (Pre)malignant lesions were found in 26% of PCA+ subjects: ECL cell hyperplasia in 7 AG+ patients, comprising 1 with a gastric carcinoid tumor, and corpus intestinal metaplasia in 11 AG+ patients, including 1 with linitis plastica.

CONCLUSIONS

PCA+ type 1 diabetic patients should be screened for autoimmune gastritis, iron deficiency, and pernicious anemia. Particularly hypergastrinemic PCA+ patients with autoimmune gastritis are at increased risk for (pre)malignant gastric lesions.

[Effects of cytotoxin-associated gene a (CagA) antibodies with Helicobacter pylori infection and lifestyle on chronic atrophic gastritis]

OBJECTIVE

We conducted a population-based study to examine differences in risk of developing chronic atrophic gastritis in association with Helicobacter pylori (H. pylori) infection, with and without the presence of cytotoxin-associated gene A (CagA) antibodies, as well as to determine associations with the lifestyle factors.

METHOD

Seventy hundred and thirty eight residents (295 men and 443 women) aged 30-64 living in a village in the southern part of Fukuoka Prefecture had an annual health checkup, and all participated in our study. We obtained information on their lifestyle with informed consent and measured the levels of serum pepsinogen I (PGI) and pepsinogen II (PGII), H. pylori and CagA antibodies. Chronic atrophic gastritis was defined as both PGI < 70 micrograms/l and PGI/PGII < 3.0.

RESULTS

The odds ratios for development of chronic atrophic gastritis were 4.26 (95% CI, 2.22-8.17) for CagA-positive H. pylori infection and 3.87 (95% CI, 1.95-7.68) for CagA-negative H. pylori infection in males, and 4.92 (95% CI, 3.06-7.92) and 3.02 (95% CI, 1.69-5.41) respectively for females, as compared with H. pylori-negative subjects. Regarding the relationship between chronic atrophic gastritis and lifestyle factors, high consumption of green tea was found to be negatively associated with risk, particularly with CagA-positive H. pylori infection.

CONCLUSIONS

Our results suggest that a CagA-positive H. pylori infection is associated with an elevated risk for developing chronic atrophic gastritis as compared with Cag-negative H. pylori infection.

[Reflux esophagitis]

There are some factors which influence reflux esophagitis, in our country atrophic gastritis is important for the degree of it especially. Helicobacter pylori(H.P.) infection is popular in aged patients, so atrophic gastritis is also popular in such patients, then the frequency of reflux esophagitis is low comparing with other countries. But because of the late of H.P. infection comes to be higher and the eradication therapy for the peptic ulcer diseases has been done in these days, the late of atrophic gastritis comes to be lower and reflux esophagitis comes to be higher. In aged patients medication and physical factors influence reflux esophagitis and these factors are different in each patient. So it is very important to treat the patient of reflux esophagitis considering of each factor.

Multifocal atrophic gastritis and gastric carcinoma

Gastric carcinoma remains a major cause of morbidity and mortality worldwide despite its significant decline in recent years. H. pylori infection begins with nonatrophic gastritis, and most individuals continue to have nonatrophic H. pylori gastritis throughout their lifetime. A minority of those with severe antral inflammation will develop a duodenal ulcer, and a few, for unknown reasons, may develop gastric MALT lymphoma. Others, who acquired the H. pylori infection in early childhood, develop progressive multifocal atrophic gastritis with loss of gastric glands. A small proportion of these individuals develop extensive, incomplete (type III) intestinal metaplasia, and an even smaller proportion will progress to dysplasia and intestinal-type gastric carcinoma. H. pylori-associated gastritis is also a risk factor for diffuse-type gastric carcinoma, which is not preceded by atrophy, intestinal metaplasia, or dysplasia. Appropriate screening and preventive measures should be considered in high-risk groups. It is also crucial to identify cofactors such as genetic susceptibility and environmental factors that might interact with H. pylori infection to increase gastric cancer risk. To make an impact on gastric cancer incidence and mortality, serious consideration should be given to early H. pylori eradication in high-risk groups and endoscopic surveillance according to the updated Sydney system in some patients with high-risk preneoplastic lesions, whereas dysplastic lesions should be removed without delay. Studies currently in progress may tell us whether H. pylori eradication can prevent later development of gastric carcinoma and thus eliminate a major cause of mortality worldwide.

Risk factors for atrophic chronic gastritis in a European population: results of the Eurohepygast study

BACKGROUND AND AIMS

The development of atrophic chronic gastritis (ACG) is multifactorial, involving environment as well as host responses to Helicobacter pylori infection. The aim of this study was to determine factors involved in ACG in a European dyspeptic population.

METHODS

Data concerning sociodemographics, social behaviour, biological aspects, diet, and virulence factors of H pylori strains were collected in a cross sectional study from 19 European centres in 14 countries. Dyspeptic H pylori positive patients with ACG or non-ACG (NACG) at histology were included. Anti-CagA antibodies were evaluated by two immunoblot tests and anti-VacA antibodies by one. Logistic regression models were constructed, and estimated odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated from the coefficients.

RESULTS

Of the 451 patients included in the study, 267 were analysed: 202 had NACG and 65 ACG. Mean age was 44.4 years and 63% were women. Risk factors for atrophy identified by multivariate analysis were: age over 60 years (OR 4.14, 95% CI 1.79-9.58), coffee consumption (OR 2.35, 95% CI 1.07-5.16), sedative consumption (OR 2.17, 95% CI 1.04-4.52), and harbouring anti-CagA and anti-VacA antibodies simultaneously (OR 3.09, 95% CI 1.26-7.56), while the odds were significantly reduced for those with an anxiety score of 6 or more (OR 0.45, 95% CI 0.21-0.99).

CONCLUSION

The simultaneous presence of anti-CagA and anti-VacA antibodies enhanced the risk of ACG in European dyspeptic patients. Failure to discern diet and family history as risk factors for ACG may suggest that diet is homogeneous in Europe and that most of the risk factors for ACG identified so far are identical to risk factors for H. pylori infection.

Seroprevalence of Helicobacter pylori in children with type 1 diabetes mellitus in Sardinia

A few studies have reported an increased prevalence of Helicobacterpylori (HP) infection in diabetic subjects, which may be one of the causes of gastrointestinal symptoms and chronic atrophic gastritis frequently seen in diabetes of long duration. We determined the prevalence of HP infection in children and adolescents with Type 1 diabetes mellitus (T1DM) in the area of Sassari (northern Sardinia, Italy), which is characterized by an ethnically homogenous population at high risk of T1DM. HP IgG and IgA titres were measured in 138 patients with T1DM and 138 age-matched healthy controls. The percentage of infected subjects did not differ between T1DM patients (29.7%) and controls (32.6%). Globally, infected subjects were more than 1 yr older (13.0 +/- 2.7 yr) than non-infected ones (11.8 +/- 2.9 yr), independently of the presence of T1DM; in most HP-positive subjects infection was asymptomatic, and only 2 subjects in each group reported clinically relevant symptoms. HP-positive and HP-negative diabetic patients had the same duration of the disease (5.6 +/- 3.5 vs 5.5 +/- 3.6 yr) and received very similar doses of insulin (0.94 +/- 0.27 vs 0.96 +/- 0.4 IU/kg/d), whereas mean HbA1c was significantly lower in HP-positive patients (7.8 +/- 1.6% vs 8.6 +/- 1.7%,p=0.02). We conclude that the prevalence of HP infection is not higher in Sardinian children with T1DM as compared to controls of similar age, and the overall clinical impact of HP infection in terms of gastrointestinal symptoms and diabetic control seems to be low.

Relation of Helicobacter pylori infection and lifestyle to the risk of chronic atrophic gastritis: a cross-sectional study in Japan

To examine the mutual association of risk factors for both Helicobacter pylori (H. pylori) infection and chronic atrophic gastritis (CAG), a cross-sectional study on 954 residents of a rural town in Japan was conducted. Using an unconditional logistic model, we calculated the odds ratios (ORs) for H. pylori infection according to each lifestyle, as well as the ORs for CAG according to each lifestyle and H. pylori infection. A significant positive association was observed between H. pylori infection and the risk of CAG (OR = 6.29). On the other hand, a significant negative association was observed between high consumption of light-colored vegetables and the risk of CAG (OR = 0.68). We also used a path analysis to examine the direct relations of gender, age, and lifestyle variables to CAG, as well as the indirect relations of these variables to CAG through H. pylori infection. Aging had a significantly direct positive association with CAG. Although aging also had an indirect positive association with CAG through H. pylori infection, aging had no association with the consumption of light-colored vegetables. The high consumption of light-colored vegetables showed no association with H. pylori infection but had a significantly direct negative association with CAG. The results of this study suggest a possibility that high light-colored vegetables consumption contributes to the prevention of CAG.

Prevalence of subtypes of intestinal metaplasia in the general population and in patients with autoimmune chronic atrophic gastritis

BACKGROUND

Gastric intestinal metaplasia (IM) is seen mostly in association with chronic gastritis, induced either by Helicobacter pylori infection or autoimmune mechanisms. IM can be categorized into three subtypes, where type III is associated with gastric carcinoma of intestinal type.

METHODS

Gastric biopsies from 475 subjects randomly selected from the general population and from 27 patients with autoimmune gastritis associated with pernicious anaemia were used. The criteria of Filipe & Jass were applied using different histochemical techniques in combination with haematoxylin and eosin stained material.

RESULTS

Twenty-three percent (109/475) of the subjects from the general population and 88% (24/27) in the group with autoimmune gastritis had IM. Type III IM occurred in 4% in both populations. Type III IM was located in the antrum in 90% in the general population. In the group with autoimmune gastritis, only one patient had type III IM, which was located in the corpus.

CONCLUSIONS

This study reveals for the first time the prevalence and distribution of subtypes of IM in a general population from the Western world. The comparatively high prevalence of type III IM in the general population (4%) indicates that its role as a precursor of gastric carcinoma may have been overemphasized. A similar prevalence of type III IM in patients with autoimmune gastritis may be considered low and suggests that mechanisms for gastric carcinogenesis other than the atrophy-metaplasia-dysplasia sequence could also operate in this condition.

Role of anti-parietal cell antibody in Helicobacter pylori-associated atrophic gastritis: evaluation in a country of high prevalence of atrophic gastritis

BACKGROUND

Helicobacter pylori plays an important part in the progression of atrophic gastritis; however, markers for predicting the progression of atrophic gastritis remain unidentified. We investigated the relation between the degree of atrophic gastritis and the amount of anti-parietal cell antibodies (APCAs) present.

METHODS

In 219 Japanese patients, APCA was investigated by enzyme-linked immunosorbent assay (ELISA) and by Western blotting. The grade of corpus atrophy was estimated by histology and serum pepsinogen levels. Serum levels of pepsinogen were evaluated by radioimmunoassay.

RESULTS

Helicobacter pylori infection did not affect the APCA levels determined by ELISA. Long-term administration of proton-pump inhibitors and H. pylori eradication did not influence the levels of APCAs. However, in H. pylori-positive patients, the levels of APCA determined by ELISA were statistically higher in patients with severe atrophy than in those with mild atrophy as determined histologically (0.67+/-0.48 versus 0.45+/-0.40; A492, mean+/-s, P=0.01) and serologically by pepsinogen levels (0.66+/-0.51 versus 0.44+/-0.40. P=0.002). The levels of pepsinogen I/II ratio were correlated with APCA levels only in the H. pylori-positive group. Western blotting showed that major antigen was identical with the beta-subunit of H+,K+-ATPase.

CONCLUSION

APCA plays an important part in the progression of corpus atrophy after H. pylori infection.

Serological comparison of serum pepsinogen and anti-parietal cell antibody levels between Japanese and German patients

BACKGROUND

Atrophic gastritis is more common in Japan than in Germany. The expression of anti-parietal cell antibody has been implicated in the genesis of atrophic gastritis associated with Helicobacter pylori infection.

OBJECTIVE

We investigated the difference in serum levels of pepsinogens and in anti-parietal cell antibody expression between Japanese and German patients.

METHODS

We recruited 102 Japanese and 46 German patients with dyspepsia. Endoscopic examination detected no localized lesions in the upper gastrointestinal tract of any patients. Anti-parietal cell antibody was investigated by enzyme-linked immunosorbent assay with the purified porcine H+,K+-ATPase fraction and immunohistochemistry. H. pylori infection was diagnosed by the presence of anti-H. pylori antibody, by using the urease test and by histological examination. Serum levels of pepsinogen I and II and of gastrin were measured by a modified radioimmunoassay.

RESULTS

Seventy-one Japanese (70%) and 17 Germans (37%) were positive for H. pylori. Serum levels of anti-parietal cell antibody were not significantly different between Japanese and Germans in both H. pylori negative and positive groups. The serum pepsinogen I/II ratio and gastrin levels were altered by H. pylori infection in both populations. Moreover, anti-parietal cell antibody levels were higher in H. pylori-positive patients with low pepsinogen levels than in those with high pepsinogen levels in both populations.

CONCLUSIONS

The levels of anti-parietal cell antibody do not differ statistically between Japanese and Germans. Anti-parietal cell antibody might play a role in the progression of atrophic gastritis in both Japanese and German patients.

General features of gastric carcinomas and comparison of HSP70 and NK cell immunoreactivity with prognostic factors

During the period of 1996-1998 ninety-four gastrectomy specimens with gastric carcinoma referred to Erciyes University, Medical Faculty, Department of Pathology, were examined histopathologically, histochemically and immunohistochemically. General characteristics of gastric carcinomas and prognostic factors were studied. According the Lauren classification, of the 94 cases of gastric carcinomas, 56 were intestinal type, 21 were diffuse type and 17 were mixed type carcinoma. The association rates of Helicobacter pylori, chronic atrophic gastritis and intestinal metaplasia with gastric carcinomas were high. There was strong immunorectivity with HSP70 in 62,5% of the intestinal type carcinomas. This ratios were lower in diffuse and mixed type carcinomas (p<0.05). The more tumor size and invasion depth increased, the more HSP70 immunoreactivity was obtained (p<0.05). HSP70 immunorectivity was considerably higher in the patients having lymph node metastasis and vascular invasion (p<0.05). It was found that the NK cell number was low in the tumor but higher around the tumor in early gastric carcinomas, compared with advanced carcinomas (p>0.05). In the tumors larger than 10 cm with vascular invasion, NK cell number was lower around the tumor (p>0.05). Defining prognostic factors of gastric carcinomas is of importance to clinicians. It is thought that HSP70 immunoreactivity, besides invasion depth, lymph node metastasis, vascular invasion, tumor size and inflammatory reaction against the tumor, is important in prognosis and associated with advanced stage.

Increased risk of developing atrophic gastritis in patients infected with CagA+ Helicobacter pylori

BACKGROUND

To clarify the possible role of CagA positive (CagA+) Helicobacter pylori strains in the development of atrophic gastritis, the prevalence of antibodies to H. pylori and CagA (120 kD protein) was studied among subjects with atrophic and non-atrophic gastritis.

METHODS

The study population was randomly selected among 12,252 Finnish men who were screened for atrophic corpus gastritis with serum pepsinogen I-assay (S-PGI). S-PGI level was used as a selection criterion. Group A consisted of 295 subjects with S-PGI <25 microg/l (low), group B of 320 subjects with S-PGI 25-100 microg/l (normal) and group C of 338 subjects with S-PGI >100 microg/l (high). Antibodies to H. pylori were measured with EIA and immunoblot analysis and antibodies to CagA with immunoblot analysis. Endoscopical and histological examinations were performed for 203 patients from group A.

RESULTS

The prevalence of antibodies to H. pylori was significantly lower in group B than in groups A or C (P < 0.0001, chi-squared test). There was a significant association between the prevalence of antibodies to CagA and the lowered level of S-PGI (P < 0.0001, Jonckheere-Terpstra trend test). There was also a linear decrease in the prevalence of antibodies to CagA as the atrophic corpus gastritis became more severe (P < 0.0001, linear-by-linear trend test).

CONCLUSION

The presence of antibodies to CagA seems to be associated with development of atrophic corpus gastritis.

Pathological disorders of the gastric mucosa surrounding carcinomas and primary lymphomas

OBJECTIVE

Gastritis, intestinal metaplasia, atrophy, and dysplasia are disorders that frequently precede the full development of gastric adenocarcinoma. On the other hand, primary gastric lymphomas seem to arise from mucosa-associated lymphoid tissue. It is well accepted that these histological changes are caused by Helicobacter pylori infection. The objective of this study is to determine the frequency and characteristics of epithelial and lymphoid tissue disorders of the gastric mucosa surrounding primary carcinomas and lymphomas.

METHODS

We studied 111 gastrectomies from patients harboring primary adenocarcinomas (30 intestinal and 30 diffuse type) and 51 gastric lymphomas. For comparative purposes, we analized 86 stomachs from patients who died of diseases other than gastric malignancies. Histopathological disorders of the gastric mucosa adjacent to primary neoplasms such as atrophy, intestinal metaplasia, and dysplasia were recorded. Lymphoid follicles were classified in two groups, with or without expansion. Expansion was characterized by increased size, irregular borders, enlarged marginal zone, and expanded germinal centers. Differences were statistically evaluated with chi2 and Fisher exact tests, odds ratio, and relative risk, with 95% CI. p values <0.05 were considered statistically significant.

RESULTS

Most intestinal-type adenocarcinomas showed atrophy (76.6%) and intestinal metaplasia (86.6%) and less frequently, dysplasia (23.3%), in the surrounding gastric mucosa. Expansive lymphoid follicles were more frequent among lymphomas than in adenocarcinomas (56.8% vs 25%); however, a high percentage of lymphomas were also associated with atrophy (50.9%), intestinal metaplasia (62.7%), and rarely dysplasia (11.8%). On the contrary, diffuse-type adenocarcinoma displayed less frequently atrophy (33%), intestinal metaplasia (50%), and dysplasia (3%). Gastric mucosa from patients without any gastric neoplasia was almost normal (84%), whereas the remaining 16% showed, both or alone, atrophy and intestinal metaplasia.

CONCLUSION

Histopathological disorders of the gastric mucosa are not specific for any neoplasm, but intestinal-type adenocarcinomas frequently showed atrophy, intestinal metaplasia, and not uncommonly, dysplasia of the surrounding non-neoplastic gastric mucosa. Diffuse-type adenocarcinomas did not frequently show such lesions. Primary lymphomas displayed expansive lymphoid follicles and also a high percentage of atrophy and intestinal metaplasia of the surrounding gastric mucosa. The presence of intestinal metaplasia, atrophy, and lymphoid follicles with expansion in endoscopic biopsies could suggest a higher suceptibility for the development of gastric intestinal-type adenocarcinoma or gastric lymphoma. Patients harboring such histopathological changes must receive eradication therapy against H. pylori and probably closer follow-up.

Screening markers for chronic atrophic gastritis in Chiapas, Mexico

Intestinal-type gastric adenocarcinomas usually are preceded by chronic atrophic gastritis. Studies of gastric cancer prevention often rely on identification of this condition. In a clinical trial, we sought to determine the best serological screening method for chronic atrophic gastritis and compared our findings to the published literature. Test characteristics of potential screening tests (antibodies to Helicobacter pyloni or CagA, elevated gastrin, low pepsinogen, increased age) alone or in combination were examined among consecutive subjects enrolled in a study of H. pylori and preneoplastic gastric lesions in Chiapas, Mexico; 70% had chronic atrophic gastritis. English-language articles concerning screening for chronic atrophic gastritis were also reviewed. Sensitivity for chronic atrophic gastritis was highest for antibodies to H. pylori (92%) or CagA, or gastrin levels >25 ng/l (both 83%). Specificity, however, was low for these tests (18, 41, and 22%, respectively). Pepsinogen levels were highly specific but insensitive markers of chronic atrophic gastritis (for pepsinogen I <25 microg/l, sensitivity was 6% and specificity was 100%; for pepsinogen I:pepsinogen II ratio <2.5, sensitivity was 14% and specificity was 96%). Combinations of markers did not improve test characteristics. Screening test characteristics from the literature varied widely and did not consistently identify a good screening strategy. In this study, CagA antibodies alone had the best combination of test characteristics for chronic atrophic gastritis screening. However, no screening test was both highly sensitive and highly specific for chronic atrophic gastritis.

Severity of chronic atrophic gastritis and subsequent gastric cancer occurrence: a 10-year prospective cohort study in Japan

Chronic atrophic gastritis is regarded as a predisposing factor for gastric cancer associated with Helicobacter pylori infection, and its severity is suggested to be a key influence on gastric cancer risk. Our purpose was to elucidate chronological change in cumulative risk of gastric cancer occurrence with various degrees of chronic atrophic gastritis by long-term follow-up. A total of 5373 subjects without cancer or resected stomachs who underwent gastroscopic examination and completed a life-style questionnaire between 1985-1989 were prospectively followed until December 1999. Relative risks of gastric cancer associated with baseline endoscopic findings were estimated using hazard ratios and their 95% confidence intervals with the Cox proportional hazard model, adjusting for gender, age and gastric cancer family history. After an average of 10 years of follow-up, 117 gastric cancer cases were identified. The risk was greatest among the subjects with moderate atrophy at baseline (hazard ratio: 2.22) and 4-6 years of follow-up (hazard ratio: 4.6-5.0). After this time point, risk attenuation with the length of follow-up period was observed. Our study gives the supportive evidence to the hypothesis that incomplete chronic atrophic gastritis and the processes occurring in atrophy are associated with development of gastric cancer.

Association of Helicobacter pylori infection with atrophic gastritis and intestinal metaplasia

AIMS

To evaluate the effect of Helicobacter pylori infection and aging on atrophy and intestinal metaplasia of the gastric mucosa.

METHODS

One hundred and sixty-three patients were divided into three age groups and underwent an upper gastrointestinal endoscopy where no esophagitis, peptic ulcers, or malignancies were detected. Two biopsy specimens were obtained from the anterior and posterior walls of the antrum and of the fundus. These were used to evaluate the grade of gastritis, bacterial culture and histologic evidence of H. pylori infection.

RESULTS

Helicobacter pylori infection was found to be directly associated with an increased risk of gastritis grade (odds ratio (OR) = 90 (95% CI; 30-270)). An age of 60 years and older along with H. pylori infection was also strongly associated with an increased risk of atrophy (OR = 6.6, (95% CI; 2.9-15.2)); OR = 9.8, (95% CI; 2.7-35.4)), as was intestinal metaplasia of the gastric mucosa (OR = 5.5, (95% CI; 1.7-17.6)); OR = 7.9, (95% CI; 2.8-46.1)). The prevalence of atrophic gastritis increased with advancing age in H. pylori-infected patients, but no such phenomenon was observed in H. pylori-uninfected patients. The prevalence of intestinal metaplasia significantly increased with advancing age, irrespective of the presence of H. pylori infection. In addition, H. pylori uninfected female patients had a decreased risk of intestinal metaplasia.

CONCLUSIONS

These results suggest that atrophic gastritis is not a normal aging process, but instead is likely to be the result of H. pylori infection, while intestinal metaplasia is caused by both the aging process and H. pylori infection. A decreased risk of intestinal metaplasia found in uninfected female subjects may partly explain the lower prevalence of gastric cancer in females than in males.

Green tea consumption and chronic atrophic gastritis: a cross-sectional study in a green tea production village

Chronic atrophic gastritis (CAG) is well known as a precancerous lesion of the stomach, and Helicobacter pylori (H. pylori) infection increases the risk of CAG. While recent studies have reported that green tea consumption decreases the risk of gastric cancer, there has been no study analyzing the relationship between green tea consumption and the both risks H. pylori infection and CAG. We conducted a cross-sectional study on 636 subjects living in a farming village in Japan to examine the relationship among green tea consumption, H. pylori infection, and CAG. Smoking, alcohol drinking, consumption of four beverages, including green tea, and of five foods were investigated as lifestyle factors that may affect H. pylori infection and CAG. The measurement of H. pylori-IgG antibodies was used to define H. pylori infection, and serum pepsinogens were used to define of CAG. The unconditional logistic regression model was used for analyzing each odds ratio (OR). H. pylori infection was positively associated with the risk of CAG (OR = 3.73; 95% confidence interval [CI], 2.59-5.36). High green tea consumption (more than 10 cups per day) was negatively associated with the risk of CAG, even after adjustment for H. pylori infection and lifestyle factors associated with green tea consumption (OR = 0.63; 95% CI, 0.43-0.93). These results support the hypothesis that high green tea consumption prevents CAG.

Relationship between serologically diagnosed chronic atrophic gastritis, Helicobacter pylori, and environmental factors in Japanese men

BACKGROUND

Whereas chronic atrophic gastritis is known to be an intermediate stage in gastric carcinogenesis, information is sparse about factors associated with this precancerous lesion except for Helicobacter pylori.

METHODS

In a cross-sectional study of 566 men aged 50-55 years in the Japan Self-Defense Forces, we examined the relation of H. pylori infection, smoking, alcohol use, and dietary factors to the prevalence of chronic atrophic gastritis as determined by serum pepsinogen I and pepsinogen II (I/II ratio < 3.0. and pepsinogen I < 70 ng/ml). Chronic atrophic gastritis was classified as severe when the pepsinogen I/II ratio was < 2.0, and as moderate otherwise.

RESULTS

The overall prevalence of chronic atrophic gastritis was 35.7% (202 of 566). The seropositivity of H. pylori was associated with a 10-fold increase in the risk of chronic atrophic gastritis, and the association was much stronger for moderate atrophic gastritis. Neither cigarette smoking nor alcohol consumption was related to the overall risk of chronic atrophic gastritis. Consumption of vegetables and fruits was each unrelated to chronic atrophic gastritis whether examined as a whole or separately for moderate and severe atrophic gastritis. Green tea was related to decreased risk of severe atrophic gastritis, although not statistically significant, whereas garlic consumption showed no protective association.

CONCLUSIONS

The findings corroborate that H. pylori infection has an important role in the development of chronic atrophic gastritis in middle-aged Japanese men. Green tea consumption may be protective against the advance of atrophic gastritis. Vegetables, fruits, or garlic had no protective effect against the development of atrophic gastritis in the study.

Chronic atrophic gastritis and Helicobacter pylori infection among Japanese Americans in Seattle

Gastric cancer is still a major cause of mortality due to cancer worldwide. The most common type of gastric cancer is intestinal type carcinoma, which usually occurs in stomachs containing chronic atrophic gastritis. Individuals with chronic atrophic gastritis are considered to be at increased risk for developing intestinal type carcinoma of the stomach. To examine the association between chronic atrophic gastritis and other gastric cancer risk factors, a cross-sectional study was conducted using serum samples and questionnaire information collected from 776 persons of full Japanese ancestry in the greater Seattle area in 1994. The presence of chronic atrophic gastritis and Helicobacter pylori infection was determined by measurement of serum pepsinogen levels and H. pylori antibodies, respectively. Based on multiple logistic regression, the significant predictors of chronic atrophic gastritis were age over 50 years, H. pylori infection, and 20 years or more lived in Japan. Alcohol consumption, smoking, prior peptic ulcer, and history of gastric cancer in parents were not significantly associated with chronic atrophic gastritis. The results imply that H. pylori infection since earlier life and other unknown exposure factors in Japan might have played an important role in the development of chronic atrophic gastritis.

Atrophic gastritis and Helicobacter pylori infection in outpatients referred for gastroscopy

BACKGROUND

Atrophic gastritis has been shown to be one of the long term sequelae of Helicobacter pylori infection.

AIMS

To determine the prevalence of atrophic gastritis in outpatients, to study the accuracy of serological methods for revealing atrophy, and to define the association of H pylori infection with atrophic gastritis in these patients.

PATIENTS/METHODS

A total of 207 consecutive outpatients referred for gastroscopy were included. Biopsy specimens from the antrum and corpus were assessed histologically according to the Sydney system. Serum samples were studied for H pylori IgG and IgA antibodies by enzyme immunoassay, CagA antibodies by immunoblot, pepsinogen I by an immunoenzymometric assay, gastrin by radioimmunoassay, and parietal cell antibodies by indirect immunofluorescence.

RESULTS

Histological examination revealed atrophic gastritis in 52 (25%) of 207 patients. H pylori and CagA antibodies were strongly associated with atrophic antral gastritis but poorly associated with atrophic corpus gastritis. Low serum pepsinogen I was the most sensitive and specific indicator of moderate and severe atrophic corpus gastritis. All six patients with moderate atrophic corpus gastritis had H pylori infection but eight of 10 patients with severe atrophic corpus had increased parietal cell antibodies and nine had no signs of H pylori infection.

CONCLUSIONS

Atrophic antral gastritis was strongly associated with CagA positive H pylori infection. Severe atrophic corpus gastritis was not determined by H pylori tests but low serum pepsinogen I, high gastrin, and parietal cell antibodies may be valuable in detecting these changes.

Helicobacter pylori infection is a major risk factor for gastric carcinoma in young patients

BACKGROUND

Helicobacter pylori has been established as a risk factor for gastric carcinoma (GCa). Since before the discovery of H. pylori, atrophic gastritis and intestinal metaplasia have been linked to GCa, especially the intestinal-type tumor. The prevalence of H. pylori infection and atrophic gastritis increase with age. Thus, analysis of H. pylori infection in young patients with GCa could help clarify the role of this bacterium in the development of GCa. Accordingly, we investigated the relationship between H. pylori infection, GCa, and histologic gastritis in patients less than 30 years old.

METHODS

Fifty GCa patients less than 30 years (mean, 26.4 years) and 100 sex- and age-matched controls (mean, 26.8 years) were examined for the presence of H. pylori infection and histologic gastritis.

RESULTS

The prevalence of H. pylori infection was significantly higher in GCa patients than in controls (94% versus 40%, P < 0.01). Its prevalence was not associated with tumor location, tumor stage, or histologic type. Gastritis, atrophy, and intestinal metaplasia significantly increased the risk of GCa. By means of multiple logistic regression analysis, the odds ratio for the risk of GCa in H. pylori-positive subjects was found to be 23.5 (95% confidence interval, 6.84-80.7).

CONCLUSIONS

We confirmed a strong association between H. pylori infection and GCa in young patients. Along with H. pylori infection, histologic gastritis might play an important role in the pathogenesis of GCa in these patients.

Does acid suppression by antacids and H2 receptor antagonists increase the incidence of atrophic gastritis in patients with or without H. pylori gastritis?

Currently there is controversial evidence that suggests that the accepted incidence of atrophic gastritis of 1.2 to 3.3% in patients with Helicobacter pylori gastritis may be increased by the long-term suppression of acid by a proton pump inhibitor (omeprazole). The purpose of this study is to show whether lesser forms of acid suppression by antacids or H2 receptor antagonists may have an influence on the development of atrophic gastritis. The authors recently reported a study in which a cohort of 36 patients with symptoms of dyspepsia were followed clinically for a period of 7 to 19 years. In that report all subjects underwent upper endoscopy with two biopsy specimens each from the antrum and fundus, on at least two occasions, 7 to 19 years apart. A diagnosis of atrophic gastritis was based on the interpretation of these biopsies by two gastrointestinal pathologists. The presence of H. pylori colonization was determined by tissue sampling and by a campylobacter-like organisms test of the antrum. Of the 36 patients in the authors' previous report, 33 had adequate baseline and follow-up data on medications consumed throughout the period of the study. In their current report they now present the findings of a retrospective review in which they correlate the presence of atrophic gastritis with the sole use of antacids and H2 receptor antagonists throughout the period of the study. In the cohort of 33 patients evaluated from the previous report, the authors found that atrophic gastritis had developed in all 28 patients positive for H. pylori, and in none of the 5 patients negative for H. pylori (p < 0.0001). A retrospective analysis of this previously studied cohort of 33 patients revealed that the use of antacids and H2 receptor antagonists did not predict the development of atrophic gastritis in either H. pylori-negative or -positive subjects. In a retrospective analysis of a cohort of 33 patients followed for an average of 11.7 years, atrophic gastritis developed in H. pylori-positive but not in H. pylori-negative subjects, irrespective of the use and duration of antacids or H2 receptor antagonists.

Helicobacter antibodies in Finnish centenarians

BACKGROUND

The prevalence of helicobacter antibodies increases with age and, in many developed countries, is highest in people born before 1940. Data on very old subjects are, however, limited. In this study we wanted to determine whether the age-related increase in the seroprevalence of H. pylori infection continues even in the oldest age group alive in Finland, the centenarians.

METHODS

Sera from 173 subjects (93% of all centenarians alive in Finland in 1991) were available for the present study. IgG and IgA antibodies against H. pylori were determined by an in-house enzyme immunoassay. To estimate the influence of atrophic gastritis on the prevalence of helicobacter antibodies, serum pepsinogen I (PG I) concentrations and parietal cell antibodies (PCAs) were measured by an enzyme immunoassay and indirect immunofluorescence, respectively.

RESULTS

The prevalence of helicobacter antibodies in Finnish centenarians was 66%. Low PG I values (<28 microg/l) were found in 36% and positive PCAs in 16% of the subjects studied. The prevalence of PCAs was especially high (50%) in H. pylori-negative subjects with low PG I values, suggesting severe gastric atrophy.

CONCLUSIONS

The age-related increase in H. pylori seroprevalence did not continue in the oldest age group alive in Finland. This may be explained partly by a relatively high frequency of atrophic gastritis (as suggested by low PG I values) in H. pylori-negative centenarians, but other factors--such as selective H. pylori-related mortality--may also have contributed to the fairly low seroprevalence (66%) observed.

The role of endoscopic findings for the diagnosis of Helicobacter pylori infection: evaluation in a country with high prevalence of atrophic gastritis

BACKGROUND

This study examines endoscopic findings in the diagnosis of Helicobacter pylori (H. pylori) in the Japanese population.

MATERIALS AND METHODS

The endoscopic findings (including gastric fold findings and degree of atrophy by the Kimura-Takemoto classification system), histologic severity of inflammation, and glandular atrophy were assessed according to the Sydney system in 642 patients (419 men; 223 women; mean age 43.5 years, range 13-86). H. pylori infection was evaluated by Giemsa staining and serum IgG antibodies.

RESULTS

391 of 642 patients (60.9%) were diagnosed as having endoscopic gastritis. Of the 391 patients with endoscopic gastritis, 318 (82.6%) had histologic gastritis and 310 (79.3%) had H. pylori infection. Of the 251 patients with endoscopically normal stomachs, 43 (17.1%) had histologic gastritis and 32 (12.7%) had H. pylori infection. Atrophic gastritis was the most prevalent finding (56.3%) among those with endoscopic gastritis. The prevalence of H. pylori infection in patients with atrophic gastritis (92.7%) and rugal hyperplastic gastritis (92.3%) was significantly higher than in those with other types of gastritis or with a normal stomach (12. 7%). A markedly high prevalence of H. pylori infection was found in subjects with tortuosity, hyperrugosity, and/or hyporugosity of the gastric folds.

CONCLUSIONS

The accurate endoscopic assessment of gastritis according to the Sydney system along with gastric fold findings and the endoscopically identified extent of gastric atrophy are valuable indicators for determining H. pylori infection and histologic gastritis in the Japanese population.

Precancerous lesions in two counties of China with contrasting gastric cancer risk

BACKGROUND

Gastric cancer (GC) is one of the most common cancers worldwide and shows remarkable geographical variation even within countries such as China. Linqu County in Shandong Province of northeast China has a GC rate that is 15 times higher than that of Cangshan County in Shandong, even though these counties are within 200 miles of each other.

METHOD

In order to evaluate the frequency of precancerous gastric lesions in Linqu and Cangshan Counties we examined 3400 adults in Linqu County and 224 adults in Cangshan County. An endoscopic examination with four biopsies was performed in each individual of the two populations.

RESULTS

The prevalence of intestinal metaplasia (IM) and dysplasia (DYS) was 30% and 15.1%, respectively, in Linqu compared to 7.9% and 5.6% in Cangshan (P < 0.01). Within these histological categories, advanced grades were found more often in Linqu than in Cangshan. The prevalences of IM and DYS were more common at each biopsy site in Linqu, where the lesions also tended to affect multiple sites.

CONCLUSIONS

The findings of this study support the concept that IM and DYS are closely correlated with risks of GC and represent late stages in the multistep process of gastric carcinogenesis.

Autoantibodies reacting with gastric antigens in Helicobacter pylori associated body gastritis of dyspeptic children

BACKGROUND

Helicobacter pylori induced antibodies reacting with fundal mucosa have been shown to be involved in the pathogenesis of chronic atrophic gastritis in adults. Furthermore, previous reports have indicated that Helicobacter pylori increases the risk of gastric carcinoma, suggesting that the bacterium plays a role in mucosal changes representing especially in adulthood important steps in the progression from gastritis to cancer.

PATIENTS AND METHODS

We investigated 16 Helicobacter pylori+ children from a series of 53 dyspeptic patients. Diagnosis of Helicobacter pylori infection was based on the positivity of at least 3 of the following tests: serology, 13C-urea breath test, rapid urease test and histology. Autoreaction was detected by incubation of gastric body sections with autologous sera and revealed by immunohistochemistry. Positive sera were tested with samples of unaffected gastric body to exclude a link with residual bacterial antigens. Proliferating cell nuclear antigen immunohistostain was also performed to evaluate the epithelial proliferative state.

RESULTS

Histologically 6 out of 16 Helicobacter pylori+ patients showed chronic pangastritis. In the remaining 10 Helicobacter pylori-related mucosal inflammation was confined to the antrum. All 6 subjects with pangastritis and 3 out of 10 with antral gastritis were anti-CagA+. The autoreaction was found in a 10-year old male child with Helicobacter pylori+ pangastritis and a clinical history of ulcer-like dyspepsia. Parietal cells, in particular, were involved and showed diffuse cytoplasm staining. Proliferating cell nuclear antigen expression demonstrated, only in this case, a zone of regeneration extending from the normal site in the neck towards the base of the glands.

CONCLUSIONS

Our finding demonstrates that an autoreaction of gastric mucosa may be found in Helicobacter pylori gastritis of childhood. Its association with some known risk factors (i.e., cytotoxic strains and increased proliferation of gastric epithelium with a changed pattern) may play a role in the progression from gastritis to atrophy and account for the increased risk of late gastric cancer when Helicobacter pylori infection occurs in paediatric age.

Correlation of ratio of serum pepsinogen I and II with prevalence of gastric cancer and adenoma in Japanese subjects

OBJECTIVE

Gastric cancer (GC) and adenoma (GA) are reported to be related to atrophic gastritis, in which the serum pepsinogen (PG) I level and the PGI/PGII ratio (I/II ratio) are reduced. To verify that the finding of a low PG level increases the risk for GC and GA, we investigated the correlation between low PG levels and the prevalence of GC and GA in individuals.

METHODS

The 2,039 subjects (734 Japanese men, mean age 68.5 yr, and 1,305 women, mean age 66.7 yr), selected from among 10,996 local residents who underwent health check-ups based on reductions in their serum PG levels, underwent upper gastrointestinal endoscopy.

RESULTS

Gastrointestinal endoscopy detected 21 GCs and 15 GAs. The prevalence of GC was higher than that in the residents without low serum PG. The percentage of early stage of GC (90%) was significantly higher than that of GC detected in unscreened residents (56.9%). The prevalence of GC in men was closely and significantly correlated with the I/II ratio (r = 0.935, p = 0.0063), whereas there was less correlation with age (r = 0.842, p = 0.0734). The prevalence of GA was also closely and significantly correlated with the I/II ratio in men (r = 0.881, p = 0.0203), but not with age (r = 0.163, p = 0.7928). In women the prevalence of GC (r = 0.744, p = 0.090) and GA (r = 0.678, p = 0.1392) did not correlate as strongly with the I/II ratio, although the highest prevalence was seen in the group with the lowest I/II ratio.

CONCLUSION

Our study verified that a low I/II ratio signifies a high risk for GC and GA and that measuring serum PG levels can be used as a screening method for GC and GA.