Comparative analysis of upper gastrointestinal endoscopy, double-contrast upper gastrointestinal barium X-ray radiography, and the titer of serum anti-Helicobacter pylori IgG focusing on the diagnosis of atrophic gastritis

Genetic Polymorphism in Alcohol Metabolism and Drinking Behavior Are Associated with Gastric Cancer Risk in Men

Objective In recent years, there has been a growing focus on health risks associated with alcohol consumption. The present study investigated whether or not the genetic variant of aldehyde dehydrogenase 2 (ALDH2) influences the risk of gastric cancer among individuals identified as hazardous drinkers using the Alcohol Use Disorders Identification Test (AUDIT), which provides a comprehensive assessment of hazardous drinking behavior. Patients We enrolled men with hazardous drinking behavior (AUDIT score ≥8) who had undergone gastric cancer screening (either endoscopy or a barium X-ray examination of the upper gastrointestinal tract) between April 2013 and March 2020 within 1 year from entry and who had subsequently undergone at least one more gastric cancer screening up to March 2021. Functional single-nucleotide polymorphisms of ALDH2 (rs671) were measured using a direct TaqMan polymerase chain reaction method with unprocessed saliva. Results A total of 246 men were enrolled, comprising 193 individuals with active ALDH2 (ALDH2*1/*1) and 53 with less-active ALDH2 (ALDH2*1/*2). The cumulative incidence of gastric cancer in the less-active group was higher than in the active ALDH2 group (p=0.01, hazard ratio: 4.6, 95% confidence interval: 1.2-16.7). Alcohol consumption was lower in the less-active ALDH2 group than in the active ALDH2 group, although no marked difference was observed in the AUDIT score. Conclusion In individuals with hazardous drinking behavior, a heightened risk of gastric cancer was observed among those with less-active ALDH2 variants, even when their alcohol consumption was comparatively lower than in those with active ALDH2 variants.

Marked intestinal trans-differentiation by autoimmune gastritis along with ectopic pancreatic and pulmonary trans-differentiation

BACKGROUND

Autoimmune gastritis (AIG) is a prevalent chronic inflammatory disease with oncogenic potential that causes destruction of parietal cells and severe mucosal atrophy. We aimed to explore the distinctive gene expression profiles, activated signaling pathways, and their underlying mechanisms.

METHODS

A comprehensive gene expression analysis was conducted using biopsy specimens from AIG, Helicobacter pylori-associated gastritis (HPG), and non-inflammatory normal stomachs. Gastric cancer cell lines were cultured under acidic (pH 6.5) conditions to evaluate changes in gene expression.

RESULTS

Gastric mucosa with AIG had a unique gene expression profile compared with that with HPG and normal mucosa, such as extensively low expression of ATP4A and high expression of GAST and PAPPA2, which are involved in neuroendocrine tumorigenesis. Additionally, the mucosa with AIG and HPG showed the downregulation of stomach-specific genes and upregulation of small intestine-specific genes; however, intestinal trans-differentiation was much more prominent in AIG samples, likely in a CDX-dependent manner. Furthermore, AIG induced ectopic expression of pancreatic digestion-related genes, PNLIP, CEL, CTRB1, and CTRC; and a master regulator gene of the lung, NKX2-1/TTF1 with alveolar fluid secretion-related genes, SFTPB and SFTPC. Mechanistically, acidic conditions led to the downregulation of master regulator and stemness control genes of small intestine, suggesting that increased environmental pH may cause abnormal intestinal differentiation in the stomach.

CONCLUSIONS

AIG induces diverse trans-differentiation in the gastric mucosa, characterized by the transactivation of genes specific to the small intestine, pancreas, and lung. Increased environmental pH owing to AIG may cause abnormal differentiation of the gastric mucosa.

Diagnostic Accuracy of Narrow-Band Imaging in Predicting Helicobacter pylori Gastritis in Patients With Dyspepsia

Background Helicobacter pylori (H. pylori) is one of the most prevalent causes of chronic gastritis that can lead to gastric cancer if left untreated. Currently, endoscopy and histology are the gold standard tests for the diagnosis of H. pylori gastritis. Recently, studies have shown the utility of narrow-band imaging (NBI) in predicting H. pylori gastritis. Therefore, we aimed to determine the diagnostic accuracy of NBI in predicting H. pylori gastritis in patients with dyspepsia. Methodology After obtaining approval from the Ethical Review Committee, Sindh Institute of Urology and Transplantation, this cross-sectional study was conducted in the outpatient Clinic of Hepatogastroenterology of the institute. Inclusion criteria involved all patients of either gender aged 18 to 65 years with dyspeptic symptoms. We excluded patients with a history of proton pump inhibitor use within two weeks before endoscopy, heart failure, previous gastrectomy, portal gastropathy, cirrhosis, use of antiplatelet medications, non-steroidal anti-inflammatory drugs or anticoagulant medication, and hemorrhagic or thrombophilia disorders. Each patient underwent endoscopy-guided NBI studies followed by biopsies from the antrum and body of the stomach. Multivariate logistic regression analysis was performed for the type of NBI pattern predicting H. pylori infection. The diagnostic accuracy was obtained individually for each NBI type and then for the presence of either two or all three NBI types in predicting H. pylori gastritis. Results Out of the total 775 patients enrolled in the study, abnormal NBI patterns were observed in 401 (51.7%) patients. The presence of abnormal NBI antral mucosal pattern on endoscopy was significantly associated with H. pylori infection (p < 0.001) with excellent diagnostic accuracy. Among the three NBI types, individually, NBI type III had excellent specificity and better diagnostic accuracy in predicting H. pylori gastritis than the other two types. Furthermore, the presence of all three abnormal NBI patterns (I+II+III) together was significantly associated with the presence of H. pylori gastritis with a sensitivity of 94.54%, specificity of 86.55%, and diagnostic accuracy of 90.32%. Conclusions NBI on endoscopy shows excellent diagnostic accuracy in identifying H. pylori gastritis in patients with dyspepsia. However, multicenter studies are required not only to validate our results but also to predict the pre-cancerous lesions on NBI in patients with H. pylori gastritis.

Raman Spectroscopy and Imaging Studies of Human Digestive Tract Cells and Tissues-Impact of Vitamin C and E Supplementation

Cancers of digestive tract such as colorectal cancer (CRC) and gastric cancer (GC) are the most commonly detected types of cancer worldwide and their origin can be associated with oxidative stress conditions. Commonly known and followed antioxidants, such as vitamin C and E, are widely considered as potential anti-cancer agents. Raman spectra have great potential in the biochemical characterization of matter based on the fact that each molecule has its own unique vibrational properties. Raman spectroscopy allows to precisely characterize components (proteins, lipids, nucleic acids). The paper presents the application of the Raman spectroscopy technique for the analysis of tissue samples and cells of the human colon and stomach. The main goal of this study is to show the differences between healthy and cancerous tissues from the human digestive tract and human normal and cancer colon and gastric cell lines. The paper presents the spectroscopic characterization of normal colon cells, CCD-18 Co, in physiological and oxidative conditions and effect of oxidative injury of normal colon cells upon supplementation with vitamin C at various concentrations based on Raman spectra. The obtained results were related to the Raman spectra recorded for human colon cancer cells-CaCo-2. In addition, the effect of the antioxidant in the form of vitamin E on gastric cancer cells, HTB-135, is presented and compared with normal gastric cells-CRL-7869. All measured gastric samples were biochemically and structurally characterized by means of Raman spectroscopy and imaging. Statistically assisted analysis has shown that normal, ROS injured and cancerous human gastrointestinal cells can be distinguished based on their unique vibrational properties. ANOVA tests, PCA (Principal Component Analysis) and PLSDA (Partial Least Squares Discriminant Analysis) have confirmed the main role of nucleic acids, proteins and lipids in differentiation of human colon and stomach normal and cancer tissues and cells. The conducted research based on Raman spectra proved that antioxidants in the form of vitamin C and E exhibit anti-cancer properties. In consequence, conducted studies proved that label-free Raman spectroscopy may play an important role in clinical diagnostic differentiation of human normal and cancerous gastrointestinal tissues and may be a source of intraoperative information supporting histopathological analysis.

Clinicopathological features and prognosis of developed gastric cancer based on the diagnosis of mucosal atrophy and enlarged folds of stomach by double-contrast upper gastrointestinal barium X-ray radiography

BACKGROUND

Mucosal atrophy and enlarged folds of stomach by double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) are two major features of Helicobacter pylori-induced chronic gastritis. These were previously shown to be risk indicators of gastric cancer, but their predictability for clinicopathological characters of developed gastric cancer is unelucidated. In addition, evidence for decreasing the mortality of gastric cancer by appropriate follow-up of UGI screening is needed.

METHODS

The 5134 generally healthy UGI-XR examinees, who underwent follow-up UGI-XR or upper gastrointestinal endoscopy (UGI-ES) more than once, were prospectively observed for 10 years.

RESULTS

At the beginning of follow-up, 1515 (29.5%) had mucosal atrophy and 990 (19.5%) had enlarged folds. For the serum anti-H. pylori IgG, 1301 (25.3%) were positive, 177 (3.4%) were possibly positive, and 3656 (71.2%) were negative. During the 10-year observation period, gastric cancer developed in 15 subjects, among which 13 had mucosal atrophy and 10 had enlarged folds. These two features were expectedly useful indicators for gastric cancer incidence, but they showed no significant association with tumor stage or histological type of developed cancer. Only one of the 5134 subjects died of gastric cancer during 10 years, which was significantly lower than the predicted number of gastric cancer death (6.78 for 10 years) according to the mortality rate in Japan.

CONCLUSIONS

Neither mucosal atrophy nor enlarged folds of stomach showed a significant association with clinicopathological features of developed gastric tumors. Appropriate follow-up of cancer screening by UGI-XR or UGI-ES can reduce the risk of gastric cancer-related death.

Stomach 3D Reconstruction Using Virtual Chromoendoscopic Images

Gastric endoscopy is a golden standard in the clinical process that enables medical practitioners to diagnose various lesions inside a patient’s stomach. If a lesion is found, a success in identifying the location of the found lesion relative to the global view of the stomach will lead to better decision making for the next clinical treatment. Our previous research showed that the lesion localization could be achieved by reconstructing the whole stomach shape from chromoendoscopic indigo carmine (IC) dye-sprayed images using a structure-from-motion (SfM) pipeline. However, spraying the IC dye to the whole stomach requires additional time, which is not desirable for both patients and practitioners. Our objective is to propose an alternative way to achieve whole stomach 3D reconstruction without the need of the IC dye. We generate virtual IC-sprayed (VIC) images based on image-to-image style translation trained on unpaired real no-IC and IC-sprayed images, where we have investigated the effect of input and output color channel selection for generating the VIC images. We validate our reconstruction results by comparing them with the results using real IC-sprayed images and confirm that the obtained stomach 3D structures are comparable to each other. We also propose a local reconstruction technique to obtain a more detailed surface and texture around an interesting region. The proposed method achieves the whole stomach reconstruction without the need of real IC dye using SfM. We have found that translating no-IC green-channel images to IC-sprayed red-channel images gives the best SfM reconstruction result. Clinical impact We offer a method of the frame localization and local 3D reconstruction of a found gastric lesion using standard endoscopy images, leading to better clinical decision.

Inverse time trends of peptic ulcer and reflux esophagitis show significant association with reduced prevalence of Helicobacter pylori infection

INTRODUCTION

Recent prevalence and trends of gastric/duodenal ulcer (GU/DU) and reflux esophagitis (RE) are inadequate.

METHODS

We reviewed the records of consecutive 211,347 general population subjects from 1991 to 2015.

RESULTS

During the 25 years, the prevalence of GU and DU has gradually decreased (from 3.0% to 0.3% and from 2.0% to 0.3%) whereas that of RE has markedly increased (from 2.0% to 22%). The prevalence of Helicobacter pylori (HP) infection has decreased from 49.8% (in 1996) to 31.2% (in 2010). Multivariable logistic regression analyses demonstrated that HP infection was positively associated with GU/DU and negatively associated with RE with statistical significance. The panel data analyses showed that reduced rate of HP infection is proportionally correlated with decrease of GU/DU and inversely correlated with increase of RE. It is further suggested other latent factors should be important for changed prevalence of these three acid-related diseases. Age-period-cohort analysis indicated the significant association of older age, male gender, and absence of HP infection with RE.

CONCLUSIONS

The prevalence of GU and DU has gradually decreased whereas that of RE has markedly increased in Japan. Inverse time trends of peptic ulcer and reflux esophagitis are significantly associated with reduced prevalence of HP infection. KEY MESSAGES The prevalence of gastric and duodenal ulcer has gradually decreased whereas that of reflux esophagitis has markedly increased in Japan. The prevalence of Helicobacter pylori infection in Japan has greatly decreased from 49.8% to 31.2% during the 14 years (from 1996 to 2010). Inverse time trends of peptic ulcer and reflux esophagitis are associated with reduced prevalence of Helicobacter pylori infection with statistical significance.

Stomach 3D Reconstruction Based on Virtual Chromoendoscopic Image Generation

Gastric endoscopy is a standard clinical process that enables medical practitioners to diagnose various lesions inside a patient's stomach. If any lesion is found, it is very important to perceive the location of the lesion relative to the global view of the stomach. Our previous research showed that this could be addressed by reconstructing the whole stomach shape from chromoendoscopic images using a structure-from-motion (SfM) pipeline, in which indigo carmine (IC) blue dye-sprayed images were used to increase feature matches for SfM by enhancing stomach surface's textures. However, spraying the IC dye to the whole stomach requires additional time, labor, and cost, which is not desirable for patients and practitioners. In this paper, we propose an alternative way to achieve whole stomach 3D reconstruction without the need of the IC dye by generating virtual IC-sprayed (VIC) images based on image-to-image style translation trained on unpaired real no-IC and IC-sprayed images. We have specifically investigated the effect of input and output color channel selection for generating the VIC images and found that translating no-IC green-channel images to IC-sprayed red-channel images gives the best SfM reconstruction result.

Deep convolutional neural network-based anomaly detection for organ classification in gastric X-ray examination

AIM

The aim of this study was to determine whether our deep convolutional neural network-based anomaly detection model can distinguish differences in esophagus images and stomach images obtained from gastric X-ray examinations.

METHODS

A total of 6012 subjects were analyzed as our study subjects. Since the number of esophagus X-ray images is much smaller than the number of gastric X-ray images taken in X-ray examinations, we took an anomaly detection approach to realize the task of organ classification. We constructed a deep autoencoding gaussian mixture model (DAGMM) with a convolutional autoencoder architecture. The trained model can produce an anomaly score for a given test X-ray image. For comparison, the original DAGMM, AnoGAN, and a One-Class Support Vector Machine (OCSVM) that were trained with features obtained by a pre-trained Inception-v3 network were used.

RESULTS

Sensitivity, specificity, and the calculated harmonic mean of the proposed method were 0.956, 0.980, and 0.968, respectively. Those of the original DAGMM were 0.932, 0.883, and 0.907, respectively. Those of AnoGAN were 0.835, 0.833, and 0.834, respectively, and those of OCSVM were 0.932, 0.935, and 0.934, respectively. Experimental results showed the effectiveness of the proposed method for an organ classification task.

CONCLUSION

Our deep convolutional neural network-based anomaly detection model has shown the potential for clinical use in organ classification.

Serum CXCL13 and PECAM-1 can be used as diagnostic and prognostic markers in elderly patients with gastric cancer

PURPOSE

To investigate the application value of serum CXC Chemokine-13 (CXCL-13) and platelet endothelial cell adhesion molecule-1 (PECAM-1) in elderly patients with gastric cancer (GC).

METHODS

Ninety-eight elderly GC patients admitted to the Affiliated Hexian Memorial Hospital of Southern Medical University were selected as a research group, and 60 healthy subjects of the same age and in relatively good health who underwent physical examination at the same period were selected as a control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of CXCL13 and PECAM-1 in serum. The clinical diagnosis and prognostic value of serum CXCL13 and PECAM-1 in elderly GC patients were analyzed.

RESULTS

The levels of CXCL13 and PECAM-1 in serum of the research group were significantly higher than those of the control group (P < 0.001). The AUC value of combined diagnosis of elderly GC patients by serum CXCL13 and PECAM-1 was 0.950, and that of combined evaluation of prognosis of patients was 0.849. Serum CXCL13 and PECAM-1 were significantly related to TNM staging, differentiation degree and tumor diameter in elderly GC patients (P < 0.05). High levels of CXCL13 and PECAM-1 were significantly associated with lower 5-year OS (P < 0.05).

CONCLUSION

Elderly GC patients with higher TNM staging, longer tumor diameters, high levels of CXCL13 and PECAM-1 had an increased risk of poor prognosis. Serum CXCL13 and PECAM-1 can be used as effective indicators for diagnosis and prognosis of elderly patients with GC, and can predict the 5-year OS in patients.

3D Reconstruction of Whole Stomach from Endoscope Video Using Structure-from-Motion

Gastric endoscopy is a common clinical practice that enables medical doctors to diagnose the stomach inside a body. In order to identify a gastric lesion's location such as early gastric cancer within the stomach, this work addressed to reconstruct the 3D shape of a whole stomach with color texture information generated from a standard monocular endoscope video. Previous works have tried to reconstruct the 3D structures of various organs from endoscope images. However, they are mainly focused on a partial surface. In this work, we investigated how to enable structure-from-motion (SfM) to reconstruct the whole shape of a stomach from a standard endoscope video. We specifically investigated the combined effect of chromo-endoscopy and color channel selection on SfM. Our study found that 3D reconstruction of the whole stomach can be achieved by using red channel images captured under chromo-endoscopy by spreading indigo carmine (IC) dye on the stomach surface.

Whole Stomach 3D Reconstruction and Frame Localization From Monocular Endoscope Video

Gastric endoscopy is a common clinical practice that enables medical doctors to diagnose various lesions inside a stomach. In order to identify the location of a gastric lesion such as early cancer and a peptic ulcer within the stomach, this work addresses to reconstruct the color-textured 3D model of a whole stomach from a standard monocular endoscope video and localize any selected video frame to the 3D model. We examine how to enable structure-from-motion (SfM) to reconstruct the whole shape of a stomach from endoscope images, which is a challenging task due to the texture-less nature of the stomach surface. We specifically investigate the combined effect of chromo-endoscopy and color channel selection on SfM to increase the number of feature points. We also design a plane fitting-based algorithm for 3D point outliers removal to improve the 3D model quality. We show that whole stomach 3D reconstruction can be achieved (more than 90% of the frames can be reconstructed) by using red channel images captured under chromo-endoscopy by spreading indigo carmine (IC) dye on the stomach surface. In experimental results, we demonstrate the reconstructed 3D models for seven subjects and the application of lesion localization and reconstruction. The methodology and results presented in this paper could offer some valuable reference to other researchers and also could be an excellent tool for gastric surgeons in various computer-aided diagnosis applications.

Detection of gastritis by a deep convolutional neural network from double-contrast upper gastrointestinal barium X-ray radiography

BACKGROUND

Deep learning has become a new trend of image recognition tasks in the field of medicine. We developed an automated gastritis detection system using double-contrast upper gastrointestinal barium X-ray radiography.

METHODS

A total of 6520 gastric X-ray images obtained from 815 subjects were analyzed. We designed a deep convolutional neural network (DCNN)-based gastritis detection scheme and evaluated the effectiveness of our method. The detection performance of our method was compared with that of ABC (D) stratification.

RESULTS

Sensitivity, specificity, and harmonic mean of sensitivity and specificity of our method were 0.962, 0.983, and 0.972, respectively, and those of ABC (D) stratification were 0.925, 0.998, and 0.960, respectively. Although there were 18 false negative cases in ABC (D) stratification, 14 of those 18 cases were correctly classified into the positive group by our method.

CONCLUSIONS

Deep learning techniques may be effective for evaluation of gastritis/non-gastritis. Collaborative use of DCNN-based gastritis detection systems and ABC (D) stratification will provide more reliable gastric cancer risk information.

Risk factors for atrophic gastritis in the Japanese young and middle-aged: a study using double-contrast upper gastrointestinal barium X-ray radiography

PURPOSE

To identify risk factors for atrophic gastritis in Japanese young and middle-age subjects by double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR).

MATERIALS AND METHODS

We included 351 consecutive Japanese subjects (158 males, 193 females; age 25-49 years, mean 44 years) seen between October 2014 and March 2016. All underwent serum Helicobacter pylori (Hp) antibody- and UGI-XR examinations. Two radiologists independently recorded their UGI-XR findings of atrophic gastritis (AG). Interobserver agreement was assessed by calculating the kappa (κ) coefficient. Univariate and multivariate analyses were performed to investigate the association between AG and the subjects' gender, smoking habit, alcohol intake, body mass index, and Hp infection.

RESULTS

AG was diagnosed in 85 subjects (24%) on UGI-XR images; interobserver agreement was good (κ = 0.745). By univariate analysis, the male gender and a high serum Hp titer (IgG ≥ 10 U/ml) were significantly association with AG (p < 0.05). Multivariate analysis revealed that a high serum Hp titer was the only independent, significant factor (p < 0.05). The odds ratio for a high serum Hp titer was 128 (95% CI, 54.8-498.4).

CONCLUSION

Our UGI-XR study indicated that Hp infection was significantly associated with AG in Japanese young and middle-aged subjects.

Preliminary opinion on assessment categories of stomach ultrasound report and data system (Su-RADS)

OBJECTIVE

Transabdominal ultrasound after oral administration of an echoic cellulose-based gastric ultrasound contrast agent (TUS-OCCA) has recently been suggested as a valuable mass-screening tool for gastric cancer. The aim of this study was to propose a producible stomach ultrasound reporting and data system (Su-RADS) using TUS-OCCA for gastric cancer screening.

PATIENTS

The study includes information of 2738 patients who underwent both gastroscopy and TUS-OCCA examinations recorded in software system. Gastroscopy examination with pathological diagnosis was considered as gold standard. Various gastric lesions were classified into category 1-5 based on gastric wall thicknesses of them (especially the mucosa layer).

RESULTS

The total malignant ratios of patients enrolled in this study were 17.1% (469/2738). The malignant ratios for category 1-5 were, respectively, 1.1, 1.7, 12.2, 34.2 and 78.1%. Category 2 indicated mild thickening of gastric wall at low risk for malignancy (1.7%); category 3 indicated moderate thickening at moderate risk for malignancy (12.2%); category 4 indicated severe thickening at high risk for malignancy (34.2%); category 5 indicated extremely severe thickening at extremely high risk for malignancy (78.1%). If category 2 was identified as cut-off point distinguishing between benign and malignant, the sensitivity and specificity by Su-RADS are 95.1 and 78.6%, respectively.

CONCLUSION

The Su-RADS system could inform the physicians about key findings, indicating the risk for malignancy and necessity of additional gastroscopy examination. Prospectively randomly controlled study design with larger clinical trial is needed for further investigations.

Preliminary study of automatic gastric cancer risk classification from photofluorography

AIM

To perform automatic gastric cancer risk classification using photofluorography for realizing effective mass screening as a preliminary study.

METHODS

We used data for 2100 subjects including X-ray images, pepsinogen I and II levels, PGI/PGII ratio, Helicobacter pylori (H. pylori) antibody, H. pylori eradication history and interview sheets. We performed two-stage classification with our system. In the first stage, H. pylori infection status classification was performed, and H. pylori-infected subjects were automatically detected. In the second stage, we performed atrophic level classification to validate the effectiveness of our system.

RESULTS

Sensitivity, specificity and Youden index (YI) of H. pylori infection status classification were 0.884, 0.895 and 0.779, respectively, in the first stage. In the second stage, sensitivity, specificity and YI of atrophic level classification for H. pylori-infected subjects were 0.777, 0.824 and 0.601, respectively.

CONCLUSION

Although further improvements of the system are needed, experimental results indicated the effectiveness of machine learning techniques for estimation of gastric cancer risk.

Gastric polyps diagnosed by double-contrast upper gastrointestinal barium X-ray radiography mostly arise from the Helicobacter pylori-negative stomach with low risk of gastric cancer in Japan

BACKGROUND

Double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) is a method broadly used for gastric cancer screening in Japan. Gastric polyp is one of the most frequent findings detected by UGI-XR, but how to handle it remains controversial.

METHODS

Gastric polyps of the 17,264 generally healthy subjects in Japan who underwent UGI-XR or upper gastrointestinal endoscopy (UGI-ES) in 2010 were analyzed.

RESULTS

Of the 6,433 UGI-XR examinees (3,405 men and 3,028 women, 47.4 ± 9.0 years old), gastric polyps were detected in 464 men (13.6 %) and 733 women (24.2 %) and were predominantly developed on the non-atrophic gastric mucosa (p < 0.0001). Multiple logistic regression analysis showed that the presence of gastric polyps has significant association with lower value of serum anti-Helicobacter pylori IgG titer, female gender, lighter smoking habit, older age, and normal range of body mass index (≥18.5 and <25), but not with drinking or serum pepsinogen I/II ratio. During the 3-year follow-up, gastric cancer occurred in 7 subjects (0.11 %), but none of them had gastric polyps at the beginning of the follow-up period. Of the 2,722 subjects with gastric polyps among the 10,831 UGI-ES examinees in the same period, 2,446 (89.9 %) had fundic, 267 (9.8 %) had hyperplastic, and 9 (0.3 %) had adenomatous/cancerous polyps.

CONCLUSIONS

Gastric polyps diagnosed by UGI-XR predominantly arise on the Helicobacter pylori-negative gastric mucosa with a low risk of gastric cancer in Japan. In the prospective observation, none of the UGI-XR examinees with gastric polyps developed gastric cancer for at least 3 years subsequently.

Atrophic gastritis and enlarged gastric folds diagnosed by double-contrast upper gastrointestinal barium X-ray radiography are useful to predict future gastric cancer development based on the 3-year prospective observation

BACKGROUND

Double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) is the standard gastric cancer screening method in Japan. Atrophic gastritis and enlarged gastric folds are considered the two major features of Helicobacter pylori-induced chronic gastritis, but the clinical meaning of evaluating them by UGI-XR has not been elucidated.

METHODS

We analyzed healthy UGI-XR examinees without a history of gastrectomy, previous Helicobacter pylori eradication and usage of gastric acid suppressants.

RESULTS AND CONCLUSIONS

Of the 6433 subjects, 1936 (30.1 %) had atrophic gastritis and 1253 (19.5 %) had enlarged gastric folds. During the 3-year prospective observational follow-up, gastric cancer developed in seven subjects, six of whom (85.7 %) had atrophic gastritis with H. pylori infection and five of whom (71.4 %) had enlarged gastric folds with H. pylori infection. The Kaplan-Meier method with log-rank testing revealed that both UGI-XR-based atrophic gastritis (p = 0.0011) and enlarged gastric folds (p = 0.0003) are significant predictors for future gastric cancer incidence.