240 Downward Trend in H. pylori Infection and Corresponding Changes of Often-Seen Upper Gastrointestinal Diseases in Southeastern China in Last Decade

Abstract

three consecutive patients diagnosed gastric adenocarcinoma at National Taiwan University Hospital are enrolled. Anti-H. pylori antibody were evaluated for all the eligible cases and the invasive H. pylori tests were also performed. H. pylori status was defined as positive result from any of the invasive or non-invasive test. The pepsinogen (PG) method was performed for all the eligible cases. PG I < 70 ng/dl and PG I/II ratio < 3.0 were diagnosed as serological atrophic gastritis(SAG). Patients with SAG were considered as positive H. pylori status whether the H. pylori test result was negative or not. Results: We found four characteristics of HPNGC in comparison to HPPGC: (1) higher proportion of the proximal tumor location (19.7%, p=0.05), (2) more diffuse histologic type (61.0 %, p=0.03), (3) younger disease onset (58.1 years, p=0.003) and (4) more AJCC 7th stage IV cancer(40%, p=0.02). In addition, HPNGC came with worse long term overall survival than HPPGC(26.6% v.s 39.3%, p=0.04). In Cox regression model, the negative H. pylori status is an independent poor prognostic factor(HR: 1.40,CI:1.01-1.96, p = 0.04). In subgroup analysis, we found the prognostic effect of negative H. pylori status were particularly significant in the patients with AJCC 7thII or IIIa gastric cancer (HR: 2.84, 95% CI: 1.24-6.51, p = 0.01). Conclusion: The negativity of H. pylori status is an independent poor prognostic factor, particularly in patients with AJCC 7th stage II or IIIa. The negative H. pylori status might be a surrogate marker for guiding clinical management at this group