Abstract
BackgroundDouble-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) is one of the most widely conducted gastric cancer screening methods. It has been executed to find gastric cancer, but has not been usually executed to detect premalignant atrophic mucosa of stomach. To understand the meaning of UGI-XR-based atrophic gastritis, we analyzed its association with several causative factors including Helicobacter pylori (HP) infection.MethodsWe evaluated 6,901 healthy adults in Japan. UGI-XR-based atrophic gastritis was diagnosed based on the irregular shape of areae gastricae and its expansion in the stomach.ResultsOf the 6,433 subjects with no history of HP eradication and free from gastric acid suppressants, 1,936 were diagnosed as UGI-XR-based atrophic gastritis (mild: 234, moderate: 822, severe: 880). These were univariately associated with serum HP IgG and serum pepsinogen I/II ratio with statistical significance. The multiple logistic analysis calculating standardized coefficients (β) and odds ratio (OR) demonstrated that serum HP IgG (β = 1.499, OR = 4.48), current smoking (β = 0.526, OR = 1.69), age (β = 0.401, OR = 1.49), low serum pepsinogen I/II ratio (β = 0.339, OR = 1.40), and male gender (β = 0.306, OR = 1.36) showed significant positive association with UGI-XR-based atrophic gastritis whereas drinking and body mass index did not. Among the age/sex/smoking/drinking-matched 227 pairs derived from chronically HP-infected and successfully HP-eradicated subjects, UGI-XR-based atrophic gastritis was detected in 99.1% of the former but in only 59.5% of the latter subjects (p<0.0001). Contrastively, UGI-XR-based atrophic gastritis was detected in 13 of 14 HP-positive proton pump inhibitor users (92.9%) and 33 of 34 HP-positive histamine H2-receptor antagonist users (97.1%), which are not significantly different from gastric acid suppressant-free subjects.ConclusionsThe presence of UGI-XR-based atrophic gastritis is positively associated with Helicobacter pylori infection, current smoking, age, decreased serum pepsinogen I/II ratio, and male gender. Eradication of Helicobacter pylori seems to superficially improve UGI-XR-based atrophic gastritis whereas intake of gastric acid suppressants does not.
Highlights
The incidence and mortality of gastric cancer has gradually fallen in the recent several decades, but it is still the second leading cause of cancer death worldwide [1,2]
For the data of healthy adults in our institutes located at Chiba prefecture in Japan, the seropositivity of H. pylori infection has markedly reduced from 47.0%
Though the effects of other causative factors should not be groundlessly underestimated, these results suggest that the four-grade categorization of upper gastrointestinal barium X-ray radiography (UGI-XR)-based atrophic gastritis strongly reflects chronic H. pylori infection and consequent mucosal atrophy of stomach
Summary
The incidence and mortality of gastric cancer has gradually fallen in the recent several decades, but it is still the second leading cause of cancer death worldwide [1,2]. The double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) is one of the most widely used screening methods for gastric cancer. UGI-XR is at present the only one method of gastric cancer screening officially authenticated in Japan [9], though other screening methods with endoscopy or serum pepsinogens are gradually spreading [10,11]. Double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) is one of the most widely conducted gastric cancer screening methods. To understand the meaning of UGI-XR-based atrophic gastritis, we analyzed its association with several causative factors including Helicobacter pylori (HP) infection
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