Does Socioeconomic Status Influence the Prevalence of Early Gastric Cancer?

Abstract

Early gastric cancer is diagnosed in low rates in western countries, compared to the eastern. Helicobacter pylori is considered a risk factor for gastric cancer and is closely related to lifestyle and socioeconomic status. Aim: To investigate the prevalence of early gastric tumors and H. pylori infection in a developing country, considering the socioeconomic status stratification. Methods: 3010 consecutive symptomatic patients underwent diagnostic upper digestive endoscopy by the same endoscopist in two different settings (first group = private clinic: 1600; and second group = public clinic: 1410 patients). Two biopsy specimens from the antrum and two from the body were collected for histologic examination and rapid urease test (CLOtest). Results: Mean age was 45.7 (SD = 16.06), and 41.8% were men. There was no significant difference between the two populations regarding age and gender, but educational level and income were higher in the first group. The prevalence of gastric cancer in this population was 0.83%, however, there was no difference in the prevalence between the studied groups, p = 0.87. Of the neoplasias, 32% were early gastric cancer, being 40% in the first group and 20% in the second group, p = 0.4. There was an association between the CLOtest and the histopathology, p = 0.00001. The sensitivity and specificity of the urease test were 92.8% and 94.3%, respectively. The overall prevalence of H. pylori infection was 50%. H. pylori infection was inversely associated to socioeconomic status, and it was detected in 39.4% of the first group vs. 63.1%, in the second group, p = 0.0001. Conclusions: 1. In this symptomatic population, the prevalence of gastric cancer was high; 2. Although there was no difference in the prevalence of the early gastric cancer between the two groups, early request for a careful endoscopic examination was relevant to diagnose early gastric tumors; 3. Socioeconomic factors were related to H. pylori infection. Early gastric cancer is diagnosed in low rates in western countries, compared to the eastern. Helicobacter pylori is considered a risk factor for gastric cancer and is closely related to lifestyle and socioeconomic status. Aim: To investigate the prevalence of early gastric tumors and H. pylori infection in a developing country, considering the socioeconomic status stratification. Methods: 3010 consecutive symptomatic patients underwent diagnostic upper digestive endoscopy by the same endoscopist in two different settings (first group = private clinic: 1600; and second group = public clinic: 1410 patients). Two biopsy specimens from the antrum and two from the body were collected for histologic examination and rapid urease test (CLOtest). Results: Mean age was 45.7 (SD = 16.06), and 41.8% were men. There was no significant difference between the two populations regarding age and gender, but educational level and income were higher in the first group. The prevalence of gastric cancer in this population was 0.83%, however, there was no difference in the prevalence between the studied groups, p = 0.87. Of the neoplasias, 32% were early gastric cancer, being 40% in the first group and 20% in the second group, p = 0.4. There was an association between the CLOtest and the histopathology, p = 0.00001. The sensitivity and specificity of the urease test were 92.8% and 94.3%, respectively. The overall prevalence of H. pylori infection was 50%. H. pylori infection was inversely associated to socioeconomic status, and it was detected in 39.4% of the first group vs. 63.1%, in the second group, p = 0.0001. Conclusions: 1. In this symptomatic population, the prevalence of gastric cancer was high; 2. Although there was no difference in the prevalence of the early gastric cancer between the two groups, early request for a careful endoscopic examination was relevant to diagnose early gastric tumors; 3. Socioeconomic factors were related to H. pylori infection.