Higher male prevalence of Helicobacter pylori associated hypertrophic gastritis is explained by tobacco and alcohol use

Abstract

Background: Radiographically detected gastric fold thickening (RGFf) is seen with Helicobacter pylori (Hp) associated hypertrophic gastritis (HpHG). Our recent data showed a higher male prevalence of RGFf in a cohort of Japanese nationals undergoing radiographic gastric cancer screening. Despite the equal prevalence of Hp in both genders, a male predominance is also observed with other Hp associated diseases including gastric cancer. These observations remain unexplained. Purpose: To evaluate a cohort of 323 Japanese nationals who underwent radiographic gastric cancer screening and determine if gender remains an independent risk factor of RGFf as a marker of HpHG. Methods: A previously compiled database of 323 adult Japanese nationals who underwent radiographic gastric cancer screening from 8/93 to 6/97 at a university affiliated clinic in Atlanta, Georgia provided the materials for this study. All patients completed questionnaires and were examined by a bilingual internist prior to radiographic examinations. 41 patients with RGFf were selected as cases. 260 patients who had normal radiographs were selected as controls. The remaining 22 patients with other radiographic abnormalities were excluded from the analysis. Univariate analysis of potential risk factors of RGFf (age, gender, tobacco use, alcohol use, non-steroidal antiinflammatory drug use, history of peptic ulcer disease, and family history of gastric cancer) was conducted. Variables remaining significant (P-values less than 0.05) were further evaluated by multivariate analysis using SAS statistical software. Results: Four variables, male gender (OR=3.38, p=0.002), history of peptic ulcer disease (OR=2.9I, p=0.Ol5), past or present smoking (OR=3.97, p=0.00004), and drinking (> Ig of alcohol! d)(OR=3.85, p=O.OOI) were significant by univariate analysis. Only smoking (aOR=3.01, p=0.013) and drinking (aOR=2.03, p=O.OO04) remained significant by multivariate analysis. Cummulative effects of tobacco and alocohol use (aOR =6.11) were seen in those who smoked and drank compared with those who did neither. No independent risk remained for gender (aOR= 1.03, p=0.95) when controlling for smoking and dringking. Conclusions: I. The gender associated risk of HpHG as represented by RGFf is entirely accounted for by the effects of tobacco and alcohol use. 2. Male predominance of other Hp associated gastric diseases including gastric cancer may be explained by the effects of tobacco and alcohol use.