Secondary Prevention Of Gastric Cancer Research Articles

Efficacy evaluation of upper gastrointestinal endoscopy screening for secondary prevention of gastric cancer using the standardized detection ratio during a medical check-up in Japan.

We used standardized detection ratio to evaluate the quality of nasal upper gastrointestinal endoscopy screening for the secondary prevention of gastric cancer, and examined the gastric cancer risk in the era of total Helicobacter pylori (H. pylori) eradication. We performed 21,931 upper gastrointestinal endoscopies, 77 subjects were diagnosed with gastric cancer. Of these, 28 had gastric cancer after H. pylori eradication, 47 had gastric cancer with H. pylori-positive or others, and 2 had H. pylori-negative gastric cancer. The Standardized detection ratios for men and women were 5.33 and 4.82, respectively. Multivariable logistic regression analyses performed exclusively on first endoscopy subjects, excluding H. pylori-negative gastric cancer, revealed that smoking was a risk factor for developing gastric cancer (adjusted odds ratio, 3.31; 95% confidence interval, 1.65-6.64; p = 0.001). A statistically significant interaction was found between daily alcohol consumpption and H. pylori eradication on gastric cancer development (p = 0.005). In conclusion, relatively high standardized detection ratio values suggest that an appropriate endoscopic diagnosis of gastric cancer should be performed during a medical check-up. Smoking is a risk factor for developing gastric cancer, and continued alcohol consumption suggests a possible risk for developing gastric cancer after H. pylori eradication.

PDCD4 and CDX-2 as immunohistochemical markers of gastric mucosa atrophy in chronic gastritis

Introduction Diagnosis of the gastric mucosa atrophy represents an important problem, the solution of which depends on the possibility of secondary prevention of gastric cancer. A possible way of solution is the use of immunohistochemical markers - proteins associated with cellular remodeling of gastric mucosa, PDCD4 and CDX2.The aim of the work is to evaluate the possibility of using immunohistochemical markers PDCD4 and CDX-2 to diagnose atrophy of the gastric mucosa in chronic gastritis and increase the informative value of biopsy examination.Materials and method The object of the study was 155 cases of biopsy examination of the gastric mucosa of patients with chronic gastritis (5 fragments per case − 775 biopsy specimens). A comparative semi-quantitative assessment of immunohistochemical expression of CDX2, PDCD4 at different stages of chronic gastritis was performed. Spearman correlation coefficient was used to assess correlation relationship.Results There were no statistically significant differences in the level of PDCD4 in studied samples depending on the stage of chronic gastritis, p=0.06. Statistically significant increase of CDX2sum index in progressing stage of chronic atrophic gastritis (p=0.005), demonstrated a pronounced positive correlation r=0.70 (p<0.01).Discussion According to the results obtained, it is shown that the decline in PDCD4 protein does not occur with the progression of atrophy severity. Complementary use of immunohistochemical marker CDX2 is able to give an idea of the presence and severity of both metaplastic and absolute atrophic changes in the gastric mucosa.Conclusion Equally high level of PDCD4 protein index in the gastric mucosa at different stages of chronic gastritis excludes the possibility of its use as an immunohistochemical marker of atrophy. Semi-quantitative immunohistochemical index of CDX2 protein can be used as an additional marker in decision support system for assessment of atrophic changes in gastric mucosa.

Therapeutic mechanisms of integrated traditional Chinese and conventional medicine underlying its treatment of precancerous lesions of gastric cancer.

China has a high incidence of gastric cancer. Secondary prevention of gastric cancer is a major public health problem that must be solved urgently. Modern medicine focuses on the pathogenesis of precancerous lesions of gastric cancer (PLGC), and it has been found that there are a variety of abnormal gene expression patterns in PLGC. This study summarizes recent advances in our understanding of the therapeutic mechanisms of PLGC from various clinical studies; this will provide a reference for studying the therapeutic mechanisms of Traditional Chinese Medicine in the treatment of PLGC from the combined points of view of Traditional Chinese and Conventional medicine.

Improving the Endoscopic Detection and Management of Gastric Intestinal Metaplasia Through Training: A Practical Guide

Improving the Endoscopic Detection and Management of Gastric Intestinal Metaplasia Through Training: A Practical Guide

Secondary prevention of gastric cancer and Traditional Chinese Medicine countermeasures

<p indent="0mm">Gastric cancer (GC) is a major public health problem threatening China’s health system. Hence, diagnosis and effective intervention for people at high risk of GC are crucial for the secondary prevention of GC. It is critical to prevent and treat GC by systematic analysis of the pathological transformation mechanism of the precancerous lesions of GC (PLGC), establish a perfect high-risk evaluation and diagnostic system for GC, and develop a safe and effective treatment. As the treasure of Chinese culture, traditional Chinese medicine (TCM) demonstrates the characteristics and advantages in the treatment of complex system diseases. It is worth noting how to systematically explain the evolution rule of the combination of diseases and TCM syndromes in every pathological state of the PLGC, objectively evaluate the advantages of clinical efficacy of the intervention, and comprehensively analyze the mechanism and material basis of the effectiveness of TCM, which will play a better role in improving the efficiency of the secondary prevention system of GC with TCM and Western Medicine cooperation. Here, we systematically review the important role of TCM in the prevention and control of GC in China and the necessity and feasibility of establishing a secondary prevention system for GC in China. Finally, in order to provide constructive opinions and suggestions for the establishment of the secondary prevention and treatment system of GC with a collaboration between TCM and Western medicine, several perspectives were provided on building a collaborative platform of TCM and Western medicine, jointly carrying out evidence-based and basic research on the treatment of PLGC with TCM.

Secondary prevention of gastric cancer: An alternative strategy

Background: Early detection and treatment provide the only curative possibility for gastric cancer. A cost-effective strategy is imperative in developing countries with high mortality rates. The objective of this study is to analyse the results of an organized endoscopic screening in a symptomatic population 40 years and older. Methods: This was a prospective observational study of patients with gastrointestinal symptomology referred by primary care who had direct access to an endoscopy unit at the secondary referral centre. Physicians were trained, and an endoscopy request form and a flowchart for referral and patient management were designed. Endoscopic performance, early detection rates, resectability and survival, overall and disaggregated by sex, were evaluated. Findings: From July 1, 1996, to June 30, 2013, 25.304 endoscopies were performed, of which 14.521 were in individuals in risk groups (70% women). A total of 339 gastric cancers were detected, for a detection rate of 2.3%. The rate of early gastric cancer (EGC) among all cancers was 34% (f: 46.6%, m: 27.6%). The resectability for both sexes was 68.1% (f: 78.8%, m: 62.4%). The EGC rate in resected patients was 45% (f: 54.8%, m: 38.4%). The five-year survival rate for all cancers was 38.1% (f: 51.7%, m: 30.8%), and that for patients who underwent resection was 57.6% (f: 69.0%, m: 50.0%). The 10-year survival for all cancers was 27.5% (f: 40.5%, m: 20.5%), and that for patients who underwent resection was 43.1% (f: 55.0%, m: 35.0%). Interpretation: Organized screening in a symptomatic population aged 40 years and older by endoscopy has high performance, increases the rate of EGC and impacts survival. Women achieved results similar to those reported by countries with mass survey. For men to achieve these results, it is necessary to educate the population at risk, especially the most vulnerable. Keywords: gastric cancer; endoscopic screening; resectability; early detection; survival.

Cost-effectiveness of Helicobacter pylori test and eradication versus upper gastrointestinal series versus endoscopy for gastric cancer mortality and outcomes in high prevalence countries

Background: The latest version of Japanese guidelines for effective secondary prevention of gastric cancer recommend upper gastrointestinal series (UGI) and endoscopy in adults 50 years of age and older. A Helicobacter pylori antibody test and eradication (H. pylori screening) reduces gastric cancer risk.Objective: This study aimed to evaluate the cost-effectiveness of H. pylori screening, compared to UGI and endoscopy in high prevalence countries.Methods: We developed decision trees with Markov models using a healthcare payer perspective and a lifetime horizon. Targeted populations were hypothetical cohorts of asymptomatic individuals at the age of 50, 60, 70 and 80 years. We calculated per-person costs and effectiveness with discounting at a fixed annual rate of 3% and compared incremental cost-effectiveness ratios.Results: H. pylori screening was cost-saving and more cost-effective for individuals at the age of 50, 60, 70, and 80 than UGI and endoscopy. One-way and multiway sensitivity analyses showed the robustness of the cost-effectiveness results. Probabilistic sensitivity analyses using Monte-Carlo simulation for 10,000 trials demonstrated that H. pylori screening was cost-effective 100% of the time at a willingness-to-pay level of US$50,000/QALY gained.Conclusions: H. pylori screening for the adults 50 years of age and older could be cost-effective compared to UGI and endoscopy in high prevalence countries. The main reasons for the superiority of H. pylori screening are that an H. pylori antibody test has a higher sensitivity and specificity than UGI and endoscopy and the benefits to reduce gastric cancer incidence and mortality.

Helicobacter pylori Infection: New Facts in Clinical Management.

The global prevalence of Helicobacter pylori remains high in spite of its significant downwards trajectory in many regions. The clinical management of H. pylori infection merits guidance to meet ongoing challenges on whom and how to test, prevent, and cure related diseases. Several international guidelines and consensus reports have updated the management strategies for cure of the H. pylori infection. The definition of H. pylori gastritis as an infectious disease independent of whether or not presenting with clinical manifestations and symptoms has broadened the use of the test and treat strategy. Patients on selected long-term medications, such as aspirin, other anti-platelet agents, NSAIDs, and PPIs should be considered for H. pylori test and treat. Important progress is made with initiatives in primary and secondary gastric cancer prevention. Uncertainties persist in the interpretation of the role of H. pylori in association with extragastric diseases. Selection of therapies needs to address individual antibiotic resistance and regional surveillance of resistance for the adoption of an effective treatment algorithm. Clinical aspects of H. pylori infection have evolved over time and the therapeutic management requires continuous adaptation. A vaccine is still a non-fulfilled promise. The future will tell us more about the role of H. pylori in interactions with the gut microbiome.

The Role of the Pathoanatomical Diagnosis «Chronic Gastritis» in the System of Personified Cancer Prevention

Aim.The aim of the review is to systematize the principles of interpretation of morphological and molecular-cellular signs underlying the biopsy diagnosis of chronic gastritis from the standpoint of personified prevention of gastric cancer.Background. The chronicle of cancer prevention is presented as an evolution of views on the possibility of clinical interpretation of structural changes in the gastric mucosa such as early (inflammation, metaplasia, atrophy) and pronounced (intraepithelial neoplasia/dysplasia) precancerous changes. The protocols of taking gastric bioptates and their violations, the principles of formulating the pathoanatomical conclusion (Updated Sydney system, OLGA system) and a personalized forecast of the risk of gastric cancer are discussed. Molecular classification of gastric cancer is considered from the standpoint of carcinogenesis cascade and WHO 2010 histological classification. New molecular and cellular targets for the preparation of bismuth tripotassium dicitrate and practical steps of its use in the prevention of gastric cancer in chronic inflammation of the mucosa of various etiologies are conceptually described.Conclusion. Biopsy diagnosis of chronic gastritis combined with the evaluation of gene structure (genetic polymorphism) and epigenomic mechanisms (microRNA) allows the risk of gastric cancer to be ranked in a particular patient even with early precancerous changes in the gastric mucosa. The activity of gastritis (infiltration of the mucosa with neutrophilic leukocytes) of any etiology is the theoretical justification for the use of bismuth tripotassium dicitrate pharmacological preparation to protect the genome of stem cells of the gastric epithelium as a secondary prevention of gastric cancer.

Strokovna stališča Slovenskega združenja za gastroenterologijo in hepatologijo o obravnavi bolnikov, okuženih z bakterijo Helicobacter pylori

The article presents a position statement of the Slovenian Association for Gastroenterology and Hepatology on the management of patients infected with Helicobacter pylori (H. pylori). Position statement was presented and adopted at the 64th SAGH meetting on 11 November 2016 in Portorož.Every patient infected with H. pylori needs treatment. Recommended first-line regimen is a 14-day treatment with esomeprazole, amoxicillin and clarithromycin. The success of treatment must be monitored by non-invasive tests (urea breath test) one month or more after completing the treatment. When the first-line treatment fails, we recommend that patient is referred to a gastroenterologist. The recommended second-line therapy consists of a 14-day treatment with levofloxacin (esomeprazole, amoxicillin, levofloxacin), or 14 per day treatment with colloidal bismuth (esomeprazole, colloidal bismuth, oxytetracycline / amoxicillin, metronidazole). All third-line treatments should be based on the results of antibiotic susceptibility testing.H. pylori is grade I carcinogen and is responsible for 89 % of all cancers of the stomach, with the exception of cancer of the cardia. Therefore, the SAGH recommends that we should start with a national screening programme for H. pylori infection in asymptomatic Slovenian population aged between 20 and 30 years. All H. pylori infected patients should be treated with a 14-day quadruple regimen (esomeprazole, colloidal bismuth, oxytetracycline / amoxicillin, metronidazole). The program must be organised and supervised along the lines of the SVIT programme.Position statement is also given for secondary gastric cancer prevention in older patients with chronic H. pylori infection and diffuse preneoplastic gastric mucosa changes (atrophy and intestinal metaplasia).

Gastritis staging in the endoscopic follow-up for the secondary prevention of gastric cancer: a 5-year prospective study of 1755 patients

ObjectiveOperative link on gastritis assessment (OLGA) staging for gastritis ranks the risk for gastric cancer (GC) in progressive stages (0–IV). This prospective study aimed at quantifying the cancer risk associated...

New opportunities for the prevention of gastric cancer

The approvals and provisions of the Management of Helicobacter pylori infection-the Maastricht V/ Florence Consensus Report and those of the Kyoto Global Consensus Conference on H. pylori-associated gastritis, concerning with the primary and secondary prevention of gastric cancer (GC), unambiguously suggest that H. pylori infection is the most important risk factor of GC. Accordingly, the basis for the primary and secondary prevention of GC is the optimization of H. pylori eradication therapy. The clear direct relationship of the risk of GC to the severity and extent of atrophic gastritis, intestinal metaplasia and dysplasia and no reversal of intestinal metaplasia and dysplasia in the presence of H. pylori eradication presume that gastroprotective agents should be used for primary and secondary prevention. Experimental and clinical findings can lead to the conclusion that rebamipide is a highly effective and safe agent for the primary and secondary prevention of GC in patients with and without H. pylori infection, by optimizing anti-Helicobacter therapy, its anti-inflammatory effect and ability to restore the cellular structure of the gastric epithelium.

Endoscopic gastritis, serum pepsinogen assay, and Helicobacter pylori infection.

Endoscopic findings of the background gastric mucosa are important in the Helicobacter pylori-seroprevalent population. It is strongly correlated not only with the risk of gastric cancer, but also with the excretion ability of gastric mucosa cells. In noninfected subjects, common endoscopic findings are regular arrangement of collecting venules, chronic superficial gastritis, and erosive gastritis. In cases of active H. pylori infection, nodularity on the antrum, hemorrhagic spots on the fundus, and thickened gastric folds are common endoscopic findings. The secreting ability of the gastric mucosa cells is usually intact in both noninfected and actively infected stomachs, and the intragastric condition becomes hyperacidic upon inflammation. Increased serum pepsinogen II concentration correlates well with active H. pylori infection, and also indicates an increased risk of diffuse-type gastric cancer. In chronic inactive H. pylori infection, metaplastic gastritis and atrophic gastritis extending from the antrum (closed-type chronic atrophic gastritis) toward the corpus (open-type chronic atrophic gastritis) are common endoscopic findings. The intragastric environment is hypoacidic and the risk of intestinal-type gastric cancer is increased in such conditions. Furthermore, there is a decrease in serum pepsinogen I concentration when the secreting ability of the gastric mucosa cells is damaged. Serologic and endoscopic changes that occur upon H. pylori infection are important findings for estimating the secreting ability of the gastric mucosa cells, and could be applied for the secondary prevention of gastric cancer.

Gastric Cancer in Asian American Populations: a Neglected Health Disparity

Gastric cancer incidence rates vary dramatically by world region with East Asia having the highest rate. The Asian population of the United States (US) is growing rapidly and over 17 million Americans are of Asian descent. A majority of Chinese, Korean and Vietnamese Americans are immigrants. Americans of East and Southeast Asian descent experience marked gastric cancer disparities and the incidence rate among Korean men in the US is over five times higher than the incidence rate among non-Hispanic white men. Randomized controlled trials have provided evidence for the effectiveness of helicobacter pylori identification and eradication in preventing gastric cancer. Additionally, Japan and South Korea have both experienced improvements in gastric cancer mortality following the implementation of programs to detect early stage gastric cancers. There are currently no clear US guidelines regarding the primary and secondary prevention of gastric cancer in high-risk immigrant populations. However, it is likely that a proportion of US physicians are already recommending gastric cancer screening for Asian patients and some Asian immigrants to the US may be completing screening for gastric cancer in their native countries. Surveys of US primary care physicians and Asian American communities should be conducted to assess current provider practices and patient uptake with respect to gastric cancer prevention and control. In the absence of clinical guidelines, US health care providers who serve high-risk Asian groups could consider a shared decision-making approach to helicobacter pylori identification and eradication, as well as gastric endoscopy.

Helicobacter pylori.

This review focuses on new treatment options for eradicating Helicobacter pylori that have emerged as a result of decreased efficacy of standard triple therapy due to increasing antibiotic resistance. We also report on new data regarding primary and secondary gastric cancer prevention strategies and the potential role of H. pylori as a risk factor for extragastric malignancies. Treatment options have shifted from triple to various quadruple modifications. The length of therapy duration has, in general, been extended from 7 to 10 and 14 days. Nonbismuth-based quadruple therapies prescribed as sequential, concomitant, and hybrid have shown superiority as compared to standard triple therapy in the eradication of clarithromycin-resistant H. pylori. Bismuth-based quadruple therapy appears almost totally independent of antibiotic resistance and maintains high eradication rates. Levofloxacin is an adequate substitute for clarithromycin and is recommended in second-line regimens. However, it should be used prudently as H. pylori has developed resistance to levofloxacin in many regions of the world. Strategies for primary gastric cancer prevention by H. pylori eradication are effective, whereas H. pylori eradication for secondary gastric cancer prevention is uncertain. Very recent data implicate H. pylori as a risk factor for extragastric malignancies. H. pylori therapy should be tailored according to local antibiotic resistance patterns. In many regions of the world, H. pylori is becoming increasingly resistant to clarithromycin, metronidazole, and levofloxacin. Gastric cancer prevention by H. pylori eradication is most effective, if implemented early in the course of infection. New data are provided which indicate H. pylori as risk factor for extragastric malignancies.

Abstract 2210: Cumulative risks of gastric cancer by PSCA polymorphism, Helicobacter Pylori infection and smoking history in Japan

Abstract Appreciating lifetime risk of gastric cancer through established risk factors is one simple way to promote preventive behavior. We have estimated cumulative risks (CRs) of gastric cancer by genetic and environmental risk factors, PSCA-rs2294008 polymorphism, Helicobacter Pylori (HP) infection and smoking, based on a case-control study involving 697 cases and 1372 controls at Aichi Cancer Center. We estimated odds ratio (OR) and 95% confidence interval (CI) for groups by these factors using logistic regression model after adjustment for age, sex, family history of gastric cancer and intake of fruit and vegetable. The ORs were combined with gastric cancer incidence rates in Japan to calculate CRs using the Peto's method. The CRs by age of 75 varied according to the risk groups, from 0.9% (95% CI, 0.3%-3.3%) for never smokers without both HP infection and risk allele of rs2294008 to 13.4% (95% CI, 13.3%-13.4%) for ever smokers with HP infection and 1-2 risk alleles. Among those with 1-2 risk alleles, the CRs were reduced to 2.0% (95% CI, 1.9%-2.0%) in those without both smoking history and HP infection, 3.9% (95% CI, 3.8%-3.9%) for ever smokers without HP infection, 9.4% (95% CI, 9.4%-9.5%) for never smokers with HP infection, although it was 13.4% in those with both smoking history and HP infection. In conclusion, the findings based on genetic and environmental risk factors in this study would be important information for promoting primary and secondary prevention of gastric cancer. Citation Format: Hidemi Ito, Isao Oze, Satoyo Hosono, Miki Watanabe, Hideo Tanaka, Keitaro Matsuo. Cumulative risks of gastric cancer by PSCA polymorphism, Helicobacter Pylori infection and smoking history in Japan. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2210. doi:10.1158/1538-7445.AM2014-2210

Recommendations of the Chilean Association for Digestive Endoscopy for the management of gastric pre-malignant lesions

An expert panel analyzed the available evidence and reached a consensus to release 24 recommendations for primary and secondary prevention of gastric cancer (CG) in symptomatic patients, with indication for upper GI endoscopy. The main recommendations include (1) Search for and eradicate H. pylori infection in all cases. (2) Systematic gastric biopsies (Sydney protocol) in all patients over 40 years of age or first grade relatives of patient with CG, to detect gastric atrophy, intestinal metaplasia or dysplasia. (3) Incorporate the OLGA system (Operative Link on Gastritis Assessment) to the pathological report, to categorize the individual risk of CG. (4) Schedule endoscopic follow-up according to the estimated risk of CG, namely annual for OLGA III- IV, every 3 years for OLGA I- II or persistent H. pylori infection, every 5 years for CG relatives without other risk factors and no follow-up for OLGA 0, H. pylori (-). (4) Establish basic human and material resources for endoscopic follow-up programs, including some essential administrative processes, and (5) Suggest the early CG/total CG diagnosis ratio of each institution and the proportion of systematic recording of endoscopic images, as quality indicators. These measures are applicable using currently available resources, they can complement any future screening programs for asymptomatic population and may contribute to improve the prognosis of CG in high-risk populations.

Gastric cancer research in Mexico: a public health priority.

This study aimed review studies conducted on Mexican patients diagnosed with gastric cancer and/or diseases associated with its development, in which at least one Mexican institute has participated, and to assess their contributions to the primary and secondary prevention of this disease. A search of the Medline database was conducted using the following keywords: gastric/stomach cancer, Mexico. Studies of the Mexican population were selected in which at least one Mexican Institute had participated and where the findings could support public policy proposals directed towards the primary or secondary prevention of gastric cancer. Of the 148 studies found in the Medline database, 100 were discarded and 48 were reviewed. According to the analysis presented, these studies were classified as: epidemiology of gastric cancer (5/48); risk factors and protectors relating to gastric cancer (9/48); relationship between Helicobacter pylori and pathologies associated with gastric cancer and the development of the disease (16/48); relationship between the Epstein-Barr virus and pathologies associated with gastric cancer and the development of the disease (3/48); molecular markers for the development of diseases associated with gastric cancer and gastric cancer (15/48). Mexico requires a program for the prevention and control of gastric cancer based on national health indicators. This should be produced by a multidisciplinary committee of experts who can propose actions that are relevant in the current national context. The few studies of gastric cancer conducted on the Mexican population in national institutes highlight the poor connection that currently exists between the scientific community and the health sector in terms of resolving this health issue. Public policies for health research should support projects with findings that can be translated into benefits for the population. This review serves to identify national research groups studying gastric cancer in the Mexican population.

Autoimmune gastritis: histology phenotype and OLGA staging

Among Western populations, the declining incidence of Helicobacter pylori infection coincides with a growing clinical impact of autoimmune gastritis. To describe the histological phenotype of autoimmune gastritis, also to test the prognostic impact of OLGA staging in the autoimmune setting. A single-institutional series (spanning the years 2003-2011) of 562 consecutive patients (M:F ratio: 1:3.7; mean age = 57.6 ± 14.4 years) with serologically confirmed autoimmune gastritis underwent histology review and OLGA staging. Helicobacter pylori infection was ascertained histologically in 44/562 cases (7.8%). Forty six biopsy sets (8.2%) featured OLGA stages III-IV; they included all four cases of incidental epithelial neoplasia (three intraepithelial and one invasive; three of these four cases had concomitant H. pylori infection). There were 230 (40.9%) and 139 (24.7%) cases, respectively, of linear and micro-nodular enterochromaffin-like cell hyperplasia; 19 (3.4%) type I carcinoids were detected. The series included 116 patients who underwent repeated endoscopy/biopsy sampling (mean time elapsing between the two procedures = 54 months; range 24-108). Paired histology showed a significant (P = 0.009) trend towards a stage progression [the stage increased in 25/116 cases (22%); it remained unchanged in 87/116 cases (75%)]. In autoimmune gastritis, the cancer risk is restricted to high-risk gastritis stages (III-IV), and is associated mainly with concomitant H. pylori infection. OLGA staging consistently depicts the time-dependent organic progression of the autoimmune disease and provides key information for secondary gastric cancer prevention strategies.

Secondary prevention of gastric cancer

The natural history of 'epidemic' intestinal-type gastric cancer provides consistent data that enable clinicians to design multidisciplinary strategies for secondary prevention. A recent paper by Dinis-Ribeiro et al. reports guidelines for the management of patients with precancerous stomach lesions.