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Kishikawa H, Nakamura K, Takarabe S, Katayama T, Sasaki A, Miura S, Hayashi Y, Hoshi H, Kanai T, Nishida J. Clinical Characteristics of Patients With Previous Helicobacter pylori Infection-Induced Atrophic Gastritis. Cureus 2024; 16:e63368. [PMID: 39070512 PMCID: PMC11283760 DOI: 10.7759/cureus.63368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
AIMS Patients with atrophic gastritis unrelated to autoimmune gastritis (AIG) and without active Helicobacter pylori (H.pylori) infection or previous eradication therapy are considered to have previous Helicobacter pylori infection-induced atrophic gastritis (PHIG). This study aimed to clarify the clinical characteristics of patients with PHIG. METHODS Consecutive patients who underwent upper gastrointestinal endoscopy during the study period were enrolled in the study. Pepsinogen and gastrin levels, H. pylori serology, and endoscopic atrophic grade were assessed. Patients were divided into five groups based on their H. pylori status and disease history (PHIG, without H. pylori infection, with active H. pylori infection, with successful H. pylori eradication, and AIG). Their gastric cancer risk status was classified according to the ABC method of serological gastric cancer screening. RESULTS Of 536 consecutive patients who underwent upper gastrointestinal endoscopy during the study period, 318 were included (31 with PHIG, 77 without H. pylori infection, 101 with active H. pylori infection, 80 with successful H. pylori eradication, and 29 with AIG). Of the 31 patients with PHIG, 21 (68%) were H. pylori-seronegative, and 20 (65%) were classified as group A (normal pepsinogen, H. pylori-seronegative). Patients with PHIG accounted for 90.1% of the patients at high risk for gastric cancer misclassified as group A. The pepsinogen and H. pylori serological profiles of patients with PHIG were similar to those of patients with successful H. pylori eradication more than six years previously. A receiver-operating characteristic curve (ROC) analysis that included 13 patients with AIG and without active H. pylori infection and no previous eradication therapy and 31 patients with PHIG revealed that an endoscopic atrophy grade of O-III or greater according to the Kimura-Takemoto classification can predict AIG. CONCLUSIONS Two-thirds of the patients with PHIG were misclassified as being at low risk (group A) according to the ABC method, suggesting that endoscopy is necessary for group A patients. The results of the serological evaluation of PHIG indicated that patients with PHIG may have experienced spontaneous H. pylori eradication, possibly because of the use of antibiotics for other conditions. Autoimmune gastritis should be considered in the presence of grade 0-III or greater gastric mucosal atrophy in patients with suspected PHIG, even if the autoantibody and histological findings are not available.
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Affiliation(s)
- Hiroshi Kishikawa
- Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, JPN
| | - Kenji Nakamura
- Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, JPN
| | - Sakiko Takarabe
- Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, JPN
| | - Tadashi Katayama
- Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, JPN
| | - Aya Sasaki
- Clinical Laboratory, Tokyo Dental College, Ichikawa General Hospital, Chiba, JPN
| | - Soichiro Miura
- Graduate School, International University of Health and Welfare, Tokyo, JPN
| | - Yukie Hayashi
- Gastroenterology and Hepatology, Keio University, Tokyo, JPN
| | - Hitomi Hoshi
- Gastroenterology and Hepatology, Keio University, Tokyo, JPN
| | - Takahiro Kanai
- Gastroenterology and Hepatology, Keio University, Tokyo, JPN
| | - Jiro Nishida
- Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, Chiba, JPN
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Xu W, Yang B, Lin S, Zhan F, Chen H, Qiu X, Liu C. Sex-specific disparities of serum pepsinogen I in relation to body mass index. Clin Chem Lab Med 2023; 61:2010-2016. [PMID: 37171227 DOI: 10.1515/cclm-2023-0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/02/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The clinical significance of serum pepsinogen (PG) for screening gastric cancer has been a controversial topic. Serum PG I levels have been demonstrated to be correlated with age, sex, and the Helicobacter pylori (HP) infection. However, the underlying factors that influence serum PG I variations remain to be fully elucidated. We aimed to evaluate the impacts of sex and body mass index (BMI) on PG I in Chinese population. METHODS The cross-sectional study recruited 4,299 apparently healthy participants in Fujian Province. Serum PG levels were automatically measured using ELISA method. Serum H. pylori-IgG antibody was detected by the colloidal gold immunoassay. Clinical characteristics were obtained by questionnaire. RESULTS Totally, 2,263 participants who had tests of serum PG and anti-HP IgG antibody were enrolled. Increased BMI and serum uric acid were observed in males with low PG I value (<70 μg/L). Multiple logistic regression showed the presence of overweight was the independent risk factor for male participants with low PG I level (odds ratio [OR] 1.519; p=0.017). However, the association was not found in females. CONCLUSIONS Sex-specific association of serum low PG I with overweight was observed in the southeast coastal areas of China. Thus, effects of sexual dimorphism should not be ignored during the clinical utilization of serum PG I.
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Affiliation(s)
- Wenshen Xu
- Department of Laboratory Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Bin Yang
- Department of Laboratory Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Fujian Key Laboratory of Laboratory Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, P.R. China
- Gene Diagnosis Research Center, Fujian Medical University, Fuzhou, P.R. China
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Sheng Lin
- Department of Laboratory Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Fujian Key Laboratory of Laboratory Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, P.R. China
- Gene Diagnosis Research Center, Fujian Medical University, Fuzhou, P.R. China
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
| | - Fuguo Zhan
- Department of Laboratory Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Gene Diagnosis Research Center, Fujian Medical University, Fuzhou, P.R. China
| | - Huijuan Chen
- Department of Laboratory Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Gene Diagnosis Research Center, Fujian Medical University, Fuzhou, P.R. China
| | - Xiaoming Qiu
- Department of Laboratory Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Gene Diagnosis Research Center, Fujian Medical University, Fuzhou, P.R. China
| | - Can Liu
- Department of Laboratory Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Department of Laboratory Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
- Fujian Key Laboratory of Laboratory Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, P.R. China
- Gene Diagnosis Research Center, Fujian Medical University, Fuzhou, P.R. China
- Fujian Clinical Research Center for Clinical Immunology Laboratory Test, the First Affiliated Hospital, Fujian Medical University, Fuzhou, P.R. China
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3
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Kishikawa H, Nakamura K, Ojiro K, Katayama T, Arahata K, Takarabe S, Sasaki A, Miura S, Hayashi Y, Hoshi H, Kanai T, Nishida J. Relevance of pepsinogen, gastrin, and endoscopic atrophy in the diagnosis of autoimmune gastritis. Sci Rep 2022; 12:4202. [PMID: 35273265 PMCID: PMC8913737 DOI: 10.1038/s41598-022-07947-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/28/2022] [Indexed: 02/07/2023] Open
Abstract
Simple objective modalities are required for evaluating suspected autoimmune gastritis (AIG). This cross-sectional study aimed to examine whether pepsinogen, gastrin, and endoscopic findings can predict AIG. The diagnostic performance of endoscopic findings and serology in distinguishing AIG was evaluated. AIG was diagnosed in patients (N = 31) with anti-parietal cell antibody and/or intrinsic factor antibody positivity and histological findings consistent with AIG. Non-AIG patients (N = 301) were seronegative for anti-parietal cell antibodies. Receiver operating characteristic curve analysis of the entire cohort (N = 332) identified an endoscopic atrophic grade cutoff point of O3 on the Kimura–Takemoto classification (area under the curve [AUC]: 0.909), while those of pepsinogen-I, I/II ratio, and gastrin were 20.1 ng/mL (AUC: 0.932), 1.8 (AUC: 0.913), and 355 pg/mL (AUC: 0.912), respectively. In severe atrophy cases (≥ O3, N = 58, AIG/control; 27/31), the cutoff values of pepsinogen-I, I/II ratio, and gastrin were 9.8 ng/mL (AUC: 0.895), 1.8 (AUC: 0.86), and 355 pg/mL (AUC: 0.897), respectively. In conclusion, endoscopic atrophy is a predictor of AIG. High serum gastrin and low pepsinogen-I and I/II ratio are predictors even in the case of severe atrophy, suggesting their usefulness when the diagnosis of AIG is difficult or as serological screening tests.
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Affiliation(s)
- Hiroshi Kishikawa
- Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan.
| | - Kenji Nakamura
- Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Keisuke Ojiro
- Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Tadashi Katayama
- Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Kyoko Arahata
- Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Sakiko Takarabe
- Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Aya Sasaki
- Department of Pathology and Laboratory Medicine, Ichikawa General Hospital, Tokyo Dental College, Ichikawa, Chiba, Japan
| | - Soichiro Miura
- Graduate School, International University of Health and Welfare, Minato-ku, Tokyo, Japan
| | - Yukie Hayashi
- Center for Diagnostic and Therapeutic Endoscopy, Keio University Hospital, Tokyo, Japan
| | - Hitomi Hoshi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Jiro Nishida
- Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
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Serum Gastrin and Pepsinogen Levels after Administration of Acid Secretion Inhibitors for Ulcers due to Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer. Gastroenterol Res Pract 2022; 2022:2830227. [PMID: 35126509 PMCID: PMC8816605 DOI: 10.1155/2022/2830227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/11/2022] [Indexed: 11/18/2022] Open
Abstract
Acid secretion inhibitors, such as proton pump inhibitors (PPIs) and potassium competitive acid blockers (PCABs), are used to treat ulcers after endoscopic submucosal dissection (ESD) for early gastric cancer. These drugs can influence serum gastrin and pepsinogen (PG) levels; however, their definite effects remain unclear. This open-label, randomized study investigated the effect of acid secretion inhibitors on the serum gastrin and pepsinogen levels. In total, 76 patients were enrolled in the study. They underwent gastric ESD and received a PPI (n = 21) or PCAB (n = 55). Changes in the serum gastrin and PG levels before and 4 weeks after administration were examined. Patient factors associated with the alteration of serum PG or gastrin levels were identified. The median serum levels of gastrin, PGI, and PGII before the administration of the acid secretion inhibitors were 110.5 pg/mL, 36.4 ng/mL, and 8.9 ng/mL, respectively; after administration, the levels increased to 300 pg/mL, 64.7 ng/mL, and 15.8 ng/mL, respectively (P < 0.01). Univariate analysis revealed that PCABs led to a more significant increase in the serum gastrin and PG levels as compared to PPIs. Furthermore, the PG levels were significantly increased in patients with previous Helicobacter pylori infections than in those with current infections. In conclusion, the serum gastrin and PG levels increased after the use of acid secretion inhibitors. This elevation was affected by the type of drug used, whereas the elevation in PGs was affected by the patient's background as well.
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Takayama T, Suzuki H, Okada K, Akiyama S, Narasaka T, Maruo K, Sakamoto T, Seo E, Tsuchiya K. The Optimal Cut-off of the Latex Immunoassay (LZ Test) for Helicobacter pylori Infection Based on the Stool Antigen Test and Helicobacter pylori-associated Gastritis. Intern Med 2022; 61:2103-2109. [PMID: 35850984 PMCID: PMC9381343 DOI: 10.2169/internalmedicine.8659-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective Helicobacter pylori antibody kits using the latex immunoassay (LIA) are widely used in Japan. However, the optimal cut-off of the LIA remains unclear. This study clarified the optimal cut-off of the LIA for assessing the current infection status of patients (currently infected, never infected, spontaneously eradicated) in clinical practice. Methods In total, 482 subjects with no history of H. pylori eradication therapy who underwent a medical examination at our hospital were enrolled. The infection status was ascertained using a stool antigen test, and the endoscopic findings of H. pylori-associated gastritis. H. pylori antibody levels were measured using the LIA. Results In total, 414, 38, and 30 subjects were categorized into the never-infected, currently infected, and spontaneously eradicated groups. The optimal cut-off based on receiver operating characteristic curve analysis was 4 U/mL, whereas the area under the curve, sensitivity, and specificity for differentiating never-infected and currently infected subjects were 0.95, 92.1%, and 94.7%, respectively. When applying the cut-off of 4 U/mL to the judgment of current infection in all subjects, the sensitivity and specificity were 92.1% and 92.6%, respectively. Conclusion Our findings suggest that 4 U/mL was the optimal cut-off for differentiating current infection from no prior infection, and the value may be stable because of the exclusion of subjects with spontaneous eradication. The cut-off may be useful in initial screening for current H. pylori infection.
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Affiliation(s)
- Takako Takayama
- Tsukuba Preventive Medical Research Center, University of Tsukuba Hospital, Japan
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Hideo Suzuki
- Tsukuba Preventive Medical Research Center, University of Tsukuba Hospital, Japan
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kosuke Okada
- Tsukuba Preventive Medical Research Center, University of Tsukuba Hospital, Japan
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Shintaro Akiyama
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Toshiaki Narasaka
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Japan
| | - Taku Sakamoto
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Emiko Seo
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
| | - Kiichiro Tsuchiya
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Japan
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Lee SY. Serum Assay Findings after Successful Helicobacter pylori Eradication. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2021.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Serum pepsinogen (PG), anti-Helicobacter pylori (H. pylori) immunoglobulin G (IgG), and gastrin-17 (G-17) are plasma biomarkers for gastritis. H. pylori serology titers and PG levels increase during active H. pylori infection; moreover, elevated PG II levels indicate a high risk for diffuse-type gastric cancer in East Asian populations. Serum PG I/II ratios and PG I levels decrease with the progression of gastric corpus atrophy; thus, a combination of serum PG I levels ≤70 ng/mL and a PG I/II ratio ≤3 (serologic atrophy) indicates a high risk of intestinal-type gastric cancer. Serum G-17 is often not used as an indicator in H. pylori-seroprevalent populations because it is usually elevated in subjects with H. pylori infections. When H. pylori is eradicated, most patients show a rapid decrease in serum PG II levels and anti-H. pylori IgG titers within a few months. Seroreversion is required for several months to years after regression of H. pylori. Moreover, seroreversion may not always be achieved in all eradicated cases. The serum PG I/II ratio starts to increase after eradication; therefore, serologic atrophy improves accordingly, unless severe atrophy is present. Thus, some eradicated patients may show normal serum assay findings but have a higher risk for developing gastric cancer than H. pylori-naive subjects. Furthermore, serum PG levels decrease after gastrectomy and increase with the intake of certain drugs (e.g., aspirin or acid suppressants) or in renal failure patients. Due to such wide variations, serum assays are inadequate for the confirmation of H. pylori eradication. It is useful when interpreted with gastroscopy and other H. pylori test findings.
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Cho JH, Jin SY, Park S. Scoring model for discriminating gastric cancer risk in patients with negative serum pepsinogen and anti-Helicobacter pylori antibody results. J Gastroenterol Hepatol 2021; 36:3345-3353. [PMID: 34328237 DOI: 10.1111/jgh.15630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/07/2021] [Accepted: 07/16/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The ABC test measures serum pepsinogen and anti-Helicobacter pylori IgG antibody levels to predict precancerous conditions in the stomach and gastric cancer. However, a limitation of this test is that the gastric cancer risk is not negligible in patients with a negative result. METHODS Based on their ABC results, 1157 patients were classified into Groups A (n = 392), B (n = 479), C (n = 247), and D (n = 39). In Group A, 24.2% of patients had atrophic gastritis and/or intestinal metaplasia and had thus been incorrectly assigned to Group A. Patients in Group A were then assigned to derivation (n = 236) and validation (n = 156) cohorts by 3:2 random sampling. Logistic regression analyses were performed to identify the factors discriminating between a correct (true) and incorrect (false) Group A classification. RESULTS A 4-point discriminative model was constructed based on a high-negative H. pylori IgG antibody titer and the patient's age (50-64 and ≥65 years). The areas under the receiver operating characteristic curve for the derivation and validation cohorts were 0.868 and 0.894, respectively. In the validation cohort, the addition of a discriminative model score ≥2 to the ABC method showed a similar accuracy for predicting gastric cancer risk compared with the ABC method alone (93.8% vs. 92.4%). CONCLUSION The 4-point discriminative model may help identify patients with a normal serological test who are nonetheless at risk of developing gastric cancer.
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Affiliation(s)
- Jun-Hyung Cho
- Digestive Disease Center, Soonchunhyang University Hospital, Seoul, South Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Suyeon Park
- Department of Medical Biostatistics, Soonchunhyang University Hospital, Seoul, South Korea
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Nishizawa T, Yoshida S, Watanabe H, Toyoshima A, Kataoka Y, Takahashi Y, Kanazawa T, Ebinuma H, Suzuki H, Koike K, Toyoshima O. Clue of Diagnosis for Autoimmune Gastritis. Digestion 2021; 102:903-910. [PMID: 34198294 DOI: 10.1159/000516624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The diagnostic clues for autoimmune gastritis (AIG) can be classified into 2 categories: endoscopic findings and pathological diagnosis. We believe that research on the AIG detection rate by endoscopists could provide a better understanding of the diagnosis of AIG. This study aimed to clarify the ratio of the endoscopic and the pathological diagnoses of AIG. METHODS We retrospectively reviewed consecutive patients who underwent esophagogastroduodenoscopy (EGD). During their first EGD, the gastric mucosa with C2 atrophy or more was biopsied for pathological evaluation based on the updated Sydney system. A gastric biopsy was also performed after Helicobacter pylori eradication, obtaining specimens from at least 2 sites, the greater curvature of the corpus and the antrum. We enrolled patients who were positive for the anti-parietal cell antibody and were diagnosed with AIG, histologically and/or endoscopically. The detection rates of AIG were compared between endoscopic diagnosis and pathological diagnosis. RESULTS A total of 10,822 patients underwent EGD during the study period. Finally, 41 patients with AIG were enrolled, leading to an AIG prevalence of 0.38% in this study. As for the clue leading to AIG detection, 31.7% (13/41) were diagnosed through endoscopy (proximal-predominant atrophy), and 68.3% (28/41) were diagnosed pathologically. The AIG detection rate by endoscopists in the posteradication group was significantly lower than in the H. pylori-negative group (p < 0.05). CONCLUSION Endoscopists frequently overlooked AIG, especially in posteradication cases. Pathological assessment using the updated Sydney system after H. pylori eradication might be a promising strategy to detect AIG better.
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Affiliation(s)
- Toshihiro Nishizawa
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.,Department of Gastroenterology and Hepatology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Shuntaro Yoshida
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Akira Toyoshima
- Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yosuke Kataoka
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.,Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Takamitsu Kanazawa
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo, Japan.,Department of Gastrointestinal Surgery, JR Tokyo General Hospital, Tokyo, Japan
| | - Hirotoshi Ebinuma
- Department of Gastroenterology and Hepatology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara city, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Fan X, Qin X, Zhang Y, Li Z, Zhou T, Zhang J, You W, Li W, Pan K. Screening for gastric cancer in China: Advances, challenges and visions. Chin J Cancer Res 2021; 33:168-180. [PMID: 34158737 PMCID: PMC8181866 DOI: 10.21147/j.issn.1000-9604.2021.02.05] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Gastric cancer (GC) is one of the major cancers in China and all over the world. Most GCs are diagnosed at an advanced stage with unfavorable prognosis. Along with some other countries, China has developed the government-funded national screening programs for GC and other major cancers. GC screening has been shown to effectively decrease the incidence of and mortality from GC in countries adopting nationwide screening programs (Japan and Korea) and in studies based on selected Chinese populations. The screening of GC relies mostly on gastroendoscopy, the accuracy, reliability and safety of which have been indicated by previous studies. However, considering its invasive screening approach, requirements on skilled endoscopists and pathologists, and a high cost, developing noninvasive methods to amend endoscopic screening would be highly needed. Numerous studies have examined biomarkers for GC screening and the combination of biomarkers involving pepsinogen, gastrin, and Helicobacter pylori antibodies has been proposed for risk stratification, seeking to narrow down the high-risk populations for further endoscopy. Despite all the achievements of endoscopic screening, evidence on appropriate screening age, intervals for repeated screening, novel biomarkers promoting precision prevention, and health economics need to be accumulated to inform policymakers on endoscopic screening in China. With the guide of Health China 2030 Planning Outline, we have golden opportunities to promote prevention and control of GC. In this review, we summarize the characteristics of screening programs in China and other East Asian countries and introduce the past and current approaches and strategies for GC screening, aiming for featuring the latest advances and key challenges, and illustrating future visions of GC screening.
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Affiliation(s)
- Xiaohan Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiangxiang Qin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yang Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhexuan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Tong Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jingying Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Weicheng You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Wenqing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Kaifeng Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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10
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Prediction of true Helicobacter pylori-uninfected status using a combination of age, serum antibody and pepsinogen: Logistic regression analysis. PLoS One 2020; 15:e0240040. [PMID: 33002056 PMCID: PMC7529238 DOI: 10.1371/journal.pone.0240040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/17/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction To prevent gastric cancer, it is important to accurately determine the presence of Helicobacter pylori (HP) infection. However, correctly identifying HP-uninfected individuals is difficult when using the combination of HP antibody and pepsinogen (PG). Objective The aim of this study was to discriminate true HP-uninfected individuals from others without the need for endoscopic examination. Methods A total of 684 subjects with no history of HP eradication who underwent a medical checkup at our hospital were enrolled. The “true uninfected individuals” were determined by a negative stool antigen test and no endoscopic findings of HP-associated gastritis. HP antibody was measured by the latex immunoassay method. Logistic regression analysis using a combination of noninvasive parameters was performed to develop a formula for predicting true uninfected individuals. Results A total of 528 subjects were classified as true uninfected individuals. Logistic regression analysis showed that statistically significant factors for true uninfected individuals were age (p < 0.001), HP antibody (p <0.001), PGI (p <0.001), and PGII (p = 0.012). The areas under the curve (AUCs) for true uninfected individuals were the highest (0.944) upon applying the prediction formula including four parameters: age, HP antibody, PGI, and PGII. Both the sensitivity and the specificity of the four-parameter prediction formula were higher than those of the traditional three-parameter model using HP antibody, PGI, and PGI/II ratio (sensitivity: 93.2% vs. 86.6% and specificity: 88.5% vs. 82.7%). Conclusions Our findings suggest that a model with a combination of four noninvasive parameters is useful for predicting true HP-uninfected individuals without the need for endoscopic examination.
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Yao K, Uedo N, Kamada T, Hirasawa T, Nagahama T, Yoshinaga S, Oka M, Inoue K, Mabe K, Yao T, Yoshida M, Miyashiro I, Fujimoto K, Tajiri H. Guidelines for endoscopic diagnosis of early gastric cancer. Dig Endosc 2020; 32:663-698. [PMID: 32275342 DOI: 10.1111/den.13684] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023]
Abstract
The Japan Gastroenterological Endoscopy Society developed the Guideline for Endoscopic Diagnosis of Early Gastric Cancer based on scientific methods. Endoscopy for the diagnosis of early gastric cancer has been acknowledged as a useful and highly precise examination, and its use has become increasingly more common in recent years. However, the level of evidence in this field is low, and it is often necessary to determine recommendations based on expert consensus only. This clinical practice guideline consists of the following sections to provide the current guideline: [I] Risk stratification of gastric cancer before endoscopic examination, [II] Detection of early gastric cancer, [III] Qualitative diagnosis of early gastric cancer, [IV] Diagnosis to choose the therapeutic strategy for gastric cancer, [V] Risk stratification after endoscopic examination, and [VI] Surveillance of early gastric cancer.
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Affiliation(s)
- Kenshi Yao
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Noriya Uedo
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Tomoari Kamada
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | | | - Masashi Oka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kazuhiko Inoue
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Katsuhiro Mabe
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takashi Yao
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Isao Miyashiro
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Hisao Tajiri
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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12
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Affiliation(s)
- Hiroshi Kishikawa
- Department of Gastroenterology, Ichikawa General Hospital, Tokyo Dental College, Japan
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Kwon H, Lee SY, Kim JH, Lee SP, Kim JH, Sung IK, Park HS, Shim CS. ABC Classification Is Less Useful for Older Koreans Born before 1960. Gut Liver 2020; 13:522-530. [PMID: 30970432 PMCID: PMC6743811 DOI: 10.5009/gnl18399] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/08/2018] [Accepted: 11/22/2018] [Indexed: 12/14/2022] Open
Abstract
Background/Aims In the ABC classification system, group A consists of seronegative subjects without gastric corpus atrophy. This study aimed to determine the prevalence and characteristics of pseudo group A subjects. Methods Group A subjects were identified among consecutive Korean adults who underwent a serum anti-Helicobacter pylori immunoglobulin G (IgG) test and pepsinogen (PG) assay on the day of endoscopy. Past infection was defined as the presence of either eradication history or endoscopic findings suggesting past infection (i.e., gastric xanthoma, metaplastic gastritis, or advanced atrophy >closed-type 1). Results Among 2,620 group A subjects, 448 (17.1%) had eradication history, and 133 (5.1%) showed endoscopic findings suggesting past infection. Older age (odds ratio [OR], 1.148; 95% confidence interval [CI], 1.067 to 1.236) and earlier year of birth (OR, 1.086; 95% CI, 1.009 to 1.168) were independent risk factors for classification into pseudo group A, with cutoff points at 50.5 years and birth year of 1959.5, respectively. Positive H. pylori test findings were found in 22 subjects (3.1%) among the 715 subjects who underwent the urea breath test or Giemsa staining on the same day. Current infection was positively correlated with PG I and PG II levels (p<0.001) but not with age, anti-H. pylori IgG titer, or classification into pseudo group A. Conclusions Among the group A subjects, 22.2% had past infection. The risk was higher in subjects older than 50 years, especially those born before 1960. Furthermore, current infection was found in 3.1% of the subjects and was correlated with increased gastric secretory ability.
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Affiliation(s)
- Hyungyung Kwon
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jun Hyun Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sang Pyo Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Hwan Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - In-Kyung Sung
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Chan Sup Shim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Kishikawa H, Ojiro K, Nakamura K, Katayama T, Arahata K, Takarabe S, Miura S, Kanai T, Nishida J. Previous Helicobacter pylori infection-induced atrophic gastritis: A distinct disease entity in an understudied population without a history of eradication. Helicobacter 2020; 25:e12669. [PMID: 31680399 PMCID: PMC7003427 DOI: 10.1111/hel.12669] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
Abstract
Individuals with chronic atrophic gastritis who are negative for active H. pylori infection with no history of eradication therapy have been identified in clinical practice. By excluding false-negative and autoimmune gastritis cases, it can be surmised that most of these patients have experienced unintentional eradication of H. pylori after antibiotic treatment for other infectious disease, unreported successful eradication, or H. pylori that spontaneously disappeared. These patients are considered to have previous H. pylori infection-induced atrophic gastritis. In this work, we define these cases based on the following criteria: absence of previous H. pylori eradication; atrophic changes on endoscopy or histologic confirmation of glandular atrophy; negative for a current H. pylori infection diagnosed in the absence of proton-pump inhibitors or antibiotics; and absence of localized corpus atrophy, positivity for autoantibodies, or characteristic histologic findings suggestive of autoimmune gastritis. The risk of developing gastric cancer depends on the atrophic grade. The reported rate of developing gastric cancer is 0.31%-0.62% per year for successfully eradicated severely atrophic cases (pathophysiologically equal to unintentionally eradicated cases and unreported eradicated cases), and 0.53%-0.87% per year for spontaneously resolved cases due to severe atrophy. Therefore, for previous H. pylori infection-induced atrophic gastritis cases, we recommend endoscopic surveillance every 3 years for high-risk patients, including those with endoscopically severe atrophy or intestinal metaplasia. Because of the difficulty involved in the endoscopic diagnosis of gastric cancer in cases of previous infection, appropriate monitoring of the high-risk subgroup of this understudied population is especially important.
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Affiliation(s)
- Hiroshi Kishikawa
- Department of GastroenterologyIchikawa General HospitalTokyo Dental CollegeIchikawaChibaJapan
| | - Keisuke Ojiro
- Department of GastroenterologyIchikawa General HospitalTokyo Dental CollegeIchikawaChibaJapan
| | - Kenji Nakamura
- Department of GastroenterologyIchikawa General HospitalTokyo Dental CollegeIchikawaChibaJapan
| | - Tadashi Katayama
- Department of GastroenterologyIchikawa General HospitalTokyo Dental CollegeIchikawaChibaJapan
| | - Kyoko Arahata
- Department of GastroenterologyIchikawa General HospitalTokyo Dental CollegeIchikawaChibaJapan
| | - Sakiko Takarabe
- Department of GastroenterologyIchikawa General HospitalTokyo Dental CollegeIchikawaChibaJapan
| | - Soichiro Miura
- Graduate SchoolInternational University of Health and WelfareMinato‐kuTokyoJapan
| | - Takanori Kanai
- Department of Internal MedicineDivision of Gastroenterology and HepatologyKeio UniversityShinjyuku‐kuTokyoJapan
| | - Jiro Nishida
- Department of GastroenterologyIchikawa General HospitalTokyo Dental CollegeIchikawaChibaJapan
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Chinda D, Shimoyama T, Mikami T, Arai T, Chiba D, Sasaki Y, Komai K, Sawada Y, Saito Y, Chiba H, Fukuda S. Serum pepsinogen levels indicate the requirement of upper gastrointestinal endoscopy among Group A subjects of ABC classification: a multicenter study. J Gastroenterol 2018; 53:924-931. [PMID: 29353347 DOI: 10.1007/s00535-018-1431-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/10/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND ABC classification has been used to assess the risk for gastric cancer. The current problem of ABC classification is that Group A contains individuals with current and past H. pylori infection. The aims of this study were to assesse the proportion of current and past infection in Group A and to establish a criteria for the identification of subjects with past infection from Group A subjects with negative results of urea breath test (UBT) and/or stool antigen test. METHODS 201 subjects classified into Group A received UBT and/or stool antigen test, and also subsequent upper gastrointestinal endoscopy. The subjects were classified by the status of H. pylori infection defined by endoscopic findings. Levels of pepsinogen (PG) I, PG II and PG I/II ratio were compared between the groups, and receiver operating characteristic curves were constructed to extract the corresponding cutoff values. RESULTS 22 subjects were tested positive by UBT and/or stool antigen test. Endoscopic images of 157 out of 179 subjects were studied. 15 of the subjects were regarded to have past H. pylori infection. The optimal cut-off value of PG I and PG I/II ratio for the determination of past H. pylori infection were ≤ 31.2 ng/mL and ≤ 4.6, respectively. CONCLUSIONS Approximately 20% of Group A subjects have current or past H. pylori infection. Addition of UBT and/or stool antigen test can identify current but not past infection. Serum PG levels would be useful to identify subjects with past H. pylori infection.
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Affiliation(s)
- Daisuke Chinda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
| | - Tadashi Shimoyama
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan
| | - Tetsu Arai
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
| | - Daisuke Chiba
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
| | - Yoshio Sasaki
- Sasaki Clinic of Gastroenterology and Internal Medicine, Aomori, Japan
| | - Kazuo Komai
- Komai Clinic of Gastroenterology and Internal Medicine, Aomori, Japan
| | | | - Yoshiharu Saito
- Shinjo Clinic of Gastroenterology and Internal Medicine, Aomori, Japan
| | - Hironobu Chiba
- Chiba Clinic of Gastroenterology and Internal Medicine, Hirosaki, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
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Horiuchi Y, Fujisaki J, Ishizuka N, Omae M, Ishiyama A, Yoshio T, Hirasawa T, Yamamoto Y, Nagahama M, Takahashi H, Tsuchida T. Study on Clinical Factors Involved in Helicobacter pylori-Uninfected, Undifferentiated-Type Early Gastric Cancer. Digestion 2017; 96:213-219. [PMID: 29050004 DOI: 10.1159/000481817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/27/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The factors associated with the pathogenesis of Helicobacter pylori-uninfected undifferentiated-type early gastric cancer (HPUGC) remain unclear. This study compared patient characteristics, including medical history and alcohol/tobacco use, of HPUGC patients with characteristics of patients with H. pylori-positive undifferentiated-type early gastric cancer (HPPGC) to clarify and gain understanding on those differences that could play a role in the pathogenesis. METHODS This retrospective study included 282 patients who were treated endoscopically from March 2005 to March 2014. This cohort consisted of 232 patients with HPPGC (82.3%) and 50 patients with HPUGC (17.7%). Patient characteristics were analyzed by subgroups of HPUGC vs. HPPGC, with comparisons for age, gender, cancer history, comorbidity of lifestyle diseases requiring medication (hypertension, type 2 diabetes, and dyslipidemia), cumulative amount of alcohol consumption, and smoking history (Brinkman index [BI]). RESULTS HPUGC patients were typically younger, had less frequent hypertension, and had higher BI values (p < 0.05 for all parameters). In a younger non-hypertensive subgroup, the OR for high BI (BI ≥340) in the HPUGC group vs. HPPGC group was 5.049 (95% CI 2.458-10.373, p < 0.0001). CONCLUSIONS The investigation of clinical factors identified smoking history as being possibly contributing to the pathogenesis of HPUGC. Future research is necessary at the cellular and genetic levels.
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Affiliation(s)
- Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Naoki Ishizuka
- Department of Clinical Trial Planning and Management, Cancer Institute Hospital, Tokyo, Japan
| | - Masami Omae
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Yorimasa Yamamoto
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Masatsugu Nagahama
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroshi Takahashi
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Tomohiro Tsuchida
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
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