Background: Despite its decreasing incidence, gastric cancer (GC) remains one of the leading cancers in the world and an important global healthcare problem due to its overall high prevalence and high mortality rate. Summary: GC is a consequence of Helicobacter pylori infection in 90% of cases, while in 10% Epstein Barr Virus may be responsible. Moreover, some recent epidemiological data suggest an increasing incidence in some young patients groups possibly due to autoimmunity, and if this tendency is confirmed, it may change the epidemiology of GC in the future. The pathogenesis of GC is mainly related to H. pylori infection, but recent data indicate the possible role of other bacteria and their metabolites, like N-nitrosocompounds or acetaldehyde, interfering during the last steps of carcinogenesis. The new molecular classifications of GCs show a great heterogeneity of this neoplasia, which may in the future help to define personalized treatment strategies for the patients. Early detection and proper surveillance of high risk patients should be our major objectives. Key Messages: GC is still an important healthcare problem, with its several aspects which remain the major challenges for the future. EpidemiologyIs part of the special issue "50th Anniversary of the EAGEN. Successes and Failures in Gastroenterology during the past 50 years with an Outlook to the Future".

These guidelines in gastric cancer are done to help decision for daily clinical practice. These recommendations are permanently being reviewed. Each individual case must be discussed within a multidisciplinary team.

Colorectal cancer (CRC) is one of the most common and lethal malignancies in Western countries. Its development is a multistep process that spans more than 15 years, thereby providing an opportunity for prevention and early detection. The high incidence and mortality rates emphasise the need for prevention and screening. Many countries have therefore introduced CRC screening programmes. It is expected, and preliminary evidence in some countries suggests, that this screening effort will decrease CRC-related mortality rates. CRC prevention involves a healthy lifestyle and chemoprevention—more specifically, oral chemoprevention that can interfere with progression from a normal colonic mucosa to adenocarcinoma. This preventive effect is important for individuals with a genetic predisposition, but also in the general population. The ideal chemopreventive agent, or combination of agents, remains unknown, especially when considering safety during long-term use. This review evaluates the evidence across 80 meta-analyses of interventional and observational studies of CRC prevention using medications, vitamins, supplements and dietary factors. This review suggests that the following factors are associated with a decreased incidence of CRC: aspirin, non-steroidal anti-inflammatory drugs, magnesium, folate, a high consumption of fruits and vegetables, fibre and dairy products. An increased incidence of CRC was observed with frequent alcohol or meat consumption. No evidence of a protective effect for tea, coffee, garlic, fish and soy products was found. The level of evidence is moderate for aspirin, β-carotene and selenium, but is low or very low for all other exposures or interventions.

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Background Analysis of serum biomarkers for the assessment of atrophic gastritis (AG), considered as gastric precancerous lesion, is of growing interest and recommended by current guidelines. Our aim was to evaluate the diagnostic performance of a panel of biomarkers (GastroPanel®) for the detection of AG in France, a country of a low gastric cancer (GC) incidence. Material and Methods In this prospective, multicenter, cross‐sectional study, consecutive patients considered at increased risk of GC and undergoing upper endoscopy with gastric biopsies were included. Blood samples were collected for the analysis of GastroPanel® (association of Pepsinogens I and II, Gastrin‐17, and Helicobacter pylori serology) using ELISA. The results of GastroPanel® were compared to the results of histology considered as the reference. Results Between 2016 and 2019, 344 patients (148 cases with AG, 196 controls without AG) were included. Sensitivity, specificity, positive, and negative predictive values for the detection of AG by GastroPanel® were of 39.9% (95% CI 31.9; 48.2), 93.4% (95% CI 88.9; 96.4), 81.9 (95% CI 71.1; 90.0), and 67.3 (95% CI 61.4; 72.8), respectively. The sensitivity was significantly higher for the detection of severe AG [60.8% (95% CI 46.1; 74.6) P = .015] and corpus AG [61.0% (95% CI 49.2; 72.0), P = .004]. Diagnostic performances of GastroPanel® tended to be better than those of Pepsinogen I alone, but the difference did not reach statistical significance (P = .068). Conclusion Serum pepsinogen and GastroPanel® tests show promising results for the detection of AG, especially of corpus AG and severe AG, in patients at high risk of GC in France.

Summary Background Obesity is a growing global public health problem. More than half the European and North American population is overweight or obese. Colon and rectum cancers are still the second leading cause of cancer death worldwide, and epidemiological data support an association between obesity and colorectal cancers (CRCs). Aim To review the literature on CRC epidemiology in obese subjects, assessing the effects of obesity, including childhood or maternal obesity, on CRC, diagnosis, management, and prognosis, and discussing targeted prophylactic measures. Method We searched PubMed for obesity/overweight/metabolic syndrome and CRC. Other key words included ‘staging’, ‘screening’, ‘treatment’, ‘weight loss’, ‘bariatric surgery’ and ‘chemotherapy’. Results In Europe, about 11% of CRCs are attributed to overweight and obesity. Epidemiological data suggest that obesity is associated with a 30%–70% increased risk of colon cancer in men, the association being less consistent in women. Visceral fat or abdominal obesity seems to be of greater concern than subcutaneous fat obesity, and any 1 kg/m2 increase in body mass index confers more risk (hazard ratio 1.03). Obesity might increase the likelihood of recurrence or mortality of the primary cancer and may affect initial management, including accurate staging. The risk maybe confounded by different factors, including lower adherence to organised CRC screening programmes. It is unclear whether bariatric surgery helps reduce rectal cancer risk. Conclusions Despite a growing body of evidence linking obesity to CRC, many questions remain unanswered, including whether we should screen patients with obesity earlier or propose prophylactic bariatric surgery for certain patients with obesity.

Introduction: Surveillance of gastric precancerous lesions (GPL) is recommended, but the data on their clinical and endoscopic management in a "real-life" practice are limited. Our aim was to study the modalities of endoscopic management of patients with GPL in France. Design: All the patients diagnosed with GPL in our center between 2000 and 2015 were grouped and analyzed according to the most severe GPL found, in the following order: atrophic gastritis only (AG), intestinal metaplasia (IM), low grade dysplasia (LGD), high grade dysplasia (HGD). Results: Out of 16,764 patients having undergone upper endoscopy with gastric biopsies, 507 were identified with GPL (detection rate 3.2%). Overall, Helicobacter pylori infection was found in 41% of patients. IM was by far the most frequently found lesion (79%), followed by LGD (17%), HGD (2%), and AG only (2%). H. pylori infection rate was decreasing, while the age of the patients was increasing, together with the increasing severity of GPL (p = 0.005). Only 28% of the patients had at least one follow-up endoscopy. No correlation was found between the endoscopist's appreciation of the mucosa and histological results. Conclusion: In France, GPL can be expected in about 3% of patients undergoing upper endoscopy with gastric biopsies for any reason. The correlation between the endoscopic evaluation and histology is poor. Spreading of published guidelines should improve the management of patients with GPL in the future.