Atrophic gastritis and enlarged gastric folds diagnosed by double-contrast upper gastrointestinal barium X-ray radiography are useful to predict future gastric cancer development based on the 3-year prospective observation

Abstract

Of the 6433 subjects, 1936 (30.1 %) had atrophic gastritis and 1253 (19.5 %) had enlarged gastric folds. During the 3-year prospective observational follow-up, gastric cancer developed in seven subjects, six of whom (85.7 %) had atrophic gastritis with H. pylori infection and five of whom (71.4 %) had enlarged gastric folds with H. pylori infection. The Kaplan-Meier method with log-rank testing revealed that both UGI-XR-based atrophic gastritis (p = 0.0011) and enlarged gastric folds (p = 0.0003) are significant predictors for future gastric cancer incidence.

Gastric polyps diagnosed by double-contrast upper gastrointestinal barium X-ray radiography mostly arise from the Helicobacter pylori-negative stomach with low risk of gastric cancer in Japan

“…The greatest risk of follow-up observation without UGI-ES is to erroneously diagnose protruded early gastric cancers as nonmalignant gastric polyps, but our results indicate such misdiagnoses are quite rare. Nowadays, it has been gradually accepted that UGI-XR can detect not only gastric cancer but also premalignant atrophic/hypertrophic gastritis [4,25,30,32]. Our recent report demonstrated that UGI-XR can diagnose chronic H. pylori infection with very high accuracy (97.8 %; 1638 of 1674 subjects) [5].…”

“…Synthetic diagnoses from the judgments of these three specialists were used for the analyses. UGI-XR-based atrophic gastritis was classified into four types according to our recent reports as follows [5,25,30]: no atrophic gastric mucosa (type A), mild atrophic gastritis (type B), moderate atrophic gastritis (type C), and severe atrophic gastritis (type D).…”

“…Several risk factors, such as chronic H. pylori infection [14,15], male gender [16,17], salt intake [18,19], and smoking [20][21][22][23], adversely affect gastric tumorigenesis. It is now established that H. pylori infection is by far the strongest risk factor among them [14], and it is also established that H. pyloriinduced ''mucosal atrophy'' (atrophic gastritis) and ''enlarged gastric folds'' (hypertrophic gastritis) are both obvious predictive indicators for future gastric cancer incidence [24,25]. During this half century, the prevalence of H. pylori infection has considerably decreased not only in Japan but also worldwide [26][27][28][29].…”

Preliminary opinion on assessment categories of stomach ultrasound report and data system (Su-RADS)

“…In Japan and Korea, barium swallow continues to be one of the main choices for mass screening of gastric cancer; approximately 4,000,000 individuals undergo barium swallow testing annually In Japan and approximately 1,000,000 individuals undergo annual barium studies in Korea [1–4, 18, 19]. A serious drawback is low uptake of the target population; fear for radiation exposure (0.6 mSv), swallowing problems with the use of unpleasant barium meal, accidental fall during the examination and constipation (6%) causing rare but more serious complications such as intestinal obstruction or diverticulitis after examination may account for the reasons for this low uptake [1].…”

Guidelines for endoscopic diagnosis of early gastric cancer

“…found that the risk of gastric cancer was 35.5‐fold higher in cases with a fold width of at least 7 mm than in those with a fold width of 4 mm or less in the gastric corpus and pointed out that the fold width in the gastric corpus was a risk factor for undifferentiated gastric cancer occurring in the gastric corpus. Yamamichi et al 13 . also found the occurrence of five cases of gastric cancer in 3‐year prospective observation of 1253 patients with enlarged fold gastritis and reported that enlarged fold was a predictor of gastric cancer.…”