Environmental Factors in Helicobacter pylori-Related Gastric Precancerous Lesions in Venezuela

Abstract

Although Helicobacter pylori (HP) infection has been acknowledged to play an etiological role in gastric carcinogenesis, its relatively weak association particularly in developing countries suggests critical roles of cofactors. Among a population with an extremely high prevalence of HP infection (≈95%) in Venezuela, we examined the relationship of household characteristics, smoking, alcohol drinking, dietary consumption, and plasma nutrient levels with the prevalence of three different stages of gastric precancerous lesions, chronic atrophic gastritis (AG; n = 337), intestinal metaplasia (IM; n = 551), and dysplasia (n = 157), in comparison with those without any of these lesions (n = 1154). Length of refrigerator use was marginally inversely associated with the prevalence of the precursor lesions studied. The association was most pronounced for AG followed by dysplasia. On the other hand, smoking status was a significant predictor for IM and dysplasia. Those smoking ≥10 cigarettes/day had 1.8-fold risk of IM and 3.6-fold risk of dysplasia compared with never smokers. There were no associations with alcohol consumption. When six food groups known to be associated with stomach cancer risk in Venezuela were tested, the prevalence of these lesions progressively increased with increasing starchy vegetable consumption and decreasing fresh fruit/fruit juice consumption. The association with fruits was more evident for dysplasia and AG and that with starchy vegetables for IM and AG. However, there were no inverse associations with plasma antioxidant vitamins. These findings offer important public health implications in preventing progression of HP-associated gastric precancerous lesions in high-risk populations.

Chinese integrated guideline on the management of gastric precancerous conditions and lesions

“…In a study [ 176 ] from South Korea in which 199,235 patients without IM were followed up, a dose-dependent increase in the risk of IM in smokers was found, and this risk was significantly reduced in those who had quit smoking. This dose-dependent correlation was also confirmed in other studies [ 177 , 178 ].Smoking is not only related to the occurrence of PLGC but also to disease severity. Long-term smokers exhibited a significantly increased risk of severe CAG and IM [ 179 – 181 ].…”

“…A case-control study of American veterans showed that smoking was an independent risk factor for IM [170]. This finding was also supported by another case-control study from the northwestern part of China [168]. A study involving 7302 Chinese patients with chronic gastritis also suggested that smoking was an independent risk factor for the occurrence of PLGC [165].…”

Risk factors in the development of gastric adenocarcinoma in the general population: A cross-sectional study of the Wuwei Cohort

“…Smoking has been reported to be a risk factor for GAC, causing a 60 and 20% increase in GAC risk for men and women, respectively ( Nagaich, 2018 ). In premalignant lesions, smoking has been reported to be associated with IM, but not with CAG ( Kato et al, 2004 ; Peleteiro et al, 2007 ; Kim et al, 2019 ; Muhsen et al, 2019 ). In our study, we did not find a significant association between CAG and smoking.…”

Association between oral health and gastric precancerous lesions

“…The intestinal subtype accounts for $70% of gastric cancer cases (3) and is characterized as having a preneoplastic sequence spanning from chronic superficial gastritis to atrophic gastritis, intestinal metaplasia, dysplasia and ultimately malignancy (4,5). Several case-control studies of gastric precancerous lesions, predominantly atrophic gastritis and intestinal metaplasia, have identified common risk factors for gastric cancer such as cigarette smoking, old age and low levels of fruit or vitamin C intake (6,7,8,9,10,11). Studies of gastric precancerous lesions may improve our understanding of the biologic basis of carcinogenesis and the natural history of gastric cancer.…”