Risk Factors for Gastric Tumorigenesis in Underlying Gastric Mucosal Atrophy

Abstract

Background/AimsAtrophic gastritis is considered a premalignant lesion. We aimed to evaluate the risk factors for gastric tumorigenesis in underlying mucosal atrophy.MethodsA total of 10,185 subjects who underwent upper gastrointestinal endoscopy between 2003 and 2004 were enrolled in this retrospective cohort study. Follow-up endoscopy was performed between 2005 and 2014. Atrophic gastritis and intestinal metaplasia were assessed by endoscopy using the Kimura-Takemoto classification. Helicobacter pylori infection was evaluated based on serum immunoglobulin G antibody levels, the rapid urease test, or the urea breath test.ResultsAtrophic gastritis was confirmed in 3,714 patients at baseline; 2,144 patients were followed up for 6.9 years, and 1,138 exhibited increased atrophy. A total of 69 subjects were diagnosed with gastric neoplasm during follow-up (35 adenoma and 34 carcinoma). Age ≥55 years (hazard ratio [HR], 1.234), alcohol consumption (HR, 1.001), and H. pylori infection (HR, 1.580) were associated with increased mucosal atrophy. The risk factors for gastric neoplasm in underlying mucosal atrophy were age ≥55 years (HR, 2.582), alcohol consumption (HR, 1.003), extent of mucosal atrophy (HR, 2.285 in C3-O1; HR, 4.187 in O2–O3), and intestinal metaplasia (HR, 2.655).ConclusionsExtent of atrophy, intestinal metaplasia, and alcohol consumption are significant risk factors for gastric neoplasm in underlying mucosal atrophy.

Body Mass Index and Risk of Intestinal Metaplasia: A Cohort Study

“…First, the diagnosis of atrophic gastritis and intestinal metaplasia was made only by endoscopic findings without histologic confirmation. In our study, the information on concordance between endoscopy and histology was not available; although a few studies have reported acceptable agreement between endoscopic and histologic diagnoses of atrophic gastritis and intestinal metaplasia, and also that endoscopically diagnosed atrophic gastritis and/or intestinal metaplasia were significantly associated with gastric cancer (53)(54)(55)(56). In addition, a reliability test among doctors who performed gastroduodenal endoscopy was not performed.…”

Prediction of progression of chronic atrophic gastritis withHelicobacter pyloriand poor prognosis of gastric cancer by CYP3A4

“…Chronic atrophic gastritis (CAG) is an important precancerous lesion for gastric cancer (GC). Helicobacter pylori infection was associated with increased mucosal atrophy . Half of the world's population is chronically infected with H. pylori .…”

“…Helicobacter pylori infection was associated with increased mucosal atrophy. 1 Half of the world's population is chronically infected with H. pylori. 2 Individuals with long-term exposure to H. pylori infection had a higher probability of progression to a more advanced diagnostic category along the precancerous cascade than those who cleared the infection and remained negative.…”

The evolving role of endoscopy in the diagnosis of premalignant gastric lesions

“…A Dutch study included all patients with histopathological diagnoses of CAG and/or GIM and described annual incidences of gastric cancer of 0.1% and 0.25%, respectively 48 . More recently, Song et al examined a retrospective cohort of 3,714 patients with confirmed CAG and demonstrated that the extent of atrophy and intestinal metaplasia, age over 55 years, and alcohol consumption were significant risk factors for the development of gastric neoplasia 50 . It is also clear that ethnicity and geographic location are determinants of gastric cancer risk in the setting of CAG and GIM.…”