A negative Helicobacter pylori serology test is more reliable for exclusion of premalignant gastric conditions than a negative test for current H. pylori infection: a report on histology and H. pylori detection in the general adult population.
OBJECTIVE
Corpus-dominant gastritis, gastric mucosal atrophy and intestinal metaplasia (IM) associated with Helicobacter pylori infection are all known potential risk markers for the development of gastric cancer. As the accuracy for finding cases at risk in the general population is unknown, we aimed to determine the prevalence of current and/or past H. pylori infection and associated gastric mucosal findings by means of histological survey of a random adult population.


METHODS
A random Swedish sample (n = 3000, age 20-81 years) was surveyed using a validated gastrointestinal symptom questionnaire with 74% response rate. One-third of the responders were selected at random for esophago-gastro-duodenoscopy with biopsies and H. pylori serology.


RESULTS
Of those endoscoped (n = 1000, mean age 53.5, 51% women), 43.0% were H. pylori+ by serology (seropositive), 33.9% had signs of current infection on either histology or culture (gold standard+), and 9.3% were seropositive, but gold standard negative. Corpus atrophy was found in 10% and IM in 13% when gold standard positive, and in a significantly higher number (17% and 21%, respectively) of those with only a serological sign of past infection. Among those who were seronegative, values were 1% and 2%, respectively. Corpus-dominant gastritis was found in 4.1%, all seropositive.


CONCLUSIONS
One-third had an ongoing H. pylori infection, and a further 10% had signs of past infection. Corpus-dominant gastritis was found mostly among the former, while detection of those with corpus atrophy and IM also required a test for past infection. Seronegativity almost excludes precancerous conditions in a screening situation.
Storskrubb
Tom
T
Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden. tom.storskrubb@nll.se
Aro
Pertti
P
Ronkainen
Jukka
J
Vieth
Michael
M
Stolte
Manfred
M
Wreiber
Karin
K
Engstrand
Lars
L
Nyhlin
Henry
H
Bolling-Sternevald
Elisabeth
E
Talley
Nicholas J
NJ
Agréus
Lars
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood*; D001706:Biopsy; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005757:Gastritis, Atrophic / Q000382:microbiology* / Q000473:pathology; D016481:Helicobacter Infections / Q000382:microbiology* / Q000473:pathology; D016480:Helicobacter pylori / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000382:microbiology* / Q000473:pathology; D011706:Pyloric Antrum / Q000473:pathology; D011897:Random Allocation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012698:Serologic Tests; D013274:Stomach Neoplasms / Q000473:pathology*; D011795:Surveys and Questionnaires; D013548:Sweden
D000907:Antibodies, Bacterial