Helicobacter pylori, chronic atrophic gastritis, inactive aldehyde dehydrogenase-2, macrocytosis and multiple upper aerodigestive tract cancers and the risk for gastric cancer in alcoholic Japanese men.
BACKGROUND
Gastric carcinoma occurs at a high rate in alcoholic Japanese men. Inactive heterozygous aldehyde dehydrogenase-2 (ALDH2*1/2*2) and macrocytosis (mean corpuscular volume [MCV] > or = 106 fl) enhance the risk for esophageal carcinoma, which frequently occurs with gastric carcinoma in this population. Whether alcoholism affects Helicobacter pylori-induced chronic atrophic gastritis (CAG) is unknown.


METHODS
This study of Japanese alcoholic men with (n = 45) and without (n = 281) gastric carcinoma included assessment of H. pylori IgG antibody, serum pepsinogen-confirmed CAG, MCV, and ALDH2 genotype.


RESULTS
The gastric carcinoma cases had a significantly higher age-adjusted prevalence of H. pylori-positivity (78%vs 57%), CAG (78%vs 42%), ALDH2*1/2*2 (36%vs 14%), MCV > or =106 fl (38%vs 20%), and concurrent esophageal/oropharyngolaryngeal carcinoma (18%vs 5%) than controls. Among gastric cancer-free controls, the prevalence of CAG was higher than generally reported in Japan, regardless of H. pylori status (H. pylori-positive, 56%vs 35-36% for Japanese general population; H. pylori-negative, 8%vs 1-3%). Alcoholism may accelerate the progression of CAG. Each of these factors increased the risk of gastric carcinoma (OR(s) = 3.7 for H. pylori-positive, 2.7 for non-severe CAG, 8.7 for severe CAG, 3.5 for ALDH2*1/2*2, 2.5 for MCV > or =106 fl, and 3.7 for concurrent carcinoma). A multivariate analysis showed that CAG and ALDH2*1/2*2 were independently related to the risk of gastric carcinoma. Combinations of CAG and ALDH2*1/2*2 showed greater risks of gastric carcinoma (OR(s) = 4.0 for non-severe CAG alone, 17.6 for severe CAG alone, 9.7 for ALDH2*1/2*2 alone, 17.1 for non-severe CAG plus ALDH2*1/2*2, and 39.2 for severe CAG plus ALDH2*1/2*2).


CONCLUSIONS
Combining blood tests for H. pylori, CAG, MCV and ALDH2 genotype could offer a new means of predicting risk of gastric carcinoma in Japanese alcoholic men.
Yokoyama
Akira
A
National Hospital Organization Kurihama Alcoholism Center, Kanagawa, Japan. a_yokoyama@kurihama1.hosp.go.jp
Yokoyama
Tetsuji
T
Omori
Tai
T
Matsushita
Sachio
S
Mizukami
Takeshi
T
Takahashi
Hisao
H
Higuchi
Susumu
S
Maruyama
Katsuya
K
Ishii
Hiromasa
H
Hibi
Toshifumi
T
D000230:Adenocarcinoma / Q000201:enzymology* / Q000382:microbiology*; D000328:Adult; D000368:Aged; D000444:Aldehyde Dehydrogenase / Q000378:metabolism*; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000201:enzymology* / Q000382:microbiology*; D005757:Gastritis, Atrophic / Q000201:enzymology* / Q000382:microbiology*; D016481:Helicobacter Infections / Q000201:enzymology*; D016480:Helicobacter pylori; D006801:Humans; D007822:Laryngeal Neoplasms / Q000201:enzymology* / Q000382:microbiology*; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000201:enzymology* / Q000382:microbiology*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000201:enzymology* / Q000453:epidemiology / Q000382:microbiology*
D000444:Aldehyde Dehydrogenase