The prevalence of premalignant gastric lesions in asymptomatic patients: predicting the future incidence of gastric cancer.
BACKGROUND
Helicobacter pylori is the main risk-factor for gastric cancer through a cascade from gastritis through atrophic gastritis (AG), intestinal metaplasia (IM), dysplasia (DYS) to malignancy. The presence of these lesions in the general population predicts the gastric cancer incidence in the coming decades. Prevalence data are mostly obtained from serological studies and endoscopy data in symptomatic patients.


OBJECTIVE
To investigate the prevalence of H. pylori infection and its related gastric changes in asymptomatic subjects.


METHODS
383 Patients undergoing routine colonoscopy were included. All subjects underwent upper GI endoscopy and completed the Gastrointestinal Symptom Rating Scale (GSRS). Biopsies were taken from antrum and corpus.


RESULTS
H. pylori infection was present in 22%. Non-Caucasian subjects had a significantly higher H. pylori prevalence (p < 0.001). AG, IM and DYS were together found in 9.3% of subjects. Subjects with AG, IM or DYS were significantly older (p < 0.001). No differences were found with respect to gender, presence of GI symptoms as scored by GSRS, lifestyle and medication use.


CONCLUSIONS
The prevalence of premalignant gastric lesions is considerable in general Western population with increasing age as the main risk factor. One time screening for premalignant lesions at the age of 60 years is a reasonable strategy since the numbers found imply that gastric cancer will remain a prevalent disease.
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. c.denhoed@erasmusmc.nl
C M
CM
den Hoed
B C
BC
van Eijck
L G
LG
Capelle
H
H
van Dekken
K
K
Biermann
P D
PD
Siersema
E J
EJ
Kuipers
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003113:Colonoscopy / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D005756:Gastritis / Q000382:microbiology; D016480:Helicobacter pylori / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000382:microbiology