title: Development of gastric cancer in nonatrophic stomach with highly active inflammation identified by serum levels of pepsinogen and Helicobacter pylori antibody together with endoscopic rugal hyperplastic gastritis.
abstract: This study aimed to elucidate groups at high risk of developing cancer among patients with serologically identified Helicobacter pylori infection and nonatrophic stomach. Annual endoscopy was performed for a mean of 5.4 years in 496 asymptomatic middle-aged men who were H. pylori antibody-positive and pepsinogen (PG) test-negative. Subjects were stratified according to the activity of H. pylori-associated gastritis measured by serum levels of PG and H. pylori antibody, and/or by endoscopic findings of rugal hyperplastic gastritis (RHG), and cancer development was investigated. During the study period, seven cases of cancer developed in the cohort (incidence rate, 261/100,000 person-years), with 85.7% developing in the group showing a PGI/II ratio ≤ 3.0, reflecting active inflammation-based high PGII levels. Cancer incidence was significantly higher in this group (750/100,000 person-years) than in groups with less active gastritis. Furthermore, cancer incidence for this group was significantly higher in the subgroup with high H. pylori antibody titers than in the low-titer subgroup. Meanwhile, endoscopic findings revealed that 11.7% of subjects showed RHG reflecting localized highly active inflammation, and cancer risk was significantly higher in patients with RHG than in patients without. Combining the two serum tests and endoscopic examination for RHG allowed identification of subjects with more active gastritis and higher cancer risk. No cancer development was observed in these high-risk subjects after H. pylori eradication. Subjects with highly active gastritis identified by the two serological tests and endoscopic RHG constitute a group at high risk of cancer development with H. pylori-infected nonatrophic stomach.
authors.affiliation: Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama City, Wakayama, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Watanabe
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.forename: Izumi
authors.initials: I
authors.lastname: Inoue
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Takeichi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Chizu
authors.initials: C
authors.lastname: Mukoubayashi
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Deguchi
authors.forename: Shotaro
authors.initials: S
authors.lastname: Enomoto
authors.forename: Kazuki
authors.initials: K
authors.lastname: Ueda
authors.forename: Takao
authors.initials: T
authors.lastname: Maekita
authors.forename: Mikitaka
authors.initials: M
authors.lastname: Iguchi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Utsunomiya
authors.forename: Nobutake
authors.initials: N
authors.lastname: Yamamichi
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Masataka
authors.initials: M
authors.lastname: Iwane
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Tekeshita
authors.forename: Osamu
authors.initials: O
authors.lastname: Mohara
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Ushijima
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
mesh_terms: D000907:Antibodies, Bacterial / Q000097:blood* / Q000276:immunology; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005757:Gastritis, Atrophic / Q000097:blood / Q000276:immunology / Q000473:pathology* / Q000821:virology; D016481:Helicobacter Infections / Q000097:blood / Q000150:complications / Q000276:immunology; D016480:Helicobacter pylori / Q000276:immunology*; D006801:Humans; D006965:Hyperplasia / Q000097:blood / Q000276:immunology / Q000473:pathology; D015994:Incidence; D007249:Inflammation / Q000097:blood / Q000276:immunology / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood*; D012307:Risk Factors; D013270:Stomach / Q000382:microbiology / Q000473:pathology; D013274:Stomach Neoplasms / Q000097:blood* / Q000276:immunology / Q000473:pathology / Q000821:virology*
chemical_list: D000907:Antibodies, Bacterial; D020116:Pepsinogen A