Gastric atrophy and oesophageal squamous cell carcinoma: possible interaction with dental health and oral hygiene habit.
BACKGROUND
Gastric fundal atrophy has been hypothesised to increase the risk of oesophageal squamous cell carcinoma (OSCC), but studies have shown inconsistent results.


METHODS
We measured serum pepsinogen I (PGI) and pepsinogen II (PGII) among 293 incident cases and 524 matched neighbourhood controls in a high-risk area of Northern Iran. Conditional logistic regression model was used to estimate odds ratios (ORs) and their 95% confidence intervals (CIs).


RESULTS
After controlling for age, sex, residence area and other potential confounders, gastric atrophy (defined by a validated criterion, PGI <55 μg dl(-1)) was associated with a two-fold increased risk (OR=2.01, 95% CI: 1.18, 3.45) of OSCC in the absence of nonatrophic pangastritis (defined as PGII <11.8 μg dl(-1)). Stratification by PGII decreased the misclassification errors due to cancer-induced gastritis. Presence of both poor dental health, indicated by higher than median sum of decayed, missing, and filled teeth (DMFT score), and gastric atrophy further increased the risk of OSCC (OR=4.15, 95% CI: 2.04, 8.42) with relative excess risk due to interaction (RERI) of 1.47 (95% CI: -1.15, 4.1). Coexistence of poor oral hygiene habit with gastric atrophy elevated OSCC risk eight times (OR=8.65, 95% CI: 3.65, 20.46) and the additive interaction index was marginally statistically significant (RERI=4.34, 95% CI: -1.07, 9.76).


CONCLUSIONS
Gastric atrophy is a risk factor for OSCC, and poor dental health and oral hygiene habit may act synergistically in increasing the risk.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 17177, Sweden.
D
D
Nasrollahzadeh
R
R
Malekzadeh
K
K
Aghcheli
M
M
Sotoudeh
S
S
Merat
F
F
Islami
F
F
Kamangar
C C
CC
Abnet
R
R
Shakeri
A
A
Pourshams
S
S
Semnani
P
P
Boffetta
S M
SM
Dawsey
W
W
Ye
D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000473:pathology*; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000097:blood / Q000473:pathology*; D005260:Female; D005757:Gastritis, Atrophic / Q000097:blood / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene / Q000379:methods*; D020116:Pepsinogen A / Q000097:blood; D020115:Pepsinogen C / Q000097:blood; D012307:Risk Factors; D011795:Surveys and Questionnaires
D020115:Pepsinogen C; D020116:Pepsinogen A