The corpus-predominant gastritis index can be an early and reversible marker to identify the gastric cancer risk of Helicobacter pylori-infected nonulcer dyspepsia.
BACKGROUND
Corpus-predominant gastritis index (CGI) is an early histological marker to identify Helicobacter pylori-infected gastric cancer relatives at risk of cancer. This study validated whether CGI is more prevalent in H. pylori-infected nonulcer dyspepsia (NUD) subjects than in duodenal ulcer (DU) controls and whether it is reversible after H. pylori eradication or is correlated with noninvasive biomarkers.


METHODS
In this longitudinal cohort study, 573 H. pylori-infected subjects were enrolled, including 349 NUD and 224 DU. Gastric specimens were provided to assess CGI, spasmolyic polypeptide-expressing metaplasia (SPEM), and Operative Link on Gastric Intestinal Metaplasia assessment (OLGIM). Serum pepsinogen I and II levels were assessed using enzyme-linked immunosorbent assay. CGI subjected were followed up at least 1 year after H. pylori eradication.


RESULTS
NUD subjects had higher prevalence rates of CGI (47.0% vs 29.9%, P<.001) and OLGIM stages III-IV (24.1% vs 15.2%, P=.01) than controls. CGI was highly prevalent in NUD subjects after the age of 40, which was 10 years earlier than atrophic gastritis and intestinal metaplasia. NUD subjects with CGI had higher risk of SPEM (OR 2.86, P<.001) and lower serum pepsinogen I/II ratios (P<.001) than those without CGI. Serum pepsinogen I/II ratios <9 could predict CGI modestly (AUROC 0.69, 95% CI: 0.63-0.74). CGI was regressed after eradication (P<.001).


CONCLUSIONS
CGI was more prevalent in H. pylori-infected NUD subjects than in controls, was correlated with SPEM, and may serve as a marker earlier than OLGIM to indicate risk of gastric cancer. Moreover, CGI could be regressed after eradication.
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Hsiu-Chi
http://orcid.org/0000-0003-0954-0647
HC
Cheng
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Executive Yuan, Tainan, Taiwan.
Yu-Ching
YC
Tsai
Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Pathology, Ton Yen General Hospital, Hsinchu, Taiwan.
Hsiao-Bai
HB
Yang
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Yi-Chun
YC
Yeh
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Wei-Lun
WL
Chang
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Hsin-Yu
HY
Kuo
Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Cheng-Chan
CC
Lu
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Executive Yuan, Tainan, Taiwan.
Bor-Shyang
BS
Sheu
D000328:Adult; D000368:Aged; D004415:Dyspepsia / Q000150:complications*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005756:Gastritis / Q000150:complications* / Q000473:pathology*; D016481:Helicobacter Infections / Q000150:complications* / Q000473:pathology*; D006651:Histocytochemistry; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*
D020116:Pepsinogen A

Helicobacter pylori
; corpus-predominant gastritis; gastric cancer screening; intestinal metaplasia; spasmolytic polypeptide-expressing metaplasia