Predicting the development of gastric cancer from combining Helicobacter pylon antibodies and serum pepsinogen status: a prospective endoscopic cohort study

Watabe, H.; Mitsushima, T.; Yamaji, Y.; Okamoto, M.; Wada, R.; Kokubo, T.; Doi, H.; Yoshida, H.; Kawabe, T.; Omata, M.
June 2005
Gut;Jun2005, Vol. 54 Issue 6, p764
Academic Journal
Background and aim: Helicobacter pylon infection and gastric atrophy are both risk factors for gastric cancer. We aimed to elucidate the natural history of gastric cancer development according to H pylon infection and gastric atrophy status. Subjects and methods: A total of 9293 participants in a mass health appraisal programme were candidates for inclusion in the present prospective cohort study: 6983 subjects revisited the follow up programme. Subjects were classified into four groups according to serological status at initial endoscopy. Group A (n = 3324) had "normal" pepsinogen and were negative for H pylon antibody; group B (n =2134) had "normal" pepsinogen and were positive for H pylon antibody; group C (n =1082) had "atrophic" pepsinogen and were positive for H pylon antibody; and group D (n =443) had "atrophic" pepsinogen and were negative for H pylon antibody. Incidence of gastric cancer was determined by annual endoscopic examination. Results: Mean duration of follow up was 4.7 years and the average number of endoscopic examinations was 5.1. The annual incidence of gastric cancer was 0.04% (95% confidence interval (CI) 0.02-0.09), 0.06% (0.03-0.13), 0.35% (0.23-0.57), and 0.60% (0.34-1.05) in groups A, B, C, and D, respectively. Hazard ratios compared with group A were 1.1(95% CI 0.4-3.4), 6.0 (2.4-14.5), and 8.2(3.2-21.5) in groups B, C, and D, respectively. Age, sex, and "group" significantly served as independent valuables by multivariate analysis. Conclusions: The combination of serum pepsinogen and anti-H pylon antibody provides a good predictive marker for the development of gastric cancer.


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