Helicobacter pylori eradication (Hp-er) has become widespread in Japan since Japanese public insurance started covering that treatment.
The data of the esophagogastroduodenoscopy (EGD) screening program from June 2012 through February 2017 at Ota Memorial Hospital (OMH) in Japan was reviewed. All cases of gastric cancer (GC) with Hp-er history (Hp-er Hx) detected in the EGD screening program were analyzed to reveal their characteristics.
21,817 individuals were enrolled in EGD screening program of OMH during the above period. 5,563 of them (25.5%) have Hp-er Hx. Fifty cases of GC were found in that program (detection rate 0.23%) and 27 of them (54%) have Hp-er Hx (detection rate 0.49% in participants with Hp-er Hx). The intervals between Hp-er and GC detection were ascertained in 19 cases. Median duration is 3 years and the longest interval is 20 years. Anti-Hp IgG antibody (Hp-Ab) was measured in 26 GC cases with Hp-er Hx. Although 6 cases still had 10 or more than 10 U/ml (Hp-Ab “positive”), other 20 showed less than 10 U/ml (Hp-Ab “negative”) and 5 of them revealed less than 3 U/ml. Seventeen cases (63%) of GC with Hp-er Hx were the current or former smoker. The median of their Brinkman index is 690. Other 10 cases were non-smoker and 8 of them (80%) had family history of GC although only 23.5% had such a family history among current or former smokers with Hp-er Hx. All 27 cases of GC with Hp-er Hx suffered from chronic atrophic gastritis (CAG). Twenty-five of them were diagnosed as the open type (or advanced type) CAG. Other two had the closed type CAG but C-3 (nearly advanced atrophy) in Kimura-Takemoto’s CAG classification. Although GC lesions were localized at any part of the stomach, all of them were found in atrophic gastric mucosa by EGD. Five of them were diffuse type and other 22 were intestinal type on Lauren’s classification in their histopathologic findings.
It is important for individuals with Hp-er Hx to take periodic or annual EGD screening to search for GC because more than half cases of GC had Hp-er Hx in EGD screening program of OMH. Among them, ones with smoking or family history of GC have high risk. It is necessary for such individuals to have meticulous EGD inspection of the whole stomach, especially the area of atrophic gastric mucosae.
Clinical trial identification
Legal entity responsible for the study
Ota Memorial Hospital
All authors have declared no conflicts of interest.