Epidemiological trends of pre-malignant gastric lesions; a long-term nationwide study in the Netherlands

A C de Vries ^1*, G A Meijer ², C WN Looman ¹, M K Casparie ³, B E Hansen ¹, N CT van Grieken ² and E J Kuipers ¹

¹ Erasmus University Medical Center, Netherlands
² VU University Medical Centre, Netherlands
³ Prismant, Netherlands

^* To whom correspondence should be addressed. E-mail: a.c.devries{at}erasmusmc.nl.

Accepted 30 June 2007

Abstract

Background: Pre-malignant gastric lesions, i.e. atrophic gastritis (AG), intestinal metaplasia (IM) and dysplasia (DYS), have long been identified as principal risk factors for gastric cancer.

Objective: To evaluate epidemiological time trends of pre-malignant gastric lesions in the Netherlands.

Methods: Patients with a first diagnosis of AG, IM or DYS between 1991 and 2005 were identified in the Dutch nationwide histopathology registry . We evaluated the number of new diagnoses per year relative to the total number of patients with a first gastric biopsy. Time trends were evaluated with age-period-cohort models using logistic regression analysis.

Results: 23.278 patients were newly diagnosed with AG, 65.937 patients with IM, and 8.517 patients with DYS. The incidence of AG declined similarly in men and women with 8.2% per year [95% CI 7.9 - 8.6], and DYS with 8.1% per year [95% CI 7.5-8.6]. The proportional number of new IM cases declined with 2.9% per year [95% CI 2.7-3.1] in males and 2.4% [95% CI 2.2-2.6] in females. With age-period-cohort models a cohort phenomenon was demonstrated for all categories of pre-malignant gastric lesions in males and in females with IM and DYS. Period phenomena with a larger decline in number of diagnoses after 1996 were also demonstrated for AG and IM.

Conclusions: The incidence of pre-malignant gastric lesions is declining. Period and cohort phenomena were demonstrated for diagnoses of AG and IM. These findings imply that a further decrease of at least 24% in the incidence of gastric cancer in the coming decade may be anticipated in Western countries without specific intervention.

Keywords: atrophic gastritis, dysplasia, epidemiology, intestinal metaplasia, pre-malignant gastric lesions

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