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Gut 54:764-768 doi:10.1136/gut.2004.055400
  • Gastric cancer

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

  1. H Watabe1,
  2. T Mitsushima2,
  3. Y Yamaji1,
  4. M Okamoto3,
  5. R Wada4,
  6. T Kokubo5,
  7. H Doi6,
  8. H Yoshida3,
  9. T Kawabe3,
  10. M Omata3
  1. 1Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan, and Makuhari Clinic, Chiba, Japan
  2. 2Makuhari Clinic, Chiba, Japan, and Department of Gastroenterology, Kameda General Hospital, Chiba, Japan
  3. 3Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
  4. 4Department of Gastroenterology, Kameda General Hospital, Chiba, Japan
  5. 5Department of Pathology, Kameda General Hospital, Chiba, Japan
  6. 6Makuhari Clinic, Chiba, Japan
  1. Correspondence to:
    Dr H Watabe
    7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; hwatabe-gi{at}umin.ac.jp
  • Accepted 14 October 2004
  • Revised 13 October 2004

Abstract

Background and aim:Helicobacter pylori 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 pylori 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 pylori antibody; group B (n = 2134) had “normal” pepsinogen and were positive for H pylori antibody; group C (n = 1082) had “atrophic” pepsinogen and were positive for H pylori antibody; and group D (n = 443) had “atrophic” pepsinogen and were negative for H pylori 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 pylori antibody provides a good predictive marker for the development of gastric cancer.

Footnotes

  • Conflict of interest: None declared.

  • Part of this study was presented in the research forum at the Annual meeting of the American Gastroenterology Association, Orlando, Florida, 20 May 2003.