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Gastric cancer and H pylori
  1. S M Dawsey1,
  2. S D Mark1,
  3. P R Taylor1,
  4. P J Limburg2
  1. 1National Cancer Institute, Bethesda, MD, USA
  2. 2Mayo Clinic, Rochester, MN, USA
  1. Correspondence to:
    Dr S M Dawsey, National Cancer Institute, 6116 Executive Blvd, Rm 705, Bethesda, MD 20892-8314, USA;

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We would like to comment on the relationship of chronic Helicobacter pylori infection and gastric cardia cancer risk discussed in the recent combined analysis of prospective serological studies presented by the Helicobacter and Cancer Collaborative Group (Gut 2001;49:347–53). It is our opinion that the null association between H pylori seropositivity and gastric cardia cancer risk reported in this analysis may have resulted in a large part from the combination of observational studies with (a) different definitions of gastric cardia cancer and (b) diverse subject populations, particularly with respect to the prevalence of gastro-oesophageal reflux disease (GORD), which we believe may affect the perceived H pylori-cardia cancer relationship.

By definition, the gastric cardia represents only the proximal 2–3 cm of the stomach. This small anatomical region can easily be overgrown by tumours that originate from adjacent mucosal sites. Thus in populations where both oesophageal and gastric adenocarcinomas are common, tumours described as “cardia cancers” undoubtedly include a mixture of neoplasms arising from the lower oesophagus as well as the gastric cardia (and perhaps even the more distal stomach). Classification of gastric cardia cancer has been further confused by the inclusion of malignant lesions …

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