TY - JOUR T1 - Digest JF - Gut JO - Gut SP - 897 LP - 897 VL - 56 IS - 7 A2 - , Y1 - 2007/07/01 UR - http://gut.bmj.com/content/56/7/897.2.abstract N2 - The aetiology of cardia cancer and the role of Helicobacter pylori in its pathogenesis remain unclear. The junctional position of this cancer is a source of misclassification; some cases may be oesophageal adenocarcinomas while others may be gastric adenocarcinomas. If the aetiology of this cancer is to be understood, we need a way of separating the two entities. Hansen et al addressed this question by comparing the premorbid state of the stomach in cardia vs non-cardia cancers. They used a nested case–control design that included 129 non-cardia cancers and 44 cardia cancers in Norway (each case had three matched controls). Serum collected a median of 11.9 years before the diagnosis of cancer was tested for anti-H pylori antibodies, pepsinogen I:II and gastrin. Cardia cancer was negatively associated with H pylori (OR 0.27, 95% CI 0.12 to 0.59), but H pylori-positive cardia cancer showed a positive association with gastric atrophy (OR 3.33, 95% CI 1.06 to 10.5) and were equally diffuse or intestinal according to Lauren classification (see fig). In contrast, H pylori negative cardia cancers without atrophy were largely intestinal. These findings confirm two aetiologies of cardia cancer and suggest that serological markers of gastric atrophy may provide the key to determining a gastric or oesophageal origin of cancer. See p 918 Serum pepsinogen I to serum pepsinogen … ER -