Original article
Noninvasive Versus Histologic Detection of Gastric Atrophy in a Hispanic Population in North America

https://doi.org/10.1016/j.cgh.2005.11.003Get rights and content

Background & Aims: Cancer risk is directly correlated with the severity and extent of mucosal atrophy, making identification of atrophy a goal in cancer prevention programs. The aim of this study was to compare targeted histology with noninvasive testing for the identification of antral and/or corpus atrophy in North America. Methods: In a cross-sectional study of a random sample of households, 8 gastric biopsy specimens were obtained from defined locations in the antrum and corpus. Biopsies were scored for the presence of Helicobacter pylori and gastric atrophy (defined as loss of normal glandular components). Atrophy was scored by using the Sydney system and a system based on the number and location of corpus biopsies with atrophy. Patients’ sera were examined for pepsinogen I, pepsinogen II, and gastrin-17 (fasting and stimulated). Results: One hundred eighty volunteers, approximately 30 per age group and ranging in age from 18–82 years, participated. There were 76 men. The overall weighted prevalence of a corpus atrophy was 4.7% (95% confidence interval, 2.3–7.0). There was a significant inverse relationship between the grade of corpus atrophy and the pepsinogen I/pepsinogen II ratio (R = −0.31, P < .01). We failed to confirm the usefulness of the proposed algorithm by using gastrin-17, H pylori serology, and serum pepsinogens to categorize the gastric histology. The Sydney system underestimated the prevalence of corpus atrophy by approximately 25%. Conclusion: Noninvasive testing is both possible and practical by using pepsinogen assays for the identification of the precancerous condition of moderate to severe corpus atrophy in North American Hispanic patients.

Section snippets

Study Design

The study was done in Ciudad Juarez, Mexico, which is on the US-Mexico border contiguous to El Paso, Texas. This was a cross-sectional study in which volunteers were recruited from a random sample of households selected by means of a multistage cluster, self-weighted design. The survey was designed to be self-weighted and stratified by age and sex. In the first stage, census tracts were selected (ie, primary sampling unit) with probability proportional to their size. In the second, blocks were

Study Population Demographics and Prevalence of Helicobacter pylori Infection

A total of 180 adult volunteers ranging in age from 17–82 years participated, 76 men and 104 women. The overall seropositivity rate of H pylori infection as defined above was 76%, increasing from 55.2% in the age 17–29 group to 90.3% at ages 50–59. There was no significant difference in the overall prevalence of H pylori infection between men and women (78.4% vs 74.5%).

Prevalence of Gastric Atrophy

Adequate biopsy specimens to assess corpus atrophy were available from 178 subjects, and data for antral atrophy were available

Discussion

It is now generally accepted that epidemic noncardiac gastric cancer is etiologically associated with H pylori infection, and that the presence of atrophic gastritis is the primary easily identifiable risk factor.1 Changes in environmental factors including diet, food storage, and sanitation have resulted in a major reduction in the prevalence of H pylori and of gastric cancer among those with the infection.26 Eradication of H pylori at a nonatrophic stage will likely prevent the subsequent

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    Supported in part by the Office of Research and Development, Medical Research Service, Department of Veterans Affairs, by Public Health Service grant DK56338 which funds the Texas Gulf Coast Digestive Diseases Center, and by a grant from Biohit Diagnostics, Helsinki, Finland. No for-profit company had any input into the study design or analyses. Dr Graham receives royalties from Baylor College of Medicine from a patent on the antigen used in the HM-CAP serologic test. The Mexican Institute for Social Security authorized the use of the General Hospital Region 6 endoscopic facility and staff support to conduct the endoscopies.

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