Helicobacter pylori in gastric atrophy and intestinal metaplasia

Francis Mégraud, MD.

Laboratoire de Bactériologie, Université Victor Segalen Bordeaux 2, Bordeaux, France

AIMS - Atrophic chronic gastritis (ACG) is recognised since many years as a premalignant condition. The development of ACG is multifactorial. In addition to environmental factors, host response to Helicobacter pylori infection has recently been implicated. The aim of this study was to determine factors involved in ACG in a European dyspeptic population. METHODS - Data concerning socio-demographics, social behaviour, biological aspects, diet, and virulence factors of H. pylori strains were collected in a cross-sectional study. Dyspeptic, H. pylori positive patients with ACG or non-ACG (NACG) at histology were included from 19 European centers in 14 countries. Anti-CagA antibodies were evaluated by two immunoblot tests and anti-VacA antibodies by one. Logistic regression models were constructed, estimated odds ratio (OR) and 95% confidence intervals (95%CI) were calculated from the coefficients. RESULTS - Of the 451 patients included in the study, 267 were analysed: 202 had NACG and 65 ACG. The mean age was 44.4 years and 63% were women. Risk factors for atrophy identified by multivariate analysis were: age over 60 (OR=4.14, 95%CI 1.79-9.58), coffee consumption (OR=2.35, 95%CI 1.07-5.16), sedative consumption (OR=2.17, 95%CI 1.04-4.52), and harbouring anti-CagA and anti-VacA antibodies simultaneously (OR=3.09, 95%CI 1.26-7.56); while the odds was significantly reduced for those with an anxiety score of 6 or more (OR=0.45, 95%CI 0.21-0.99). CONCLUSION - The simultaneous presence of anti-CagA and anti-VacA antibodies enhanced the risk for ACG in European dyspeptic patients. Failure to discern diet and family history as risk factors for ACG may suggest that diet is homogeneous in Europe and that most of the risk factors for ACG identified so far are identical to risk factors for H. pylori infection.

For more information, contact

Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Risk Assessment & Prognosis.