BACKGROUND AND AIMS: The incidence of gastric cancer in Japan is four times higher than in the UK. It usually arises in a stomach with corpus predominant or pangastritis that has undergone extensive atrophy and intestinal metaplasia. We hypothesised that a Japanese population would have a more severe gastritis with a corpus predominant or pangastritis pattern and a greater degree of atrophy and intestinal metaplasia than that found in the UK. To test this we designed a comparative trial. METHODS: A total of 252 age matched consecutive patients were recruited from the endoscopy services in Leeds and Tokyo. In each centre, 21 patients were prospectively selected from each decennial, between the ages of 20-80 years. All had epigastric discomfort as their predominant symptom. Patients with peptic ulcer, cancer, and oesophagitis were excluded. Five gastric biopsies were examined by two histopathologists using the updated Sydney system. Helicobacter pylori infection was assessed by histology and culture of biopsies and enzyme linked immunosorbent assay and immunoblot of plasma. RESULTS: Gastritis was found by both pathologists in 59 (47%) UK and 76 (60%) Japanese patients (chi(2) test, p = 0.04). In those patients with gastritis, corpus predominant or pangastritis was commoner in the Japanese (63% Japan v 36% in the UK (chi(2) test, p = 0.003) Atrophy and intestinal metaplasia were more extensive and severe (Mann-Whitney U test, p<0.001) and chronic inflammation and polymorph activity were also greater, especially in the corpus (Mann-Whitney U test, p<0.001). Fifty three of 59 UK gastritis patients (90%) and 67/76 (88%) (chi(2) test, p = 1) Japanese gastritis patients were positive for H pylori. Using a previously described "gastric cancer risk index" among H pylori positive patients, there were significantly more Japanese than UK subjects with a "high risk" score. CONCLUSION: In Japanese as opposed to English patients, gastritis is more prevalent and severe with more corpus predominant atrophy and intestinal metaplasia. These differences may partially explain the higher incidence of gastric cancer in Japan.
BACKGROUND AND AIMS: The incidence of gastric cancer in Japan is four times higher than in the UK. It usually arises in a stomach with corpus predominant or pangastritis that has undergone extensive atrophy and intestinal metaplasia. We hypothesised that a Japanese population would have a more severe gastritis with a corpus predominant or pangastritis pattern and a greater degree of atrophy and intestinal metaplasia than that found in the UK. To test this we designed a comparative trial. METHODS: A total of 252 age matched consecutive patients were recruited from the endoscopy services in Leeds and Tokyo. In each centre, 21 patients were prospectively selected from each decennial, between the ages of 20-80 years. All had epigastric discomfort as their predominant symptom. Patients with peptic ulcer, cancer, and oesophagitis were excluded. Five gastric biopsies were examined by two histopathologists using the updated Sydney system. Helicobacter pylori infection was assessed by histology and culture of biopsies and enzyme linked immunosorbent assay and immunoblot of plasma. RESULTS:Gastritis was found by both pathologists in 59 (47%) UK and 76 (60%) Japanese patients (chi(2) test, p = 0.04). In those patients with gastritis, corpus predominant or pangastritis was commoner in the Japanese (63% Japan v 36% in the UK (chi(2) test, p = 0.003) Atrophy and intestinal metaplasia were more extensive and severe (Mann-Whitney U test, p<0.001) and chronic inflammation and polymorph activity were also greater, especially in the corpus (Mann-Whitney U test, p<0.001). Fifty three of 59 UK gastritispatients (90%) and 67/76 (88%) (chi(2) test, p = 1) Japanese gastritispatients were positive for H pylori. Using a previously described "gastric cancer risk index" among H pylori positive patients, there were significantly more Japanese than UK subjects with a "high risk" score. CONCLUSION: In Japanese as opposed to English patients, gastritis is more prevalent and severe with more corpus predominant atrophy and intestinal metaplasia. These differences may partially explain the higher incidence of gastric cancer in Japan.
Authors: N Uemura; S Okamoto; S Yamamoto; N Matsumura; S Yamaguchi; M Yamakido; K Taniyama; N Sasaki; R J Schlemper Journal: N Engl J Med Date: 2001-09-13 Impact factor: 91.245
Authors: B Ruiz; J Garay; W Johnson; D Li; M Rugge; M F Dixon; R Fiocca; R M Genta; T Hattori; J Lechago; A B Price; P Sipponen; E Solcia; H Watanabe; P Correa Journal: Histopathology Date: 2001-09 Impact factor: 5.087
Authors: Emad M El-Omar; Charles S Rabkin; Marilie D Gammon; Thomas L Vaughan; Harvey A Risch; Janet B Schoenberg; Janet L Stanford; Susan T Mayne; James Goedert; William J Blot; Joseph F Fraumeni; Wong-Ho Chow Journal: Gastroenterology Date: 2003-05 Impact factor: 22.682
Authors: Céu Figueiredo; José Carlos Machado; Paul Pharoah; Raquel Seruca; Sónia Sousa; Ralph Carvalho; Ana Filipa Capelinha; Wim Quint; Carlos Caldas; Leen-Jan van Doorn; Fátima Carneiro; Manuel Sobrinho-Simões Journal: J Natl Cancer Inst Date: 2002-11-20 Impact factor: 13.506
Authors: Arto Kokkola; Timo U Kosunen; Pauli Puolakkainen; Pentti Sipponen; Matti Harkonen; Frank Laxen; Jarmo Virtamo; Reijo Haapiainen; Hilpi Rautelin Journal: APMIS Date: 2003-06 Impact factor: 3.205
Authors: José Carlos Machado; Céu Figueiredo; Paulo Canedo; Paul Pharoah; Ralph Carvalho; Sérgio Nabais; Catarina Castro Alves; Maria Luisa Campos; Leen-Jan Van Doorn; Carlos Caldas; Raquel Seruca; Fátima Carneiro; Manuel Sobrinho-Simões Journal: Gastroenterology Date: 2003-08 Impact factor: 22.682