Identifying persons at risk for gastric cancer?

BACKGROUND: Although considerable evidence suggests that Helicobacter pylori infection plays a crucial role in the pathogenesis of gastric carcinoma, a striking difference exists between the number of infected individuals and the proportion of those developing gastric carcinoma. The purpose of this article is to review the available evidence supporting the existence of identifiable risk factors for the development of gastric carcinoma.
METHODS: We performed a critical review of the pertinent literature, which forms the basis for this study.
RESULTS: In terms of treatment strategies for prevention of gastric carcinoma, cure of H. pylori infection in all infected patients seems unfeasible, mainly for economic reasons. However, the final and definite step to prove that infection with H. pylori is a preneoplastic condition for the development of gastric cancer would be the observation that cure of the infection leads to a significant reduction in gastric cancer incidence rates in comparison with an untreated population. Therefore, in 1997 a multicenter preventive interventional study on gastric carcinoma will be started in Germany. The target group in this study includes patients with a specific pattern of H. pylori gastritis who will be summarized by a "gastric cancer risk index."
CONCLUSIONS: It is hoped that long-term follow-up of these patients will reveal whether preventive treatment of H. pylori infection is capable of reducing the risk for development of gastric cancer.