Helicobacter pylori Infection and the Development of Gastric Cancer

doi:10.1056/NEJMoa001999

Volume 345:784-789		September 13, 2001		Number 11

Helicobacter pylori Infection and the Development of Gastric Cancer

Naomi Uemura, M.D., Shiro Okamoto, M.D., Soichiro Yamamoto, M.D., Nobutoshi Matsumura, M.D., Shuji Yamaguchi, M.D., Michio Yamakido, M.D., Kiyomi Taniyama, M.D., Naomi Sasaki, M.D., and Ronald J. Schlemper, M.D.

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by Fox, J. G.

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ABSTRACT

Background Although many studies have found an association betweenHelicobacter pylori infection and the development of gastriccancer, many aspects of this relation remain uncertain.

Methods We prospectively studied 1526 Japanese patients whohad duodenal ulcers, gastric ulcers, gastric hyperplasia, ornonulcer dyspepsia at the time of enrollment; 1246 had H. pyloriinfection and 280 did not. The mean follow-up was 7.8 years(range, 1.0 to 10.6). Patients underwent endoscopy with biopsyat enrollment and then between one and three years after enrollment.H. pylori infection was assessed by histologic examination,serologic testing, and rapid urease tests and was defined bya positive result on any of these tests.

Results Gastric cancers developed in 36 (2.9 percent) of theinfected and none of the uninfected patients. There were 23intestinal-type and 13 diffuse-type cancers. Among the patientswith H. pylori infection, those with severe gastric atrophy,corpus-predominant gastritis, and intestinal metaplasia wereat significantly higher risk for gastric cancer. We detectedgastric cancers in 21 (4.7 percent) of the 445 patients withnonulcer dyspepsia, 10 (3.4 percent) of the 297 with gastriculcers, 5 (2.2 percent) of the 229 with gastric hyperplasticpolyps, and none of the 275 with duodenal ulcers.

Conclusions Gastric cancer develops in persons infected withH. pylori but not in uninfected persons. Those with histologicfindings of severe gastric atrophy, corpus-predominant gastritis,or intestinal metaplasia are at increased risk. Persons withH. pylori infection and nonulcer dyspepsia, gastric ulcers,or gastric hyperplastic polyps are also at risk, but those withduodenal ulcers are not.

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From the Departments of Gastroenterology (N.U., S.O., S.Y., N.M., S.Y., M.Y.) and Clinical Pathology (K.T., N.S.), Kure Kyosai Hospital, Kure City; and the Department of Internal Medicine, Fukuoka University School of Medicine, Fukuoka (R.J.S.) — both in Japan.

Address reprint requests to Dr. Uemura at the Department of Gastroenterology, Kure Kyosai Hospital, 2-3-28 Nishi-chuo, Kure City, Japan, or at n-uemura{at}mua.biglobe.ne.jp.

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