FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 335:242-249 July 25, 1996 Number 4 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Helicobacter pylori infection, now considered to be a cause of gastric cancer, is also strongly associated with gastric and duodenal ulcer disease. The discovery of these relations has brought the long-controversial connection between peptic ulcers and gastric cancer into focus.

Methods We estimated the risk of stomach cancer in a large cohort of hospitalized patients with gastric or duodenal ulcers, as recorded in the Swedish Inpatient Register between 1965 and 1983. Altogether, 57,936 patients were followed through 1989, for an average of 9.1 years. The standardized incidence ratio — the ratio of the observed number of cancers to the number expected on the basis of the incidence in the Swedish population at large — was used as a measure of relative risk.

Results After peaking in the first 3 years of follow-up, the standardized incidence ratio for gastric cancer among 29,287 patients with gastric ulcers leveled off at 1.8 (95 percent confidence interval, 1.6 to 2.0) and remained significantly increased throughout follow-up, which was as long as 24 years for some patients. Prepyloric ulcer, diagnosed in 8646 patients, was not associated with a significant excess risk (standardized incidence ratio, 1.2; 95 percent confidence interval, 0.8 to 1.6). In the cohort of patients with duodenal ulcers (24,456 patients), the incidence of gastric cancer was significantly lower than expected. After the second year of follow-up, the standardized incidence ratio was only 0.6 (95 percent confidence interval, 0.4 to 0.7) and remained stable thereafter.

Conclusions Gastric ulcer disease and gastric cancer have etiologic factors in common. A likely cause of both is atrophic gastritis induced by H. pylori. By contrast, there appear to be factors associated with duodenal ulcer disease that protect against gastric cancer.

Source Information

From the Department of Cancer Epidemiology, University Hospital (L.-E.H., O.N., R.B., S.J., H.-O.A.), and the Department of Statistics (R.B.), Uppsala University, Uppsala, Sweden; the Department of Surgery, Mora Hospital, Mora, Sweden (L.-E.H.); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Md. (A.W.H., J.F.F.); the International Epidemiology Institute, Rockville, Md. (W.-H.C.); and the Department of Epidemiology, Harvard School of Public Health, Boston (H.-O.A.).

Address reprint requests to Dr. Nyrén at the Department of Cancer Epidemiology, University Hospital, S-751 85 Uppsala, Sweden.

Full Text of this Article

This article has been cited by other articles:

• Wang, F., Xia, P., Wu, F., Wang, D., Wang, W., Ward, T., Liu, Y., Aikhionbare, F., Guo, Z., Powell, M., Liu, B., Bi, F., Shaw, A., Zhu, Z., Elmoselhi, A., Fan, D., Cover, T. L., Ding, X., Yao, X. (2008). Helicobacter pylori VacA Disrupts Apical Membrane-Cytoskeletal Interactions in Gastric Parietal Cells. J. Biol. Chem. 283: 26714-26725 [Abstract] [Full Text]  
• Chen, C.-Y., Wu, D.-C., Kuo, Y.-T., Lee, C.-H., Jaw, T.-S., Kang, W.-Y., Hsu, J.-S. (2008). MDCT for Differentiation of Category T1 and T2 Malignant Lesions from Benign Gastric Ulcers. Am. J. Roentgenol. 190: 1505-1511 [Abstract] [Full Text]  
• Hjalgrim, H., Edgren, G., Rostgaard, K., Reilly, M., Tran, T. N., Titlestad, K. E., Shanwell, A., Jersild, C., Adami, J., Wikman, A., Gridley, G., Wideroff, L., Nyren, O., Melbye, M. (2007). Cancer Incidence in Blood Transfusion Recipients. JNCI J Natl Cancer Inst 99: 1864-1874 [Abstract] [Full Text]  
• Lee, C.-W., Rao, V. P., Rogers, A. B., Ge, Z., Erdman, S. E., Whary, M. T., Fox, J. G. (2007). Wild-Type and Interleukin-10-Deficient Regulatory T Cells Reduce Effector T-Cell-Mediated Gastroduodenitis in Rag2-/- Mice, but Only Wild-Type Regulatory T Cells Suppress Helicobacter pylori Gastritis. Infect. Immun. 75: 2699-2707 [Abstract] [Full Text]  
• Croxen, M. A., Ernst, P. B., Hoffman, P. S. (2007). Antisense RNA Modulation of Alkyl Hydroperoxide Reductase Levels in Helicobacter pylori Correlates with Organic Peroxide Toxicity but Not Infectivity. J. Bacteriol. 189: 3359-3368 [Abstract] [Full Text]  
• Larsson, S. C, Bergkvist, L., Naslund, I., Rutegard, J., Wolk, A. (2007). Vitamin A, retinol, and carotenoids and the risk of gastric cancer: a prospective cohort study. Am. J. Clin. Nutr. 85: 497-503 [Abstract] [Full Text]  
• Rodriguez, L A G., Lagergren, J, Lindblad, M (2006). Gastric acid suppression and risk of oesophageal and gastric adenocarcinoma: a nested case control study in the UK. Gut 55: 1538-1544 [Abstract] [Full Text]  
• Azodi, O. S., Bellocco, R., Eriksson, K., Adami, J. (2006). The impact of tobacco use and body mass index on the length of stay in hospital and the risk of post-operative complications among patients undergoing total hip replacement. J Bone Joint Surg Br 88-B: 1316-1320 [Abstract] [Full Text]  
• Lin, Y.-F., Wu, M.-S., Chang, C.-C., Lin, S.-W., Lin, J.-T., Sun, Y.-J., Chen, D.-S., Chow, L.-P. (2006). Comparative Immunoproteomics of Identification and Characterization of Virulence Factors from Helicobacter pylori Related to Gastric Cancer. Mol. Cell. Proteomics 5: 1484-1496 [Abstract] [Full Text]  
• Kusters, J. G., van Vliet, A. H. M., Kuipers, E. J. (2006). Pathogenesis of Helicobacter pylori Infection. Clin. Microbiol. Rev. 19: 449-490 [Abstract] [Full Text]  
• Suzuki, T., Matsuo, K., Ito, H., Hirose, K., Wakai, K., Saito, T., Sato, S., Morishima, Y., Nakamura, S., Ueda, R., Tajima, K. (2006). A past history of gastric ulcers and Helicobacter pylori infection increase the risk of gastric malignant lymphoma. Carcinogenesis 27: 1391-1397 [Abstract] [Full Text]  
• Noone, P. A., Waclawski, E. R., Watt, A. D. (2006). Are endoscopy nurses at risk of infection with Helicobacter pylori from their work?. Occup Med (Lond) 56: 122-128 [Abstract] [Full Text]  
• Ando, T, El-Omar, E M, Goto, Y, Nobata, K, Watanabe, O, Maeda, O, Ishiguro, K, Minami, M, Hamajima, N, Goto, H (2006). Interleukin 1B proinflammatory genotypes protect against gastro-oesophageal reflux disease through induction of corpus atrophy. Gut 55: 158-164 [Abstract] [Full Text]  
• Khamri, W., Moran, A. P., Worku, M. L., Karim, Q. N., Walker, M. M., Annuk, H., Ferris, J. A., Appelmelk, B. J., Eggleton, P., Reid, K. B. M., Thursz, M. R. (2005). Variations in Helicobacter pylori Lipopolysaccharide To Evade the Innate Immune Component Surfactant Protein D. Infect. Immun. 73: 7677-7686 [Abstract] [Full Text]  
• Ohyauchi, M, Imatani, A, Yonechi, M, Asano, N, Miura, A, Iijima, K, Koike, T, Sekine, H, Ohara, S, Shimosegawa, T (2005). The polymorphism interleukin 8 -251 A/T influences the susceptibility of Helicobacter pylori related gastric diseases in the Japanese population. Gut 54: 330-335 [Abstract] [Full Text]  
• Cui, G., Koh, T. J., Chen, D., Zhao, C.-M., Takaishi, S., Dockray, G. J., Varro, A., Rogers, A. B., Fox, J. G., Wang, T. C. (2004). Overexpression of Glycine-Extended Gastrin Inhibits Parietal Cell Loss and Atrophy in the Mouse Stomach. Cancer Res. 64: 8160-8166 [Abstract] [Full Text]  
• Mandell, L., Moran, A. P., Cocchiarella, A., Houghton, J., Taylor, N., Fox, J. G., Wang, T. C., Kurt-Jones, E. A. (2004). Intact Gram-Negative Helicobacter pylori, Helicobacter felis, and Helicobacter hepaticus Bacteria Activate Innate Immunity via Toll-Like Receptor 2 but Not Toll-Like Receptor 4. Infect. Immun. 72: 6446-6454 [Abstract] [Full Text]  
• Engel, L. S., Chow, W.-H., Vaughan, T. L., Gammon, M. D., Risch, H. A., Stanford, J. L., Schoenberg, J. B., Mayne, S. T., Dubrow, R., Rotterdam, H., West, A. B., Blaser, M., Blot, W. J., Gail, M. H., Fraumeni, J. F. Jr. (2003). Population Attributable Risks of Esophageal and Gastric Cancers. JNCI J Natl Cancer Inst 95: 1404-1413 [Abstract] [Full Text]  
• Risch, H. A. (2003). Etiology of Pancreatic Cancer, With a Hypothesis Concerning the Role of N-Nitroso Compounds and Excess Gastric Acidity. JNCI J Natl Cancer Inst 95: 948-960 [Abstract] [Full Text]  
• Lim, C.-Y., Lee, K.-H., Cho, M.-J., Chang, M.-W., Kim, S.-Y., Myong, N.-H., Lee, W.-K., Rhee, K.-H., Kook, Y.-H. (2003). Detection of Helicobacter pylori in Gastric Mucosa of Patients with Gastroduodenal Diseases by PCR-Restriction Analysis Using the RNA Polymerase Gene (rpoB). J. Clin. Microbiol. 41: 3387-3391 [Abstract] [Full Text]  
• Ohkusa, T, Okayasu, I, Miwa, H, Ohtaka, K, Endo, S, Sato, N (2003). Helicobacter pylori infection induces duodenitis and superficial duodenal ulcer in Mongolian gerbils. Gut 52: 797-803 [Abstract] [Full Text]  
• Correa, P. (2003). Bacterial Infections as a Cause of Cancer. JNCI J Natl Cancer Inst 95: E3-E3 [Full Text]  
• Uemura, N., Okamoto, S., Yamamoto, S., Matsumura, N., Yamaguchi, S., Yamakido, M., Taniyama, K., Sasaki, N., Schlemper, R. J. (2001). Helicobacter pylori Infection and the Development of Gastric Cancer. NEJM 345: 784-789 [Abstract] [Full Text]  
• Fox, J. G., Wang, T. C. (2001). Helicobacter pylori -- Not a Good Bug after All. NEJM 345: 829-832 [Full Text]  
• Nogueira, C., Figueiredo, C., Carneiro, F., Taveira Gomes, A., Barreira, R., Figueira, P., Salgado, C., Belo, L., Peixoto, A., Bravo, J. C., Bravo, L. E., Realpe, J. L., Plaisier, A. P., Quint, W. G. V., Ruiz, B., Correa, P., van Doorn, L.-J. (2001). Helicobacter pylori Genotypes May Determine Gastric Histopathology. Am. J. Pathol. 158: 647-654 [Abstract] [Full Text]  
• Correa, P., Fontham, E. T. H., Bravo, J. C., Bravo, L. E., Ruiz, B., Zarama, G., Realpe, J. L., Malcom, G. T., Li, D., Johnson, W. D., Mera, R. (2000). Chemoprevention of Gastric Dysplasia: Randomized Trial of Antioxidant Supplements and Anti-Helicobacter pylori Therapy. JNCI J Natl Cancer Inst 92: 1881-1888 [Abstract] [Full Text]  
• Goldacre, M., Kurina, L., Yeates, D., Seagroatt, V., Gill, L. (2000). Use of large medical databases to study associations between diseases. QJM 93: 669-675 [Abstract] [Full Text]  
• Yamagata, H., Kiyohara, Y., Aoyagi, K., Kato, I., Iwamoto, H., Nakayama, K., Shimizu, H., Tanizaki, Y., Arima, H., Shinohara, N., Kondo, H., Matsumoto, T., Fujishima, M. (2000). Impact of Helicobacter pylori Infection on Gastric Cancer Incidence in a General Japanese Population: The Hisayama Study. Arch Intern Med 160: 1962-1968 [Abstract] [Full Text]  
• Spechler, S. J., Fischbach, L., Feldman, M. (2000). Clinical Aspects of Genetic Variability in Helicobacter pylori. JAMA 283: 1264-1266 [Full Text]  
• Covacci, A., Telford, J. L., Giudice, G. D., Parsonnet, J., Rappuoli, R. (1999). Helicobacter pylori Virulence and Genetic Geography. Science 284: 1328-1333 [Abstract] [Full Text]  
• Zhang, Z W, Patchett, S E, Perrett, D, Katelaris, P H, Domizio, P, Farthing, M J G (1998). The relation between gastric vitamin C concentrations, mucosal histology, and CagA seropositivity in the human stomach. Gut 43: 322-326 [Abstract] [Full Text]  
• Stolte, M., Meining, A. (1998). Helicobacter pylori and Gastric Cancer. The Oncologist 3: 124-128 [Abstract] [Full Text]  
• Manton, K. G., Stallard, E., Corder, L. (1997). Education-Specific Estimates of Life Expectancy and Age-Specific Disability in the U.S. Elderly Population 1982 to 1991. J Aging Health 9: 419-450 [Abstract]  
• Allison, M. C, Williams, D., Forman, D., Axon, A. (1997). Helicobacter gastroduodenitis. BMJ 315: 1015-1016 [Full Text]  
• Martin, S. L., Edbrooke, M. R., Hodgman, T. C., van den Eijnden, D. H., Bird, M. I. (1997). Lewis X Biosynthesis in Helicobacter pylori. MOLECULAR CLONING OF AN alpha (1,3)-FUCOSYLTRANSFERASE GENE. J. Biol. Chem. 272: 21349-21356 [Abstract] [Full Text]  
• Mitchell, H. M., Hazell, S. L., Rubin, C. E., Graham, J. R., Parsonnet, J., Kuipers, E. J., Meuwissen, S. G.M., Havu, N. (1996). Helicobacter pylori, Gastric Ulcer, and Duodenal Ulcer. NEJM 335: 1841-1843 [Full Text]  
• Parsonnet, J. (1996). Helicobacter pylori in the Stomach -- A Paradox Unmasked. NEJM 335: 278-280 [Full Text]