Original Contribution
The American Journal of Gastroenterology (2006) 101, 926–933; doi:10.1111/j.1572-0241.2006.00497.x
Preservation of Gastric Acid Secretion May Be Important for the Development of Gastroesophageal Junction Adenocarcinoma in Japanese People, Irrespective of the H. pylori Infection Status
Yoshifumi Inomata MD, Tomoyuki Koike MD, Shuichi Ohara MD, Yasuhiko Abe MD, Hitoshi Sekine MD, Katsunori Iijima MD, Ken Ariizumi MD, Hatsushi Yamagishi MD, Yasushi Kitagawa MD, Akira Imatani MD and Tooru Shimosegawa MD
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
Correspondence: Tomoyuki Koike, MD, Division of Gastroenterology, Tohaku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi 980-8574, Japan.
Received 28 March 2005; Accepted 13 September 2005.
Abstract
BACKGROUND:
We have previously reported that Helicobacter pylori infection prevents reflux esophagitis (RE) and Barrett's esophagus (BE) by decreasing gastric acid secretion. Gastroesophageal (GE) junction adenocarcinoma, including Barrett's adenocarcinoma, has been thought to be a complication of gastroesophageal reflux disease (GERD). However, the relationship between H. pylori infection, gastric acid secretion, and GE junction adenocarcinoma has not yet been investigated in Japan. The aim of this study was to evaluate this relationship in the Japanese population.
METHODS:
A total of 168 Japanese patients (RE alone: 80, short-segment BE (SSBE): 16, long-segment BE (LSBE): 20, GE junction adenocarcinoma: 12, distal early gastric cancer (EGC): 40; male/female = 106/62; mean age 61.5 yr) and 80 Japanese control subjects who had no localized lesions in the upper gastrointestinal tract (male/female = 43/37, mean age 58.1 yr) were enrolled for this study. The prevalence of H. pylori infection was determined by biopsy, the rapid urease test, and measurement of the serum H. pylori IgG antibody. Gastric acid secretion was assessed by the endoscopic gastrin test (EGT). RE was diagnosed according to the Los Angeles classification.
RESULTS:
The prevalence of H. pylori infection in the patients with RE alone (30%) was significantly lower than that in control subjects (71.2%). There was also a tendency for the prevalence of H. pylori infection to be lower in patients with BE (SSBE, 18.7%; LSBE, 0%) when compared to that in patients with RE alone. On the other hand, while the prevalence of H. pylori infection in patients with GE junction adenocarcinoma (58.3%) was significantly lower than that in patients with EGC (87.5%), it tended to be higher than that in patients with RE alone or BE. The mean EGT value in patients with RE alone (3.74 mEq/10 min) was significantly higher than that in control subjects (1.83). The mean EGT value in patients with BE (SSBE, 4.74; LSBE, 4.76) tended to be even higher than that in patients with RE alone. The mean EGT value in patients with GE junction adenocarcinoma (3.94) was significantly higher than that in control subjects and patients with EGC (0.67), but it was comparable to that independent of the H. pylori infection status in patients with RE alone or BE.
CONCLUSION:
Preservation of gastric acid secretion may be important for the development of GE junction adenocarcinoma in Japanese people, irrespective of the H. pylori infection status.
