Chronic Gastritis and Gastric Cancer – Beyond Helicobacter Pylori

Gastric cancer is the fifth most frequently diagnosed cancer and the third highest cause of cancer-related death in the world.

Helicobacter pylori (H. pylori) has been characterized as a single predominant etiology of gastric cancer, and demonstrated of its molecular mechanism as a carcinogen. Eradication of H.pylori can attribute a significant reduction in the incidence of gastric cancer, however, does not always prevent gastric cancer or allow for regression of preneoplastic lesions. It seems that earlier stages of H.pylori-related gastritis may be more benefitted by eradication. Although most patients with gastric cancer have been shown to have history of H.pylori infection, there are a few exceptions.

Other risk factors for gastric cancer

Studies showed many risk factors for gastric cancer, including high salt or low fiber diet, exposure to N-nitroso compounds from diet or smoking, alcohol consumption, low socioeconomic status, high BMI, diabetes and old age. These have all linked to the incidence of gastric cancer, and may affect the outcome of H.pylori infection. There are also some rare hereditary conditions that increase the risk of gastric cancer, such as Peutz-Jeghers syndrome and familial adenomatous polyposis.

Autoimmune gastritis

Autoimmune gastritis is an increasingly prevalent immune mediated disorder characterized by malabsorption of iron and vitamin B12. Autoimmune gastritis accounts for less than 5% of all cases of chronic gastritis. Compared to H.pylori-related gastritis in which the destruction occurs from the antrum (the anal side of the stomach), the destruction in autoimmune gastritis occurs from the fundus and cardia (the oral side of the stomach). 10% of patients with autoimmune gastritis are reported to develop gastric cancer.

Non-Helicobacter pylori Helicobacters

Helicobacter suis (H.suis) is the second-most prevalent helicobacter species in the human stomach, and has recently isolated and successfully cultured by Japanese researchers. It has also shown to be the cause of gastric diseases, although does not share molecular pathogenicity with H.Pylori. It often fail to be detected by diagnostic tests for H.Pylori, but can be treated with the same regimen of medication. H.pylori frequently infect children but rarely adults; by contrast, H.suis may also infect adults. Researchers are currently developing diagnostic kits for either serum antibody or stool antigen specific for H.suis.


胃がんは、世界で5番目に頻繁に診断されるがんであり、がんに関連する死亡の3番目に高い原因です。ヘリコバクターピロリ(H. pylori)は、胃癌の単一の主要な病因として特徴付けられており、発癌物質としてのその分子メカニズムが実証されています。 H.pyloriの除菌により、胃癌の発生率は有意に減少することが示されていますが、必ずしも全例で胃癌を予防したり、前腫瘍性病変の退縮を可能にしたりするわけではありません。 H.pylori関連胃炎が初期であればあるほど、除菌による効果は大きいことが示されています。胃癌のほとんどの患者はH.pylori感染の既往があることが示されていますが、いくつかの例外があります。






ヘリコバクター・スイス(H.suis)は、ヒトの胃で2番目に多いヘリコバクター種であり、最近、日本の研究者によって分離され、培養に成功しました。 H.Pyloriと分子病原性を共有していませんが、胃疾患の原因でもあることが示されています。 H.Pyloriの診断テストでは検出されないことがよくありますが、同じ投薬レジメンで治療することができます。 H.pyloriは主に子供に感染しますが、成人にはめったに感染しません。 対照的に、H.suisは成人にも感染する可能性があります。 研究者たちは現在、H.suisに特異的な血清抗体または便抗原の診断キットを開発しています。

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