Non-cardia gastric adenocarcinoma is positively associated with Helicobacter pylori infection and atrophic gastritis.
The role of H pylori infection and atrophic gastritis in cardia cancer is unclear.
Professor Professor McColl and colleagues from Scotland compared cardia versus non-cardia cancer with respect to the premorbid state of the stomach.
The research team undertook a nested case-control study.
The team matched 3 controls to each of 129 non-cardia and 44 cardia cancers.
Serum collected a median of 12 years before the diagnosis of cancer was tested for anti-H. pylori antibodies, pepsinogen I:II and gastrin.
Non-cardia cancer was positively associated with H. pylori, and gastric atrophy.
|H. pylori-positive cardia cancer was associated with gastric atrophy |
The diffuse and intestinal histological subtypes of non-cardia cancer were of similar proportions, and both showed a positive association with H pylori and atrophy.
The team found that cardia cancer was negatively associated with H. pylori.
However, the researchers noted that H. pylori-positive cardia cancer showed an association with gastric atrophy.
The predominant histological subtype of cardia cancer was intestinal, and was not associated with gastric atrophy compared with the diffuse subtype.
Cardia cancer in patients with atrophy had an intestinal: diffuse ratio similar to non-cardia cancer.
The team observed that cardia cancers in patients without atrophy were predominantly intestinal.
Professor McColl's team concluded, "These findings indicate 2 etiologies of cardia cancer."
"The first of these etiologies is associated with H. pylori atrophic gastritis, resembling non-cardia cancer."
"The other is associated with non-atrophic gastric mucosa, resembling esophageal adenocarcinoma."
"Serological markers of gastric atrophy may provide the key to determining gastric versus esophageal origin of cardia cancer."