The incidence of gastric cancer in Japan is 4 times higher than in the United Kingdom.
It usually arises in a stomach with corpus predominant or pangastritis that has undergone extensive atrophy and intestinal metaplasia.
Dr Naylor and colleagues from England compared the incidence of severe gastritis with a corpus predominant or pangastritis pattern, atrophy and intestinal metaplasia between the 2 countries.
A total of 252 age matched consecutive patients were recruited from the endoscopy services in Leeds, England and Tokyo, Japan.
In each centre, 21 patients were prospectively selected from each decennial, between the ages of 20 to 80 years.
The research team noted that all had epigastric discomfort as their predominant symptom.
|88% of Japanese gastritis patients were positive for H pylori|
Patients with peptic ulcer, cancer, and esophagitis were excluded.
Using the updated Sydney system, 5 gastric biopsies were examined by 2 histopathologists.
The team assessed Helicobacter pylori infection by histology, culture of biopsies, enzyme linked immunosorbent assay, and immunoblot of plasma.
The team report that gastritis was found by both pathologists in 47% of patients in England, and 60% of Japanese patients.
In those patients with gastritis, corpus predominant or pangastritis was commoner in the Japanese patients.
The investigators found that atrophy and intestinal metaplasia were more extensive and severe in Japanese patients.
The team noted that chronic inflammation and polymorph activity were also greater, especially in the corpus, in Japanese patients.
The team observed that 90% of patients in England, and 88% of Japanese gastritis patients were positive for H pylori.
The investigators used a previously described ‘gastric cancer risk index' among H pylori positive patients.
Using this index, the team found there were significantly more Japanese than English subjects with a ‘high risk' score.
Dr Naylor's team concludes, “In Japanese as opposed to English patients, gastritis is more prevalent and severe with more corpus predominant atrophy and intestinal metaplasia.”
“These differences may partially explain the higher incidence of gastric cancer in Japan.”