توپوگرافی گاستریت مزمن در مبتلایان به عفونت هلیکوباکترپیلوری در یک منطقه پرشیوع آدنوکارسینوم کاردیای معده

Background: Many recent studies have examined potential risk factors of H. pylori gastritis to improve our understanding of the early events in gastric carcinogenesis. We evaluated the extent and topography of chronic gastritis in a high risk area for gastric cardia cancer and investigated the critical role of H.pylori, risk index and age in its pathogenesis. Materials and Methods: During a national population-based endoscopic survey, we enrolled 508 participants aged ≥40 from urban and rural areas of Meshkin-Shahr, Ardebil province of Iran. After informed consent, all underwent complete upper GI endoscopy. At least one mucosal biopsy was obtained from 6 standard sites: three of antrum (sites 1, 2, 3), two of corpus (sites 4, 5) and one of cardia (site 6). Severity, activity and combined inflammatory scores (CIS) of chronic gastritis and H.pylori infection status were assessed according to modified Sydney Classification of Gastritis. Statistical effects of H.pylori, age, gender, and residency place on mean gastritis severity, activity and CIS were separately calculated in each site. Results: Total of 508 participants with mean age (±SD) of 54.6(±SD) were enrolled. 234(46.1%) were male and 274(53.9%) were female. Histologically 80.5% of cases were H.pylori positive. Mean activity scores of all sites except for site 5 are significantly (P<0.01) higher in H.pylori + cases. Mean CIS of all sites was significantly (P<0.01) higher in H.pylori + patients. In 44% of infected subjects, CIS of the corpus was at least equally as severe as that in antrum. Also in 54% of H.pylori + cases, cardia’s CIS was ≥ than antral CIS. Age had a significant (P<0.01) negative relationship with CIS of antral site, but this relationship in cardia was positive and more potent. Conclusion: H.pylori is the main cause of gastritis activity in all sites of stomach this causality is more potent in antrum and cardia. Continuous cardia inflammation in advanced age may contribute to high incidence of gastric cardia cancer in this region.