Serum anti- Helicobacter pylori antibody titer and its association with gastric nodularity, atrophy, and age: A cross-sectional study

Abstract

Aim: To clarify the role of serum anti-Helicobacter pylori (H. pylori) antibody titers in gastric cancer.

Methods: In this cross-sectional study, the effect of patients' baseline characteristics and endoscopic findings on their serum antibody titers were assessed. We evaluated consecutive patients who underwent esophagogastroduodenoscopy and their first evaluation for H. pylori infection using a serum antibody test. We excluded patients with a history of eradication therapy. The participants were divided into four groups according to their E-plate serum antibody titer. Patients with serum antibody titers < 3, 3-9.9, 10-49.9, and ≥ 50 U/mL were classified into groups A, B, C, and D, respectively.

Results: In total, 874 participants were analyzed with 70%, 16%, 8.7%, and 5.1% of them in the groups A, B, C, and D, respectively. Patients in group C were older than patients in groups A and B. Gastric open-type atrophy, intestinal metaplasia, enlarged folds, diffuse redness, and duodenal ulcers were associated with a high titer. Regular arrangements of collecting venules, fundic gland polyps, superficial gastritis, and gastroesophageal reflux disease were related to a low titer. Multivariate analysis revealed that nodularity (P = 0.0094), atrophy (P = 0.0076), and age 40-59 years (vs age ≥ 60 years, P = 0.0090) were correlated with a high serum antibody titer in H. pylori-infected patients. Intestinal metaplasia and atrophy were related to age ≥ 60 years in group C and D.

Conclusion: Serum antibody titer changes with age, reflects gastric mucosal inflammation, and is useful in predicting the risk of gastric cancer.

Keywords: Antibody; Endoscopy; Gastric cancer; Gastritis; Helicobacter pylori.

Figure 1

Representative endoscopic images of patients in each of the groups. A and B: Group A (serum antibody titer < 3 U/mL). A 20-year-old woman with a serum antibody titer < 3 U/mL and Kyoto classification score of 0. Atrophy was absent and RAC and superficial gastritis were present; C and D: Group C (serum antibody titer of 10-49.9 U/mL). A 36-year-old woman with a serum antibody titer of 25.5 U/mL and Kyoto classification score of 1. Closed-type atrophy was present and enlarged folds, nodularity, diffuse redness, and RAC were absent; E and F: Group D (serum antibody titer ≥ 50 U/mL). A 50-year-old woman with a serum antibody titer ≥ 100 U/mL and Kyoto classification score of 7. Open-type atrophy, enlarged folds, nodularity, and diffuse redness were present, and RAC was absent. RAC: Regular arrangement of collecting venules.

Figure 2

Proportion of Helicobacter pylori-infected patients. A: The proportion of patients in each of the groups, stratified by age. B: The proportion of patients in groups C and D, stratified by age.