Age-related twin-peak prevalence profiles of H. pylori infection, gastritis, GIN and gastric cancer: Analyses of 70,534 patients with gastroscopic biopsies

Abstract

Objectives: H. pylori (Hp) infection has been indicated in the pathogenesis of gastric diseases including gastric cancer (GC). This study aimed at exploring the relationships between Hp infection and gastric diseases including GC in a large dataset of routine patients undergoing gastroscopy.

Methods: From November 2007 to December 2017, 70,534 first-time visiting patients aged 18-94 years with gastroscopic biopsies were histologically diagnosed and analyzed. Patients' data were entered twice in an Excel spreadsheet database and analyzed using the SPSS (version 22.0) software package and statistical significance was defined as P<0.05 for all analyses.

Results: The first interesting observation was age-related twin-peak prevalence profiles (TPPs) for Hp infection, gastritis, and advanced diseases with different time spans (TS) between the first and second occurring peaks. Hp infection and gastritis had TPPs occurring at earlier ages than TPPs of gastric introepithelial neoplasia (GIN) and GC. More patients were clustered at the second occurring TPPs. The time spans (TS) from the first occurring peak of Hp infection to the first occurring peaks of other gastric diseases varied dramatically with 0-5 years for gastritis; 5-15 years for GINs, and 5-20 years for GC, respectively. The number of males with Hp infection and gastric diseases, excluding non-atrophic gastritis (NAG), was more than that of females (P<0.001).

Conclusions: We have first observed age-related twin-peak prevalence profiles for Hp infection, gastritis, GIN, and GC, respectively, among a large population of patients undergoing gastroscopy. The second prevalence peak of GC is at ages of 70-74 years indicating that many GC patients would be missed during screening because the cut-off age for screening is 69 years old in China.

Fig 1. Patients in the overall sample (N = 70,534).

A total of 70,534 cases of patients aged 18–94 (13,962 was excluded with multiple-visit endoscopic biopsy (n = 36,401) in total 98,241) who underwent gastroscopic biopsy for the first time in the First Affiliated Hospital of School of Medicine, Shihezi University from November 7, 2007 to December 31, 2017 were selected. Among them, 33,617 were non-atrophic gastritis (NAG) cases, 30,074 were chronic atrophic gastritis (CAG) cases, 805 were low-grade gastrointestinal intraepithelial neoplasia (LGIN) cases, 197 were high-grade gastric intraepithelial neoplasia (HGIN) cases, and 1293 were gastric cancer (GC) cases. *4548 were other diseases: lymphoma, gastric polyps, neuroendocrine neoplasm, liomyoma, gastric stromal tumor. Among them, 59,848 patients were detected for H. pylori infection.

Fig 2. Age distributions of patients in Hp infection and gastric diseases detected by conventional gastroscopy.

(A) age distributions of patients in gastritis and Hp infection; (B) age distributions of patients in GIN and Hp infection; (C) age distributions of patients in GC and Hp infection; (D) age distributions of patients in Hp infection, gastritis, GIN and GC; For males, The time spans (TS) from the first peak of Hp infection to the first peaks of gastric diseases varied dramatically depending on different gastric diseases: the overlapping peaks (0–5 years) for patients with gastritis; 5–10 years for patients with GINs, 15–20 years for patients with gastric cancer, respectively. It was interesting to note that the longest TS was 25–30 years from the first peak of Hp infection to the second peak of gastric cancer. The time spans (TS) from the ages of Hp infection patients at the second detection peak to the ages of gastritis, GIN, and GC patients at the second detection peak are 0–5 years. For females, The time spans (TS) from the first peak of Hp infection to the first peaks of gastric diseases varied dramatically depending on different gastric diseases: the overlapping peaks (0–5 years) for patients with gastritis; 5–10 years for patients with LGIN, 15–20 years for patients with HGIN, 5–10 years for patients with gastric cancer, respectively. It was interesting to note that the longest TS was 25–30 years from the first peak of Hp infection to the second peak of gastric cancer. However, there were also differences in time intervals from Hp infection at the second detection peak to the second peak of gastritis (0–5 years), GIN (5–10 years), and GC (5–10 years), respectively.