Risk Factors for Gastric Intestinal Metaplasia

Bárbara Peleteiro

Serviço de Higiene e Epidemiologia, Faculdade de Medicina da Universidade do Porto

 

Abstract

The infection with Helicobacter pylori affects more than 50% of the world adult population, and approximately two thirds of all cases of stomach cancer are attributed to it, but a large proportion of the infected subjects will never develop cancer. Gastric carcinogenesis is currently interpreted as a multifactorial and multistage process, with environmental exposures (H. pylori infection and behavioural factors), and genetic susceptibility contributing for the occurrence of cancer. The study of the risk factors for precancerous lesions is a major field of research with potential to clarify the aetiology of gastric cancer, namely through the understanding of the mechanisms that modulate the progression to cancer among the infected.

Key-words: gastric cancer; precancerous lesions; intestinal metaplasia; Helicobacter pylori; risk factors

 

Resumo

Factores de Risco para o Desenvolvimento de Metaplasia Intestinal da Mucosa Gástrica

A infecção por Helicobacter pylori afecta mais de 50% da população adulta mundial, à qual são atribuídos cerca de dois terços de todos os casos de cancro, mas apenas uma pequena proporção de indivíduos infectados desenvolve a doença. Actualmente, a carcinogénese gástrica é interpretada como um processo multifactorial em que exposições ambientais (infecção por H. pylori e factores comportamentais) e a susceptibilidade genética contribuem para a ocorrência de cancro. O estudo dos factores de risco para as lesões pré-cancerosas é um importante campo de investigação com potencial para melhorar o conhecimento acerca da etologia do cancro do estômago e possibilitar o desenvolvimento de estratégias de prevenção.

Palavras-chave: cancro do estômago; lesões pré-cancerosas; metaplasia intestinal; Helicobacter pylori; factores de risco

 

Texto completo disponível apenas em PDF.

Full text only available in PDF format.

 

REFERENCES

1 - Coleman MP, Esteve J, Damiecki P, Arslan A, Renard H. Trends in cancer incidence and mortality. IARC Sci Publ. 1993;(121):1-806.

        [ Links ]

2 - Parkin DM. International variation. Oncogene. 2004; 23: 6329-40.

3 -Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55(2):74-108.

4 - Roder DM. The epidemiology of gastric cancer. Gastric Cancer 2002;5 (suppl1):5-11.

5 - Levi F, Lucchini F, Gonzalez JR, Fernandez E, Negri E, La Vecchia C. Monitoring falls in gastric cancer mortality in Europe. Ann Oncol 2004;15:338-45.

6 - Bouvier AM, Esteve J, Mitry E, Clinard F, Bonithon-Kopp C, Faivre J. Trends in gastric cancer incidence in a well-defined French population by time period and birth cohort. Eur J Cancer Prev 2002;11:221-7.

7 - Kaneko S, Yoshimura T. Time trend analysis of gastric cancer incidence in Japan by histological types, 19751989. Br J Cancer 2001;84:400-5.

8 - Henson DE, Dittus C, Younes M, Nguyen H, Albores-Saavedra J. Differential trends in the intestinal and diffuse types of gastric carcinoma in the United States, 1973-2000: increase in the signet ring cell type. Arch Pathol Lab Med 2004;128:765-70.

9 - Liu Y, Kaneko S, Sobue T. Trends in reported incidences of gastric cancer by tumour location, from 1975 to 1989 in Japan. Int J Epidemiol 2004;33:808-15.

10 - Botterweck AA, Schouten LJ, Volovics A, Dorant E, van Den Brandt PA. Trends in incidence of adenocarcinoma of the oesophagus and gastric cardia in ten European countries. Int J Epidemiol 2000;29:645-54.

11 - Blot WJ, Devesa SS, Kneller RW, Fraumeni JF, Jr. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. Jama 1991;265:1287-9.

12 - Pinheiro PS, Tyczynski JE, Bray F, Amado J, Matos E, Parkin DM. Cancer incidence and mortality in Portugal. Eur J Cancer 2003;39:2507-20.

13 -Tsukuma H, Ajiki W, Ioka A, Oshima A. Survival of Cancer Patients Diagnosed between 1993 and 1996: a Collaborative Study of Population-Based Cancer Registries in Japan. Jpn J Clin Oncol. 2006:[in press].

14 - Herbst RS, Bajorin DF, Bleiberg H, et al. Clinical Cancer Advances 2005: major research advances in cancer treatment, prevention, and screening—a report from the American Society of Clinical Oncology. J Clin Oncol 2006;24:190-205.

15 - Coleman MP, Gatta G, Verdecchia A, et al. EUROCARE3 summary: cancer survival in Europe at the end of the 20^th century. Ann Oncol 2003;14 (suppl 5):v128-49.

16 - Brenner H, Arndt V, Stegmaier C, Ziegler H, Rothenbacher D. Is Helicobacter pylori infection a necessary condition for noncardia gastric cancer? Am J Epidemiol 2004;159 (3):252-8.

17 - Eslick GD, Lim LL, Byles JE, Xia HH, Talley NJ. Association of Helicobacter pylori infection with gastric carcinoma: a meta-analysis. Am J Gastroenterol 1999;94:2373-9.

18 - Huang JQ, Sridhar S, Chen Y, Hunt RH. Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. Gastroenterology 1998;114:1169-79.

19 - Koizumi Y, Tsubono Y, Nakaya N, et al. Cigarette smoking and the risk of gastric cancer: a pooled analysis of two prospective studies in Japan. Int J Cancer 2004;112:1049-55.

20 - Tredaniel J, Boffetta P, Buiatti E, Saracci R, Hirsch A. Tobacco smoking and gastric cancer: review and meta-analysis. Int J Cancer 1997;72:565-73.

21 - Lunet N, Lacerda-Vieira A, Barros H. Fruit and vegetables consumption and gastric cancer: a systematic review and meta-analysis of cohort studies. Nutr Cancer 2005;53:1-10.

22 - Riboli E, Norat T. Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk. Am J Clin Nutr 2003;78(3 suppl):559S-69S.

23 - Chui SY, Clay TM, Lyerly HK, Morse MA. The development of therapeutic and preventive vaccines for gastric cancer and Helicobacter pylori. Cancer Epidemiol Biomarkers Prev 2005;14:1883-9.

24 -Wong BC, Lam SK, Wong WM, et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA 2004;291:187-94.

25 - Leung WK, Lin SR, Ching JY, et al. Factors predicting progression of gastric intestinal metaplasia: results of a randomised trial on Helicobacter pylori eradication. Gut 2004;53:1244-9.

26 - Correa P, Fontham ET, Bravo JC, et al. Chemoprevention of gastric dysplasia: randomized trial of antioxidant supplements and anti-Helicobacter pylori therapy. J Natl Cancer Inst 2000;92:1881-8.

27 - Oliveira C, Seruca R, Carneiro F. Genetics, pathology, and clinics of familial gastric cancer. Int J Surg Pathol 2006; 14:21-33.

28 - Helicobacter and Cancer Collaborative Group. Gastric cancer and Helicobacter pylori: a combined analysis of 12 case control studies nested within prospective cohorts. Gut 2001;49:347-53.

29 - Huang JQ, Zheng GF, Sumanac K, Irvine EJ, Hunt RH. Meta-analysis of the relationship between cagA seropositivity and gastric cancer. Gastroenterology 2003;125:1636-44.

30 - Lauren P. The Two Histological Main Types of Gastric Carcinoma: Diffuse and So-Called Intestinal-Type Carcinoma. an Attempt at a Histo-Clinical Classification. Acta Pathol Microbiol Scand 1965;64:31-49.

31 - Correa P, Sasano N, Stemmermann GN, Haenszel W. Pathology of gastric carcinoma in Japanese populations: comparisons between Miyagi prefecture, Japan, and Hawaii. J Natl Cancer Inst 1973;51:1449-59.

32 - Ekstrom AM, Hansson LE, Signorello LB, Lindgren A, Bergstrom R, Nyren O. Decreasing incidence of both major histologic subtypes of gastric adenocarcinoma—a popula-tion-based study in Sweden. Br J Cancer 2000;83:391-6.

33 - Lauren PA, Nevalainen TJ. Epidemiology of intestinal and diffuse types of gastric carcinoma. A time-trend study in Finland with comparison between studies from high- and low-risk areas. Cancer 1993;71:2926-33.

34 - Correa P, Haenszel W, Cuello C, Tannenbaum S, Archer M. A model for gastric cancer epidemiology. Lancet1975;2:58-60.

35 - Filipe MI, Jass JR. Intestinal metaplasia subtypes and cancer risk. In: Filipe MI, Jass JR, editors. Gastric Carcinoma. London: Churchil Livingstone; 1986. p.87-115.

36 - Reis CA, David L, Correa P, et al. Intestinal metaplasia of human stomach displays distinct patterns of mucin (MUC1, MUC2, MUC5AC, and MUC6) expression. Cancer Res 1999;59:1003-7.

37 - Howson CP, Hiyama T, Wynder EL. The decline in gastric cancer: epidemiology of an unplanned triumph. Epidemiol Rev 1986;8:1-27.

38 - Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984;1:1311-5.

39 - Schistosomes, liver flukes and Helicobacter pylori. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon, 7-14 June 1994. IARC Monogr Eval Carcinog Risks Hum 1994;61:1-241.

40 - Parkin DM. The global health burden of infection-associ-ated cancers in the year 2002. Int J Cancer. 2006:[in press].

41 - Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001;345:784-9.

42 - Holcombe C. Helicobacter pylori: the African enigma. Gut 1992;33:429-31.

43 - Miwa H, Go MF, Sato N. H. pylori and gastric cancer: the Asian enigma. Am J Gastroenterol 2002;97:1106-12.

44 - Fernando N, Holton J, Zulu I, Vaira D, Mwaba P, Kelly P. Helicobacter pylori infection in an urban African population. J Clin Microbiol 2001;39:1323-7.

45 - Louw JA, Kidd MS, Kummer AF, Taylor K, Kotze U, Hanslo D. The relationship between Helicobacter pylori infection, the virulence genotypes of the infecting strain and gastric cancer in the African setting. Helicobacter 2001;6 :268-73.

46 - Lunet N, Barros H. Helicobacter pylori infection and gastric cancer: facing the enigmas. Int J Cancer 2003;106:953-60. Campbell DI, Warren BF, Thomas JE, Figura N, Telford JL.

47 - Sullivan PB. The African enigma: low prevalence of gastric atrophy, high prevalence of chronic inflammation in West African adults and children. Helicobacter 2001;6:263-7.

48 - Zhang ZW, Patchett SE, Perrett D, Domizio P, Farthing MJ. Gastric alpha-tocopherol and beta-carotene concentrations in association with Helicobacter pylori infection. Eur J Gastroenterol Hepatol 2000;12:497-503.

49 - Feiz HR, Mobarhan S. Does vitamin C intake slow the progression of gastric cancer in Helicobacter pylori-in-fected populations? Nutr Rev 2002;60:34-6.

50 - Siman JH, Forsgren A, Berglund G, Floren CH. Tobacco smoking increases the risk for gastric adenocarcinoma among Helicobacter pylori-infected individuals. Scand J Gastroenterol 2001;36:208-13.

51 - Brenner H, Arndt V, Bode G, Stegmaier C, Ziegler H, Stumer T. Risk of gastric cancer among smokers infected with Helicobacter pylori. Int J Cancer 2002;98:446-9.

52 - Alcohol drinking. IARC Working Group, Lyon, 13-20 October 1987. IARC Monogr Eval Carcinog Risks Hum 1988;44:1-378.

53 - Inoue M, Tajima K, Hirose K, Kuroishi T, Gao CM, Kitoh T. Life-style and subsite of gastric cancer—joint effect of smoking and drinking habits. Int J Cancer 1994;56:494-9.

54 - Machado JC, Figueiredo C, Canedo P, et al. A pro-inflam-matory genetic profile increases the risk for chronic atrophic gastritis and gastric carcinoma. Gastroenterology 2003;125: 364-71.

55 - El-Omar EM, Carrington M, Chow WH, et al. Interleukin-1 polymorphisms associated with increased risk of gastric cancer. Nature 2000;404:398-402.

56 - Kato I, Vivas J, Plummer M, et al. Environmental factors in Helicobacter pylori-related gastric precancerous lesions in Venezuela. Cancer Epidemiol Biomarkers Prev 2004;13: 468-76.

57 - Kneller RW, You WC, Chang YS, et al. Cigarette smoking and other risk factors for progression of precancerous stomach lesions. J Natl Cancer Inst 1992;84:1261-6.

58 - Dobrilla G, Benvenuti S, Amplatz S, Zancanella L. Chronic gastritis, intestinal metaplasia, dysplasia and Helicobacter pylori in gastric cancer: putting the pieces together. Ital J Gastroenterol 1994;26:449-58.

59 -You WC, Li JY, Zhang L, et al. Etiology and prevention of gastric cancer: a population study in a high risk area of China. Chin J Dig Dis 2005;6:149-54.

60 - Weck MN, Brenner H. Prevalence of chronic atrophic gastritis in different parts of the world. Cancer Epidemiol Biomarkers Prev 2006:[in press].

61 - Plummer M, Buiatti E, Lopez G, et al. Histological diagnosis of precancerous lesions of the stomach: a reliability study. Int J Epidemiol 1997;26:716-20.

62 - Chen XY, van der Hulst RW, Bruno MJ, et al. Interobserver variation in the histopathological scoring of Helicobacter pylori related gastritis. J Clin Pathol 1999;52:612-5.

63 - Aydin O, Egilmez R, Karabacak T, Kanik A. Interobserver variation in histopathological assessment of Helicobacter pylori gastritis. World J Gastroenterol 2003;9:2232-5.

64 - Misiewice JJ, Tytgat GNJ, Goodwin CS. The Sydney system: a new classification of gastritis. J Hepatol Gastroenterol 1991;6:209-22.

65 - Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol 1996;20:1161-81.

66 - Shousha S, Barrison IG, El-Sayeed W, Khan S, Parkins RA. A study of incidence and relationship of intestinal metaplasia of gastric antrum and gastric metaplasia of duodenum in patients with nonulcer dyspepsia. Dig Dis Sci 1984; 29:311-6.

67 - Tatsuta M, Iishi H, Okuda S. Effect of cigarette smoking on extent of acid-secreting area and intestinal metaplasia in the stomach. Dig Dis Sci 1988;33:23-9.

68 - Jedrychowski W, Popiela T, Drews M, et al. Effect of Helicobacter pylori infection, smoking and dietary habits on the occurrence of antrum intestinal metaplasia. Clinico-epidemiological study in Poland. Pol J Pathol 1999;50:289-95.

69 - Jedrychowski W, Popiela T, Drews M, et al. Effect of Helicobacter pylori infection, smoking and dietary habits on the occurrence of antrum intestinal metaplasia. Clinico-epidemiological study in Poland. Pol J Pathol 1999;50:289-95.

70 - Nakamura M, Haruma K, Kamada T, et al. Cigarette smoking promotes atrophic gastritis in Helicobacter pyloripositive subjects. Dig Dis Sci 2002;47:675-81.

71 - Stemmermann GN, Nomura AM, Chyou PH, Hankin J. Impact of diet and smoking on risk of developing intestinal metaplasia of the stomach. Dig Dis Sci 1990;35:433-8.

72 - Nomura A, Yamakawa H, Ishidate T, et al. Intestinal metaplasia in Japan: association with diet. J Natl Cancer Inst 1982;68:401-5.

73 - You WC, Zhang L, Gail MH, et al. Precancerous lesions in two counties of China with contrasting gastric cancer risk. Int J Epidemiol 1998;27:945-8.

74 - Chen VW, Abu-Elyazeed RR, Zavala DE, et al. Risk factors of gastric precancerous lesions in a high-risk Colombian population. I. Salt. Nutr Cancer 1990;13:59-65.

75 - ECP-EURONUT-Intestinal Metaplasia Study: urinary and gastric juice analyses. Eur J Cancer Prev 1994;3:413-8.

76 - Malekzadeh R, Sotoudeh M, Derakhshan MH, et al. Prevalence of gastric precancerous lesions in Ardabil, a high incidence province for gastric adenocarcinoma in the northwest of Iran. J Clin Pathol 2004;57:37-42.

77 - Judd PA. Diet and precancerous lesions of the stomach. Eur J Cancer Prev 1993;2 (Suppl 2):65-71.

78 - Zhang L, Blot WJ, You WC, et al. Serum micronutrients in relation to pre-cancerous gastric lesions. Int J Cancer 1994;56:650-4.

79 - Ohkuma K, Okada M, Murayama H, et al. Association of Helicobacter pylori infection with atrophic gastritis and intestinal metaplasia. J Gastroenterol Hepatol 2000;15: 1105-12.

80 - Warburton VJ, Everett S, Mapstone NP, Axon AT, Hawkey P, Dixon MF. Clinical and histological associations of cagA and vacA genotypes in Helicobacter pylori gastritis. J Clin Pathol 1998;51:55-61.

81 - Nogueira C, Figueiredo C, Carneiro F, et al. Helicobacter pylori genotypes may determine gastric histopathology. Am J Pathol 2001;158:647-54.

82 - Prinz C, Schoniger M, Rad R, et al. Key importance of the Helicobacter pylori adherence factor blood group antigen binding adhesin during chronic gastric inflammation. Cancer Res 2001;61:1903-9.

83 - Yu J, Leung WK, Go MY, et al. Relationship between Helicobacter pylori babA2 status with gastric epithelial cell turnover and premalignant gastric lesions. Gut 2002;51:480-4.

84 - Zambon CF, Navaglia F, Basso D, Rugge M, Plebani M. Helicobacter pylori babA2, cagA, and s1 vacA genes work synergistically in causing intestinal metaplasia. J Clin Pathol 2003;56:287-91.

85 - Silva F, Carvalho F, Peixoto A, et al. MUC1 gene polymorphism in the gastric carcinogenesis pathway. Eur J Hum Genet 2001;9:548-52.

86 - Silva F, Carvalho F, Peixoto A, et al. MUC1 polymorphism confers increased risk for intestinal metaplasia in a Colombian population with chronic gastritis. Eur J Hum Genet 2003;11:380-4.

87 - Zambon CF, Basso D, Navaglia F, et al. Helicobacter pylori virulence genes and host IL-1RN and IL-1beta genes interplay in favouring the development of peptic ulcer and intestinal metaplasia. Cytokine 2002;18:242-51.

88 - Chen A, Li CN, Hsu PI, et al. Risks of interleukin-1 genetic polymorphisms and Helicobacter pylori infection in the development of gastric cancer. Aliment Pharmacol Ther 2004;20:203-11.

89 - Figueiredo C, Machado JC, Pharoah P, et al. Helicobacter pylori and interleukin 1 genotyping: an opportunity to identify high-risk individuals for gastric carcinoma. J Natl Cancer Inst 2002;94:1680-7.

90 - Zambon CF, Basso D, Navaglia F, et al. Pro-and anti-inflammatory cytokines gene polymorphisms and Helicobacter pylori infection: interactions influence outcome. Cytokine 2005;29:141-52.

 

Correspondência:

Drª Bárbara Peleteiro Serviço de Higiene e Epidemiologia Faculdade de Medicina da Universidade do Porto

Alameda Prof. Hernâni Monteiro 4200-319 Porto

e-mail: barbarap@med.up.pt