Screening Tests for Gastric Ca

A combination of a test for serum pepsinogen status and antibodies to Helicobacter pylori may be a good way to screen patients who are at risk for gastric cancer, according to the results of a prospective cohort study.

Hirotsugo Watabe of the University of Tokyo and associates followed 6,983 Japanese individuals for nearly 5 years after an initial, routine health check-up. Gastric cancer developed in 7 (0.04%) of 3,324 patients with normal pepsinogen status and a negative H. pylori antibody test, 6 (0.06%) of 2,134 patients with normal pepsinogen status and H. pylori positivity, 18 (0.36%) of 1,082 patients with pepsinogen status indicative of gastric atrophy and H. pylori positivity, and 12 (0.60%) of 443 patients with pepsinogen status indicative of gastric atrophy and a negative H. pylori test (Gut 2005;54:764–8).

The significant, independent risk factors for developing gastric cancer were being members of the latter two study groups, as well as being older than 60 years and of male gender. The highest annual incidence rates of the cancer were recorded in men (1.8%) and women (1.5%) older than 60 years with pepsinogen status indicative of atrophy and negative H. pylori results. It is known that the H. pylori burden drops substantially and that the H. pylori antibodies disappear in patients with an atrophic level of pepsinogen.

The investigators defined pepsinogen status as atrophic when the serum level of pepsinogen I was 70 ng/mL or less and the pepsinogen I/II ratio was 3 or less. The patients had an average of 5.1 annual endoscopic exams.

Evidence of Gastric Ca Prevention?

Treating Helicobacter pylori infection does appear to prevent stomach cancer, according to an 8-year study from China.

Liya Zhou, M.D., of the department of gastroenterology at the Third Hospital at Beijing University and colleagues followed 552 individuals living in an area with a high incidence of gastric cancer, in Shandong Province. The participants had been part of an H. pylori eradication trial. Almost half had been treated in the trial, of whom 89% had become H. pylori negative at the end of treatment, Dr. Zhou reported at the annual Digestive Disease Week.

At 8 years, there were 6 cases of gastric cancer among the 306 individuals who had not been treated or who had not been treated successfully, and there was 1 case among the 246 individuals who had been treated successfully.

The patients also underwent endoscopy at 8 years, and the endoscopy findings showed that successfully treated patients had much less of the type of pathologic atrophy and irritation that may be associated with H. pylori infection.

H. pylori Boosts Healing With PPI

The presence of Helicobacter pylori infection has significant positive effects on the rate of healing during proton pump inhibitor therapy in patients with erosive gastroesophageal reflux disease and the rate of complete resolution of heartburn in patients with nonerosive reflux disease, reported Peter Malfertheiner, M.D., of Otto-von-Guericke University, Magdeburg, Germany, and his colleagues.

Among 2,867 patients with erosive gastroesophageal reflux disease in a prospective study, those who did not have Barrett's esophagus (BE) had a higher rate of healed erosions after 8 weeks of treatment with esomeprazol than those with BE (91% vs. 72%). In the 417 patients with BE, those who tested positive for H. pylori infection at baseline had a significantly greater healing rate at 8 weeks than patients who tested negative for the infection (83% vs. 70%) (Gut 2005;54:746–51).

In the same study, 2,740 patients had nonerosive reflux disease. After 8 weeks of treatment, patients who tested positive for H. pylori infection at baseline were slightly more likely to have complete resolution of heartburn than patients who tested negative for the infection (68% vs. 64%).

Statins May Curb Colorectal Ca Risk

The use of statins for at least 5 years appears to be associated with a significant, 47% reduction in the relative risk of developing colorectal cancer, according to findings from a case-control study.

Jenny N. Poynter of the University of Michigan, Ann Arbor, and her associates reported on 1,953 patients with colorectal cancer and 2,015 control patients from Israel. The results did not change substantially when the investigators compared unmatched and matched control patients with those who had colorectal cancer. The association also remained unchanged after making adjustments for age, sex, ethnic group, sports participation, hypercholesterolemia, history of colorectal cancer in a first-degree relative, vegetable consumption, and use of aspirin or other nonsteroidal antiinflammatory drugs. The most commonly used statins—simvastatin (Zocor) and pravastatin (Pravachol)—were associated with similar relative reductions in the risk of colorectal cancer (N. Engl J. Med. 2005; 352:2184–92).

“It is too early to recommend statins as chemopreventive agents against colorectal cancer outside the context of a clinical trial,” wrote Ernest Hawk, M.D., and Jaye L. Viner, M.D., of the National Cancer Institute, in an editorial (N. Engl. J. Med. 2005;352:2238–9).

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