Associated Factors of Atrophic Gastritis Diagnosed by Double-Contrast Upper Gastrointestinal Barium X-Ray Radiography: A Cross-Sectional Study Analyzing 6,901 Healthy Subjects in Japan

• Published in: PloS one Vol. 9; no. 10; p. e111359
• Main Authors: Yamamichi, Nobutake, Hirano, Chigaya, Shimamoto, Takeshi, Minatsuki, Chihiro, Takahashi, Yu, Nakayama, Chiemi, Matsuda, Rie, Fujishiro, Mitsuhiro, Konno-Shimizu, Maki, Kato, Jun, Kodashima, Shinya, Ono, Satoshi, Niimi, Keiko, Mochizuki, Satoshi, Tsuji, Yosuke, Sakaguchi, Yoshiki, Asada-Hirayama, Itsuko, Takeuchi, Chihiro, Yakabi, Seiichi, Kakimoto, Hikaru, Wada, Ryoichi, Mitsushima, Toru, Ichinose, Masao, Koike, Kazuhiko
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.10.2014; Public Library of Science (PLoS)
• Subjects: Acids; Adult; Adults; Age; Aged; Aged, 80 and over; Analysis; Background radiation; Barium; Biology and Life Sciences; Body mass; Body mass index; Body size; Cancer; Cancer screening; Chronic Disease; Contrast Media; Cross-Sectional Studies; Diagnosis; Diagnostic imaging; Endoscopy; Female; Gastric cancer; Gastric juice; Gastritis; Gastritis, Atrophic - complications; Gastritis, Atrophic - diagnostic imaging; Gastritis, Atrophic - microbiology; Gastroenterology; Gastrointestinal Tract - diagnostic imaging; Gender; Healthy Volunteers; Helicobacter infections; Helicobacter Infections - complications; Helicobacter Infections - diagnostic imaging; Helicobacter Infections - microbiology; Helicobacter pylori; Helicobacter pylori - physiology; Histamine; Histamine H2 Antagonists - therapeutic use; Humans; Immunoglobulin G; Infections; Internal medicine; Japan; Male; Mathematical analysis; Medical screening; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Mucosa; Multivariate Analysis; Proton pump inhibitors; Proton Pump Inhibitors - therapeutic use; Radiography; Smoking; Statistical analysis; Stomach; Stomach cancer; Ulcers; X-ray radiography; X-Rays; Young Adult; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0111359

Double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) is one of the most widely conducted gastric cancer screening methods. It has been executed to find gastric cancer, but has not been usually executed to detect premalignant atrophic mucosa of stomach. To understand the meaning of UGI-XR-based atrophic gastritis, we analyzed its association with several causative factors including Helicobacter pylori (HP) infection. We evaluated 6,901 healthy adults in Japan. UGI-XR-based atrophic gastritis was diagnosed based on the irregular shape of areae gastricae and its expansion in the stomach. Of the 6,433 subjects with no history of HP eradication and free from gastric acid suppressants, 1,936 were diagnosed as UGI-XR-based atrophic gastritis (mild: 234, moderate: 822, severe: 880). These were univariately associated with serum HP IgG and serum pepsinogen I/II ratio with statistical significance. The multiple logistic analysis calculating standardized coefficients (β) and odds ratio (OR) demonstrated that serum HP IgG (β = 1.499, OR = 4.48), current smoking (β = 0.526, OR = 1.69), age (β = 0.401, OR = 1.49), low serum pepsinogen I/II ratio (β = 0.339, OR = 1.40), and male gender (β = 0.306, OR = 1.36) showed significant positive association with UGI-XR-based atrophic gastritis whereas drinking and body mass index did not. Among the age/sex/smoking/drinking-matched 227 pairs derived from chronically HP-infected and successfully HP-eradicated subjects, UGI-XR-based atrophic gastritis was detected in 99.1% of the former but in only 59.5% of the latter subjects (p<0.0001). Contrastively, UGI-XR-based atrophic gastritis was detected in 13 of 14 HP-positive proton pump inhibitor users (92.9%) and 33 of 34 HP-positive histamine H2-receptor antagonist users (97.1%), which are not significantly different from gastric acid suppressant-free subjects. The presence of UGI-XR-based atrophic gastritis is positively associated with Helicobacter pylori infection, current smoking, age, decreased serum pepsinogen I/II ratio, and male gender. Eradication of Helicobacter pylori seems to superficially improve UGI-XR-based atrophic gastritis whereas intake of gastric acid suppressants does not.