Helicobacter pylori gastritis of the gastric carcinoma phenotype: is histology capable of identifying high-risk gastritis?

Several studies have shown that Helicobacter pylori infection implies an increased risk for developing gastric carcinoma. However, it has to be considered that only a few among those infected with H. pylori develop gastric cancer. It is therefore desirable to identify risk indicators of H. pylori gastritis in the presence of which gastric carcinoma is most likely to occur. In our view, the risk indicators intestinal metaplasia and atrophy, frequently cited in the literature, are not suitable, as they are focal changes whose detection at the routine diagnostic workup may be confounded by sampling error and because early carcinoma (in particular of the diffuse type) is often not associated with intestinal metaplasia or atrophy. For this reason we investigated the diffuse gastritis parameters "grade of gastritis" and "activity of gastritis" for their suitability as risk indicators. We found that H. pylori gastritis, particularly in the corpus, is significantly more pronounced in gastric carcinoma patients or individuals with a family history of gastric cancer than in matched controls. Hence, a simple comparison of the grade of gastritis and activity of gastritis in the antrum and corpus might help identify patients with H. pylori gastritis with an increased cancer risk. Currently. we are testing this hypothesis in an ongoing gastric cancer prevention study in Germany, Austria, and Czechia.