Epidemiology of chronic atrophic gastritis: population-based study among 9444 older adults from Germany (Weck et al., Aliment Pharmacol Ther 2007 [1])
Chronic atrophic gastritis (CAG) plays a crucial role in the development of intestinal-type gastric carcinoma. Helicobacter pylori infection seems to be the main cause of CAG. Diagnosis of CAG is based mostly on gastroscopy and histological findings following gastric biopsy, which is difficult to apply in large-scale population-based studies. An approach more suitable for such studies is to obtain information on the gastric mucosal status by measuring pepsinogen (PG) concentrations in the blood, as has been developed by Miki et al. [2] and Samloff et al. [3]. The objectives of this study by Weck et al. were to estimate prevalence of CAG by using two diagnostic criteria and to examine the association between CAG and potential risk factors and clinical consequences in a large population-based study among elderly individuals in Germany. From the variety of cut-off points used to define CAG in previous epidemiological studies, the following two were chosen: (i) PG I < 25 ng/mL, which was used in the EUROGAST study by Webb et al. [4], the only large international comparative study to delineate severe forms of CAG; and (ii) PG I < 70 ng/mL and PG I/PG II < 3, as used in several studies from Japan to define any form of CAG. With the definition used in the EUROGAST study (PG I < 25 ng/mL), prevalence of CAG increased from 4.8 % in the age group 50 – 54 years to 8.7 % in the age group 70 – 74 years. The alternative definition of CAG (PG I < 70 ng/mL and PG I/PG II < 3) used in the Japanese studies, revealed a greater increase with age (from 2.7 % to 9.1 %) and a strong association with H. pylori infection. Prevalence of CAG was found to be at a low level in this large study of older adults in Germany, and strongly increased with age but was unrelated to sex, smoking, and alcohol consumption. A strong association with H. pylori infection emerged only when CAG was defined by both PG I and the PG I/PG II ratio. Therefore, the role of H. pylori infection may be underestimated in studies where CAG is defined only by PG I levels, supporting the use of the PG I/PG II ratio for the definition of CAG in epidemiological studies.
Patients with CAG, formerly known as type A gastritis, are frequently asymptomatic but may have an increased risk of developing gastric cancer. Therefore, it is important to make an early diagnosis in patients at risk and to find useful serum markers. Recently, Checchi et al. have reported that serum ghrelin levels are the most sensitive and specific markers for selecting those patients at high risk of gastric damage that needs to undergo further investigation, including gastric biopsy [5].
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