Extensive gastric atrophy: An increased risk factor for superficial esophageal squamous cell carcinoma in Japan

Objectives: A recent study in Sweden has reported that gastric atrophy is associated with an increased risk for esophageal squamous cell carcinoma. However, this finding needs to be confirmed in other ethnic groups due to the wide geographic variation of this cancer. Objectives: To investigate whether gastric atrophy is associated with a risk for esophageal squamous cell carcinoma using a case-control study in Japanese subjects, a population known to have a high prevalence of H. pylori infection and accompanying gastric atrophy. Methods: Seventy-three patients who had undergone endoscopic mucosal resection for superficial esophageal squamous cell carcinoma, and 73 sex- and age-matched controls, were enrolled prospectively. Gastric fundic atrophy was evaluated by histology of biopsy specimens and serum pepsinogen I level (cutoff level 25 ng/mL). Conditional logistic regression model with adjustment for potential confounding factors was used to assess the associations. Results: Gastric atrophy, defined histologically or serologically, was independently associated with an increased risk for esophageal squamous cell carcinoma and the risk seemed to increase with the progression of the atrophy. Multivariate odds ratio (95% confidence interval) for histological fundic atropy, fundic intestinal metaplasia, and serological atrophy are 4.2 (1.5-11.7), 10.7 (2.3-50.4), and 8.2 (2.2-30.4), respectively. Conclusions: Gastric atrophy, a newly recognized risk factor for esophageal squamous cell carcinoma in Sweden, is likely to be a risk factor in other areas. Further studies are warranted to explore the causal relationship.