Predicting the development of gastric cancer from combining Helicobacter pylori antibodies and serum pepsinogen status:: a prospective endoscopic cohort study

Background and aim: Helicobacter pylori infection and gastric atrophy are both risk factors for gastric cancer. We aimed to elucidate the natural history of gastric cancer development according to H pylori infection and gastric atrophy status. Subjects and methods: A total of 9293 participants in a mass health appraisal programme were candidates for inclusion in the present prospective cohort study: 6983 subjects revisited the follow up programme. Subjects were classified into four groups according to serological status at initial endoscopy. Group A ( n = 3324) had `` normal'' pepsinogen and were negative for H pylori antibody; group B ( n = 2134) had `` normal'' pepsinogen and were positive for H pylori antibody; group C ( n = 1082) had `` atrophic'' pepsinogen and were positive for H pylori antibody; and group D ( n = 443) had `` atrophic'' pepsinogen and were negative for H pylori antibody. Incidence of gastric cancer was determined by annual endoscopic examination. Results: Mean duration of follow up was 4.7 years and the average number of endoscopic examinations was 5.1. The annual incidence of gastric cancer was 0.04% ( 95% confidence interval ( CI) 0.02 - 0.09), 0.06% ( 0.03 - 0.13), 0.35% ( 0.23 - 0.57), and 0.60% ( 0.34 - 1.05) in groups A, B, C, and D, respectively. Hazard ratios compared with group A were 1.1 ( 95% CI 0.4 - 3.4), 6.0 ( 2.4 - 14.5), and 8.2 ( 3.2 - 21.5) in groups B, C, and D, respectively. Age, sex, and `` group'' significantly served as independent valuables by multivariate analysis. Conclusions: The combination of serum pepsinogen and anti- H pylori antibody provides a good predictive marker for the development of gastric cancer.