Gastric cancer is one of the most common malignant tumors worldwide, and it is even more common in China. in 2015, the new incidence rate of gastric cancer in China was 679/100,000 and the mortality rate was 498/100,000, ranking the second highest among all malignant tumors.
Hp infection is a risk factor for gastric cancer
There are obvious geographical differences in the incidence of gastric cancer, and factors such as diet, infection and genetics are also related to the incidence of gastric cancer. According to the survey, the rate of H. pylori (Hp) infection among adults in China’s high incidence areas is over 60%. Hp can promote the conversion of nitrate into nitrite and nitrosamines, causing chronic inflammation of gastric mucosa, and environmental pathogenic factors can accelerate the excessive proliferation of mucosal epithelial cells, leading to aberration and carcinogenesis.
In 1994, the International Agency for Research on Cancer designated Hp infection as a class I carcinogenic factor for gastric cancer, and the newly released Asia-Pacific Consensus on the Prevention and Treatment of Gastric Cancer identified Hp infection as the most important modifiable risk factor for gastric cancer prevention.
It is currently believed that.
1, Hp infection is a necessary but not yet sufficient condition for the occurrence of intestinal-type gastric cancer (which accounts for the majority of gastric cancers).
2. the occurrence of gastric cancer is the result of the combined effect of Hp infection, genetic factors and environmental factors
3.The role of environmental factors in the occurrence of gastric cancer is secondary to Hp infection.
4. Hp eradication can reduce the risk of gastric cancer, and better results can be achieved by eradication before the occurrence of gastric mucosal atrophy/intestinal metaplasia.
HP eradication can prevent the occurrence of gastric cancer
Hp eradication can reduce the risk of gastric cancer, and the degree of risk reduction depends on the severity and extent of gastric mucosal atrophy at the time of eradication.
Several population-based intervention studies conducted in China have demonstrated the effectiveness of Hp eradication in reducing the incidence of gastric cancer, including a 7.5-year population-based intervention trial that showed that Hp eradication before the onset of gastric mucosal atrophy and/or intestinal metaplasia significantly reduced the incidence of gastric cancer.
In addition, several studies have shown that Hp eradication improves gastric mucosal inflammation, prevents or delays the onset and progression of gastric mucosal atrophy and intestinal chemosis, and partially reverses atrophy. These studies all suggest that Hp eradication should be used as a primary preventive measure for gastric cancer.
Hp eradication can not only reduce the risk of gastric cancer, but also effectively prevent the occurrence and recurrence of peptic ulcer and Hp-related dyspepsia.
The Fifth National Consensus Report on the Management of H. pylori Infection in China in 2017 strongly recommended screening and eradication of Hp in areas with a high incidence of gastric cancer and in high-risk populations to increase public awareness of gastric cancer prevention.
Hp high-risk screening groups are
1. Patients who have a history of peptic ulcer but have not received H. pylori testing and treatment.
2.People with family history of gastric cancer should be tested promptly even if they have no history of peptic ulcer or other symptoms.
3.Suspect patients with frequent upper abdominal pain, fullness and discomfort after meals.
4.Taking aspirin or other antipyretic and analgesic drugs for a long time.
5, Unexplained iron deficiency anemia or vitamin B12 deficiency.
Common ways of detecting Hp
1.Whistle test.
2.Fecal test to detect antigen.
3, blood chemistry tests to detect antibodies.
4, specimens obtained by invasive gastroscopy for testing.
Among them, the breath test is the most convenient and reliable means of detection, and is usually preferred when gastroscopy is not required.