Clinical Characteristics and Helicobacter pylori Status of Gastric Cancer in Thailand

  • Published : 2014.11.06


Background: Gastric cancer is the second leading course of cancer death worldwide and H. pylori infection is an important risk factor for gastric cancer development. This study was design to evaluate the clinical, pathological features, survival rate and prevalence of H. pylori infection in gastric cancer in Thailand. Materials and Methods: Clinical information, histological features, endoscopic findings and H. pylori status were collected from gastric cancer patients from Thammasat university hospital during June 1996-December 2011. H. pylori infection was assessed by histological evaluation, rapid urease test and serological test. Clinical information, endoscopic findings and histopathology of all patients were recorded and compared between patients with active or non-active H. pylori infection. Results: A total of 100 gastric cancer patients (55 men and 45 women with mean age of $55{\pm}16.8years$) were enrolled in this study. Common presenting symptoms were dyspepsia (74%), weight loss (66%), anemia (63%) and anorexia (38%). Mean duration of symptoms prior to diagnosis was 98 days. Overall prevalence of H. pylori infection was 83% and active H. pylori infection was 40%. 1-year and 5-year survival rates were 43% and 0%. There was no significant difference between active H. pylori infection in different locations (proximal vs non-proximal: 47.1% vs 48.5%; P-value = 0.9, OR=0.9; 95%CI=0.3-3.1) and histology of gastric cancer (diffuse type vs intestinal type: 47.4% vs 50%; P-value = 0.8, OR=0.9, 95%CI=0.3-2.7). However, linitis plastica was significantly more common in non-active than active H. pylori infection (27.9% vs 0%; P-value<0.0001, OR=13.3, 95%CI=3.2-64.5). Moreover, gastric cancer stage 4 was higher in non-active than active H. pylori infection (93% vs 50%, P-value<0.001). Conclusions: Prevalence of H. pylori infection in Thai gastric cancer patients was high but active infection was low. Most gastric cancer patients presented in advance stage and had a grave prognosis. Screening for gastric cancer in high risk individuals might be an appropriate tool for early detection and improve the treatment outcome for this particular disease in Thailand.


  1. Asaka M, Kato M, Sakamoto N (2014). Roadmap to eliminate gastric cancer with Helicobacter pylori eradication and consecutive surveillance in Japan. J Gastroenterol, 49, 1-8
  2. Abebaw W, M Kibret, B Abera (2014). Prevalence and risk factors of H. pylori from dyspeptic patients in northwest Ethiopia: a hospital based cross-sectional study. Asian Pac J Cancer Prev, 15, 4459-63.
  3. Basiri Z, R Safaralizadeh, MJ Bonyadi, et al (2014). Helicobacter pylori vacA d1 genotype predicts risk of gastric adenocarcinoma and peptic ulcers in northwestern Iran. Asian Pac J Cancer Prev, 15, 1575-9.
  4. Demirel BB, BE Akkas, GU Vural (2013). Clinical factors related with Helicobacter pylori infection--is there an association with gastric cancer history in first-degree family members? Asian Pac J Cancer Prev, 14, 1797-02.
  5. Chua TS, Fock KM, Chan YH, et al (2002). Seroreactivity to 19.5-kDa antigen in combination with absence of seroreactivity to 35-kDa antigen is associated with an increased risk of gastric adenocarcinoma. Helicobacter, 7, 257-64.
  6. Fock KM, Talley N, Moayyedi P, et al (2008). Asia-Pacific consensus guidelines on gastric cancer prevention. J Gastroenterol Hepatol, 23, 351-65.
  7. Hazell SL, Hennessy WB, Borody TJ, et al (1987). Campylobacter pyloridis gastritis. II. Distribution of bacteria and associated inflammation in the gastroduodenal environment. Am J Gastroenterol, 82, 297-301.
  8. Lin WL, Sun JL, Chang SC, et al (2014). Factors predicting survival of patients with gastric cancer. Asian Pac J Cancer Prev, 15, 5835-8.
  9. Huang J-Q, Sridhar S, Chen Y, et al (1998). Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. Gastroenterology, 1148, 1167-9.
  10. IARC (1994). "Schistosomes, liver flukes and Helicobacter pylori. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon, 7-14 June 1994." IARC Monogr Eval Carcinog Risks Hum, 61, 1-241.
  11. Karami N, Talebkhan Y, Saberi S, et al (2013). Seroreactivity to Helicobacter pylori antigens as a risk indicator of gastric cancer. Asian Pac J Cancer Prev, 14, 1813-7.
  12. Mahachai V, Vilaichone RK (2011). Current Status of Helicobacter pylori Infection in Thailand. Helicobacter Res 15, 38-44.
  13. Martin-de Argila C, Boixeda D, Redondo C, et al (1997). Relation between histologic subtypes and location of gastric cancer and Helicobacter pylori. Scand J Gastroenterol, 32, 303-7.
  14. Nomura A, Stemmermann GN, Chyou P-H, et al (1991). Helicobacter pylori infection and gastric carcinoma among Japanese Americans in Hawaii. N Engl J Med, 325, 1132-6.
  15. Ono S, Kato M, Suzuki M, et al (2012). Frequency of Helicobacter pylori -negative gastric cancer and gastric mucosal atrophy in a Japanese endoscopic submucosal dissection series including histological, endoscopic and serological atrophy. Digestion, 86, 59-65.
  16. Parsonnet J, Friedman GD, Vandersteen DP, et al (1991). Helicobacter pylori infection and the risk of gastric cancer. N Engl J Med, 325, 1127-31.
  17. Robey-Cafferty SS1, Ro JY, Cleary KR (1989). The prevalence of Campylobacter pylori in gastric biopsy from cancer patients. Mod Pathol, 2, 473-476.
  18. Vilaichone RK, Mahachai V, Graham DY (2006). Helicobacter pylori: Diagnosis and management. Gastroenterol Clin North Am, 35, 229-47.
  19. Sano H, Goto R, Hamashima C (2014). What is the most effective strategy for improving the cancer screening rate in Japan? Asian Pac J Cancer Prev, 15, 2607-12.
  20. Talley NJ, Zinsmeister AR, Weaver A, et al (2001). Gastric carcinoma and Helicobacter pylori infection. J Natl Cancer Inst, 83, 1734-9.
  21. Uemura N, S Okamoto, S Yamamoto, et al (2001). Helicobacter pylori infection and the development of gastric cancer. N Engl J Med, 345, 784-9.
  22. Vilaichone RK, Mahachai V, Kositchaiwat C, Graham DY, Yamaoka Y (2003). Relation between seroreactivity to lowmolecular-weight Helicobacter pylori-specific antigens and disease presentation. Clin Diagn Lab Immunol, 10, 1025-8.

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