GEOGRAPHIC FACTORS PROBABLY MODULATING ALTERNATIVE PATHWAYS IN HELICOBACTER-PYLORI-ASSOCIATED GASTRODUODENAL PATHOLOGY - A HYPOTHESIS

It is hypothesized that probable geographic factors of nutritional typ e, nonrelated to development or socioeconomic level, may modulate the conversion of Helicobacter pylori-associated active chronic gastritis from its early stages to chronic atrophic gastritis (CAG). The factors could be diets low in antioxidant vitamins and other micronutrients s uch as selenium, In regions of the world where these modulating factor s are not present, active chronic gastritis tends to stay in its early stages and to predispose individuals to duodenal ulcer. On the contra ry, in regions where the modulating factors are present, the frequency of CAG increases markedly. When CAG becomes severe and extensive, hyp ochlorhydria ensues. Hypochlorhydria decreases the predisposition to d uodenal ulcer, while CAG, a precancerous lesion, predisposes individua ls to gastric cancer of the intestinal type. The hypothesis could be t ested in a multicenter, multiregional study to (1) determine endoscopi cally and histologically the prevalence rates of duodenal ulcer, gastr ic ulcer, gastric cancer, and H. pylori-associated CAG in large series of dyspeptic patients and (2) correlate these prevalence rates with b lood levels of micronutrients in these patients.