GASTRIC ATROPHY AND REGIONAL VARIATION IN UPPER GASTROINTESTINAL-DISEASE

Objective: To compare the upper gastrointestinal disease profiles of H elicobacter pylori-infected patients drawn from two distinct regions o f China, one with a low incidence of gastric cancer (Guangzhou) and th e other with a high incidence of gastric cancer (Lanzhou). The age-sta ndardized prevalence of H. pylori within the populations of these two cities was similar (similar to 56%). In these patient groups, the prev alence of different gastrointestinal disease states and the occurrence and severity of gastritis, gastric atrophy, and intestinal metaplasia were compared. Methods: This study was based on consecutive patients: 265 from Guangzhou and 275 from Lanzhou. The grading of gastritis and the detection of H. pylori was determined by histology using the ''Sy dney System''. Results: The ratio of cases of duodenal to gastric ulce ration for the two cities was: Guangzhou 14:1 and Lanzhou 3:1. Gastric cancer was more prevalent in the patients from Lanzhou (9.8%) than fr om Guangzhou (3%). In nonulcer dyspepsia patients from Guangzhou, gast ritis was predominantly antral, whereas, in Lanzhou, gastritis was pre dominantly uniform. The amount and severity of atrophy was significant ly greater in Lanzhou compared with Guangzhou. Conclusions: The preval ence of atrophy, rather than age of acquisition and prevalence of H. p ylori infection, appears to be a marker of the major upper gastrointes tinal disease profiles of a region. Development of atrophy, although a pparently related to H. pylori infection, may be a multifactorial cond ition. Differences in diet, as seen between Guangzhou and Lanzhou, may be important in this regard. Understanding the factors leading to the development of atrophy may enhance our understanding of processes lea ding to gastric malignancy.