Most gastric cancer occurs on the distal side of the endoscopic atrophic border

Background: The endoscopic atrophic border indicates the extent of atrophic gastritis. The aims of this study were to examine the relation of intestin al and diffuse types of gastric cancer to the atrophic border and to study the pathologic condition of the atrophic border. Methods: In 83 patients wi th gastric cancer the extent of atrophic gastritis was assessed macroscopic ally. In 46 patients gastric biopsy specimens were also taken, to compare t he histologic features of gastritis proximal and distal to the atrophic bor der. Results: Eighty-five per cent of gastric cancers (including 93% of int estinal type) occurred on the distal side of the atrophic border. Early dif fuse gastric cancer arose closer to the atrophic border than intestinal typ e cancer and was more likely to be sited proximal to it. Histologically, th e grade of polymorphonuclear cell infiltration (inflammatory activity) and Helicobacter pylori density were significantly greater on the proximal side (P < 0.05), whereas the grades of glandular atrophy and intestinal metapla sia were significantly greater distally (P < 0.001). Conclusions: The atrop hic border delineates the area of atrophic gastritis and intestinal metapla sia, and it is within the distal part of the stomach that gastric cancer oc curs most frequently. Endoscopists should observe the distal side particula rly carefully to identify early gastric cancer. The relationship of the two histologic types of cancer to areas of intestinal metaplasia and 'active' inflammation may have implications for the pathogenesis of cancer and, if s o, for the potential protective effect of H. pylori eradication.