Abstract
Because Helicobacter pylori (Hp) infection is related to gastric cancer, as part of gastric cancer screening it is important to identify whether the infection is present. We previously reported Hp infection could be identified at barium X-ray examination by classifying the gastric mucosal pattern as smooth (uninfected), rough (infected), or intermediate types (possibly infected). We examined the mucosal pattern of gastric cancer cases diagnosed with barium X-ray examination in our department since 2001 to 2008 and all 12 subjects diagnosed (100%) with gastric cancer had the rough mucosal pattern. This study involved 209 subjects who underwent barium X-ray examination, Hp stool antigen (HpSA), serum anti-Hp antibody (HpAb), and serum pepsinogen (PG) tests at the Healthcare Department of Social Insurance Shiga Hospital from April, 2004 to March, 2005. Hp positive/negative status was defined by agreement of HpSA and HpAb tests; 23 cases with disagreement of the two tests were excluded. Hp infection was present in 2 of 71 (2.8%), 97 of 100 (97%) and 5 of 15 (33%) with smooth, rough and intermediate mucosal patterns, respectively. The sensitivity and specificity of smooth and rough patterns for Hp infection were 98% and 95.8%, respectively. If PG test results were scored as positive with PG I<70 and PG I/II <3 in the 209 subjects, 68/73 (93.2%) subjects with smooth mucosal pattern were negative in all 3 tests; 97/116 (83.6%) of those with rough mucosal pattern had positive results in both HpSA and HpAb irrespective of the result in PG test. However, there was a small group (3/81, 3.7%) of those with negative results in all 3 tests evaluated in the rough pattern (i.e., high risk subjects for gastric cancer). If HpAb and PG tests had been used for screening high-risk subjects for gastric cancer (so-called ABC method), 15 of the 83 (18%) in group A (HpAb-negative and PG-negative) had a rough (4/83, 4.8%) or intermediate (11/ 83, 13.3%) mucosal pattern and thus would have possibly been falsely categorized as low risk for gastric cancer. On the other hand, those with smooth pattern and negative results in all three tests (68/209, 32.5%) could be excluded from future gastric cancer screening. These results suggest that barium X-ray examination is not only useful for screening of gastric cancer but also for separating subjects at a high risk for gastric cancer from those at low risk.
