2023 Volume 61 Issue 2 Pages 141-152
Herein, I summarize the history of the discovery of Helicobacter pylori (H. pylori) in the gastric mucosal background on barium X-ray radiography and the future perspectives on gastric cancer screening in Japan. H. pylori was first reported in 1983, and an antrum-type acute gastric mucosal lesion (AGML) was proven to be a clinical manifestation of acute H. pylori infection in 1995. In 1996, the Updated Sydney System was proposed to unify microscopic diagnoses of the gastric mucosa. In 1997, Uemura et al. reported a relationship between H. pylori infection and gastric cancer and suggested the possibility of gastric cancer prevention with eradication therapy. We first reported the diagnosis of H. pylori infection obtained using barium X-ray radiography in 1999 and proposed that examination of the gastric mucosal background should be included in gastric cancer screening in 2007. A large-scale cohort study is currently underway to determine if we can prolong the duration of screening in H. pylori-naïve patients. The efficiency of endoscopic gastric cancer screening is expected to worsen in the future because the prevalence of H. pylori infection is decreasing. Screening using barium X-ray radiography or the ABC method before endoscopic examination is expected to improve the efficiency of endoscopic gastric cancer screening. Gastric cancer screening programs should be designed in combination with these methods, according to the characteristics of the community. Because the sensitivity and specificity of gastritis screening are expected to be higher (>90%) than those of conventional gastric cancer screening using barium X-ray radiography, I propose that conventional gastric cancer screening should be shifted to gastritis screening.
