Abstract
Objective: The ABC classification designed for early gastric cancer screening seems to be a useful means of detecting high-risk subjects, some of whom may be candidates for Helicobacter pylori (Hp) eradication. However, one well-known major problem of using this classification is to eliminate ‘not truly low-risk cases with previous/present Hp infection’ as “group pseudo-A”. Another controversial issue concerns “group D”, that has been shown to be a mixture of diverse statuses of Hp infection and non-Hp-related causes. The aim of our study was to clarify the characteristics of “group pseudo-A” and “group D” among our subjects.
Methods: A total of 6,236 examinees of our health check-up program were enrolled for ABC classification from April 2014 to March 2015. Subjects in group B, C and D were referred for further examinations and/or Hp eradication. Those with possible present Hp infection in group A were also referred for additional assessment. Their clinical information, which had been collected until the end of 2015, and laboratory data were analyzed.
Results: The proportions of the enrolled subjects classified into group A, B, C and D were 73.6%, 15.7%, 9.2% and 1.5%, respectively. Among the 4,591 subjects in group A, 342 (7.4%) had high negative titers for serum anti-Hp antibody in the range 3.0 - 9.9 U/mL. In detailed examinations that they were referred for, 38.5% were Hp positive and differences in pepsinogen (PG) values between them and negative examinees were statistically significant. In group D, the rate of present Hp infection was 38.0%. Other notable observations were that 28.2% of group D seemed to be non-infected, and 21.1% were previously infected or had non-Hp-related atrophic gastritis.
Conclusion: As the proportion of younger examinees undergoing our health check-up program is high, it is important to evaluate them according to the three different Hp infection statuses, which are non-infected, presently infected and previously infected. The interpretation of the results of the ABC classification should be done in conjunction with a consideration of clinical history, actual Hp titer and PG values, together with X-ray/endoscopy findings. This will help ensure that candidates for Hp eradication are identified and that latent high-risk cases are discovered.
