Arjama Roy, Amity University Kolkata
Gastric adenocarcinoma is the 5th most typical cancer worldwide. The main risk factor for non-cardia gastric adenocarcinoma is atrophic gastritis. It is because of infection with Helicobacter pylori (H pylori). However, in Western populations, due to the decreasing pervasiveness of H pylori infections, the incidence of gastric adenocarcinoma has declined successively.
Recent studies show that the incidence of proximal gastric adenocarcinoma has increased among younger adults (<50 years of age) in Western countries. Researchers conducted a population-based nested case-control study to assess if hypergastrinemia was associated with an increased risk of developing gastric adenocarcinoma in humans or not. Serum was collected from 78,962 participants in which 181 incident gastric adenocarcinoma cases were identified matched with 359 control. The risk of gastric adenocarcinoma was compared between participants with pre-diagnostic hypergastrinemia and normal serum gastrin. Logistic regression provided odds ratios with 95% confidence intervals, adjusted for body mass index, tobacco smoking and comorbidity.
The reasons behind this increase include the increasing prevalence of autoimmune gastritis and long-term use of proton pump inhibitors (PPIs), both causing hypergastrinemia. The hormone gastrin which is the main stimulator of gastric acid secretion and oxyntic mucosal growth is released by the antral G-cells in the distal stomach in response to elevation of intragastric pH and protein-containing meals. Subsequently, gastrin stimulates enterochromaffin-like cells of the oxyntic mucosa within the proximal stomach to secrete histamine, which successively stimulates the parietal cells to secrete acid. Gastritis causing atrophy of the oxyntic mucosa which results in a reduction in acid secretion, and also the resulting loss of feedback on gastrin release results in hypergastrinemia.
Hypergastrinemia is related to increased risk of gastric adenocarcinoma overall and specifically for gastric adenocarcinoma with proximal location, but not with gastric adenocarcinoma with the distal location. It is also related to an increased risk of gastric adenocarcinoma of intestinal histological type, but not for diffuse histological type. Hence, hypergastrinemia is associated with an increased risk of proximal and intestinal-type gastric adenocarcinoma.
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Source: Eivind Ness‐Jensen, Erling Audun Bringeland, Fredrik Mattsson, Patricia Mjønes, Jesper Lagergren, Jon Erik Grønbech, Helge Lyder Waldum, Reidar Fossmark, Hypergastrinemia is associated with an increased risk of gastric adenocarcinoma with proximal location: a prospective population‐based nested case‐control study. DOI: https://doi.org/10.1002/ijc.33354
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