Sains Malaysiana 47(8)(2018): 1811–1818

http://dx.doi.org/10.17576/jsm-2018-4708-20

 

Risk Factors of Gastric Premalignant Lesion in Gastritis Patients

(Faktor Risiko Lesi Gastrik Premalignan pada Pesakit Gastritis)

 

GONTAR ALAMSYAH SIREGAR^1*, IDA PARWATI², TRI HANGGONO ACHMAD³

& YONI FUADAH SYUKRIANI⁴

 

¹Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Jl. Dr. T. Mansur No.5, Kampus USU, Medan 20155, Indonesia

 

²Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM 21, Jatinangor 45363, Bandung, Indonesia

 

³Department of Biochemistry, Faculty of Medicine, Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM 21, Jatinangor 45363, Bandung, Indonesia

 

⁴Department of Forensic and Legal Medicine, Faculty of Medicine, Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM 21, Jatinangor 45363, Bandung, Indonesia

 

Received: 15 January 2018/Accepted: 23 April 2018

 

ABSTRACT

Gastric cancer is the second leading cause of cancer-related mortality and the fourth most common cancer globally. Gastric premalignant lesions are well known risk factors for the development of gastric cancer. The purpose of this study was to investigate the risk factors of gastric premalignant lesion. This cross-sectional study observed gastritis patients at Adam Malik General Hospital, Permata Bunda General Hospital, Universitas Sumatera Utara Hospital, all located in Medan, Indonesia. A total of 120 gastritis patients were included in this study. Patients were interviewed with a questionnaire to obtain demographic data, alcohol intake, smoking status, high salt diet and NSAID use. Diagnosis of Helicobacter pylori infection was made using positive results of the carbon-14 urea breath test (14C-UBT), rapid urease test, and/or immunohistochemistry. Endoscopy and biopsy were conducted to diagnose gastric premalignant lesion. Gastric premalignant lesion diagnosis was made when one or more of the following were present: Chronic atrophic gastritis, intestinal metaplasia, or dysplasia. Data were analysed using SPSS version 22. There were 35/120 (29.2%) of gastritis patients having gastric premalignant lesion. Multivariate analysis has shown that H. pylori infection, patients with family history of gastric cancer, alcohol consumption and Batak ethnic have increased risk to develop gastric premalignant lesion (p<0.05). All these results implied that risk factors of gastric premalignant lesion were H. pylori infection, family history of gastric cancer, alcohol intake and Batak ethnic.

 

Keywords: Gastric cancer; gastric premalignant lesion; Helicobacter pylori; risk factors

 

ABSTRAK

Kanser gastrik merupakan penyebab kedua terbesar dalam kejadian kematian berkaitan dengan kanser dan berada di tempat keempat dalam kejadian kanser yang paling sering terjadi di seluruh dunia. Faktor risiko yang terkenal dalam perkembangan kanser gastrik adalah lesi gastrik premalignan. Objektif penyelidikan ini adalah untuk mengkaji faktor risiko kejadian lesi gastrik premalignan. Kajian keratan rentas ini dilakukan pada pesakit gastritis di hospital yang berlokasi di Medan, Indonesia seperti Hospital Umum Adam Malik, Hospital Umum Permata Bunda dan Hospital Universiti Sumatera Utara. Jumlah pesakit gastriris yang terlibat dalam penyelidikan ini adalah seramai 120 orang. Pesakit ditemu duga dengan soal selidik yang merangkumi pertanyaan mengenai data demografi, pengunaan alkohol, status penghisapan rokok, diet yang mengandungi garam tinggi serta penggunaan ubat NSAID. Diagnosis pada infeksi Helicobacter pylori ditentukan daripada hasil positif pada ujian karbon-14 pernafasan urea (14C-UBT), ujian pantas urease dan/atau immunohistokimia. Endoskopi dan biopsi dijalankan untuk pendiagnosisan lesi gastrik premalignan. Diagnosis lesi gastrik premalignan dilakukan sekiranya salah satu daripada lesi ini ditemui: Gastritis atrofik kronik dan/atau metaplasia atau displasia usus. Data dianalisis dengan menggunakan SPSS versi 22. 35 daripada 120 (29.2%) pesakit gastritis mempunyai lesi gastrik premalignan. Analisis secara multivariat menunjukkan bahawa infeksi H. pylori, pesakit dengan sejarah keluarga kanser gastrik, penggunaan alkohol serta etnik Batak didapati meningkatkan risiko perkembangan lesi gastrik premalignan (p<0.05). Kesimpulannya, keputusan kajian menunjukkan bahawa faktor risiko terjadinya lesi gastrik premalignan adalah infeksi H. pylori, pesakit dengan sejarah keluarga kanser gastrik, penggunaan alkohol dan etnik Batak.

 

Kata kunci: Faktor risiko; Helicobacter pylori; kanser gastrik; lesi gastrik premalignan

REFERENCES

Adlekha, S., Chadha, T., Krishnan, P. & Sumangala, B. 2013. Prevalence of Helicobacter pylori infection among patients undergoing upper gastrointestinal endoscopy in a Medical College Hospital in Kerala, India. Annals of Medical and Health Sciences Research 3(4): 559-563.

Almouradi, T., Hiatt, T. & Attar, B. 2013. Gastric intestinal metaplasia in an underserved population in the USA: prevalence, epidemiologic, and clinical features. Gastroenterology Research and Practice 2013: Article ID. 856256.

Ambarsari, F. & Widodo, P. 2012. Implementasi unsur tradisi dan kebudayaan Batak dengan pendekatan modern dalam perancangan interior Museum Ulos Sumatera Utara. Interior Design 1(1): 1-6.

Ang, T.L. & Fock, K.M. 2014. Clinical epidemiology of gastric cancer. Singapore Medical Journal 55(12): 621-628.

Bedoya, A., Sanson, F., Fuertes, Y.Y., Santacruz, C., Cifuentes, Y., Calvache, D. & Bedoya, A. 2012. Prevalence and severity of gastric cancer precursor lesions in a high risk area. Revista Colombiana de Gastroenterologia 27(4): 274-280.

Benberin, V., Bektayeva, R., Karabayeva, R., Lebedev, A., Akemeyeva, K., Paloheimo, L. & Syrjanen, K. 2013. Prevalence of H. pylori infection and atrophic gastritis among symptomatic and dyspeptic adults in Kazakhstan. A hospital based screening study using a panel of serum biomarkers. Anticancer Research 33: 4595-4602.

Bilman, F.B., Ozdemir, M., Baysal, B. & Kurtoglu, M.G. 2016. Prevalence of H. pylori in gastric biopsy specimen in the southeastern region of Turkey. Journal of Infection in Developing Countries 10(11): 1177-1182.

Cheung, D.Y. 2017. Atrophic gastritis increases the risk of gastric cancer in asymptomatic population in Korea. Gut Liver 11(5): 575-576.

Crew, K.D. & Neugut, A.I. 2016. Epidemiology of gastric cancer. World Journal of Gastroenterology 12(3): 354-362.

De Vries, A.C., Meijer, G.A., Looman, C.W., Casparie, M.K., Hansen, B.E., van Grieken, N.C. & Kuipers, E.J. 2007. Epidemiological trends of premalignant gastric lesions: A long-term nationwide study in The Netherlands. Gut 56: 1665-1670.

De Vries, A.C., van Grieken, N.C., Looman, C.W., Casparie, M.K., de Vries, E., Meijer, G.A. & Kuipers, E.J. 2008. Gastric cancer risk in patients with premalignant gastric lesions: A nationwide cohort study in The Netherlands. Gastroenterology 134(4): 945-952.

Den Hoed, C.M., van Eijck, B.C., Capelle, L.G., van Dekken, H., Biermann, K., Siersema, P.D. & Kuipers, E.J. 2011. The prevalence of premalignant gastric lesions in asymptomatic patients: Predicting the future incidence of gastric cancer. European Journal of Cancer 47: 1211-1218.

El-Omar, E.M., Oien, K., Murray, L.S., El-Nujumi, A., Wirz, A., Gillen, D., Williams, C., Fullarton, G. & McColl, K.E. 2000. Increased prevalence of precancerous changes in relatives of gastric cancer patients: Critical role of H. pylori. Gastroenterology 118(1): 22-30.

Felley, C., Bouzourene, H., VanMelle, M.B., Hadengue, A., Michetti, P., Dorta, G., Spahr, L., Giostra, E. & Frossard, J.L. 2012. Age, smoking and overweight contribute to the development of intestinal metaplasia of the cardia. World Journal of Gastroenterology 18: 2076-2083.

Ferlay, J., Parkin, D.M. & Steliarova-Foucher, E. 2010. Estimates of cancer incidence and mortality in Europe in 2008. European Journal of Cancer 46: 765-781.

Gaol, N.L. & Husin, S. 2013. Dilema pemberantasan minuman keras terhadap pelestarian budaya masyarakat Batak Toba (studi kasus di Desa Ria-Ria Kecamatan Pollung Kabupaten Humbang Hasundutan). Citizenship 1: 101-121.

Haziri, A., Shkololli, A.J., Gashi, Z., Berisha, D. & Haziri, A. 2010. Helicobacter pylori infection and precancerous lesions of the stomach. Medicinski. Arhiv. 64: 248-249.

Hu, B., Hajj, N.E., Sittler, S., Lammert, N., Barnes, R. & Meloni-Ehrig, A. 2012. Gastric cancer: Classification, histology, and application of molecular pathology. Journal of Gastrointestinal Oncology 3(3): 251-261.

Ishaq, S. & Nunn, L. 2015. Helicobacter pylori and gastric cancer: A state of the art review. Gastroenterology and Hepatology from Bed to Bench 8: S6-14.

Joo, Y.E., Park, H.K., Myung, D.S., Baik, G.H., Shin, J.E., Seo, G.S., Kim, G.H., Kim, H.Y., Cho, S.I. & Kim, N. 2013. Prevalence and risk factors of atrophic gastritis and intestinal metaplasia: A nationwide multicenter prospective study in Korea. Gut Liver 7: 303-310.

Karim-Kos, H.E., de Vries, E., Soerjomataram, I., Lemmens, V., Siesling, S. & Coebergh, J.W. 2008. Recent trends of cancer in Europe: A combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. European Journal of Cancer 44: 1345-1389.

Karimi, P., Islami, F., Anandasabapathy, S., Freedman, N.D. & Kamangar, F. 2014. Gastric cancer: Descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiology, Biomarkers & Prevention 23(5): 700-713.

Kim, N., Park, Y.S., Cho, S.I., Lee, H.S., Choe, G., Kim, I.W., Won, Y.D., Park, J.H., Kim, J.S., Jung, H.C. & Song, I.S. 2008. Prevalence and risk factors of atrophic gastritis and intestinal metaplasia in a Korean population without significant gastro-duodenal disease. Helicobacter 13: 245- 255.

Kusters, J.G., van Vliet, A.H. & Kuipers, E.J. 2006. Pathogenesis of Helicobacter pylori infection. Clinical Microbiology Reviews 19(3): 449-490.

Lage, J., Uedo, N., Dinis-Ribeiro, M. & Yao, K. 2016. Surveillance of patients with gastric precancerous conditions. Best Practice & Research Clinical Gastroenterology 30(6): 913-922.

Li, H., Ma, L., Chen, J., Zen, W., Jin, L., Xu, X., Xu, C. & Li, Y. 2016. ZJU index is associated with prevalence of Helicobacter pylori infection in a Chinese population. International Journal of Clinical and Experimental Medicine 9(11): 22324-22330.

Liu, J., Sun, L., Gong, Y. & Yuan, Y. 2010. Risk factors of precancerous gastric lesions in a population at high risk of gastric cancer. Chinese Journal of Cancer Research 22(4): 267-273.

Malik, T.H., Zhao, C., Al-Ahmed, J.M., Alam, S.A. & Xu, H. 2017. Gastric intestinal metaplasia is the most common histopathological phenotype among endoscopically diagnosed atrophic gastritis patients in North-East China. Open Journal of Gastroenterology 7: 65-74.

Mansour-Ghanaei, F., Joukar, F., Soati, F., Mansour-Ghanaei, A. & Atrkar-Roushan, Z. 2013. Outcome of intestinal metaplasia in gastric biopsy of patients with dyspepsia in Guilan Province, North Iran. Asian Pacific Journal of Cancer Prevention 14(6): 3549-3554.

Maran, S., Lee, Y.Y., Xu, S., Rajab, N., Hasan, N., Aziz, S.H., Majid, N.A. & Zilfalil, B.A. 2013. Gastric precancerous lesions are associated with gene variants in Helicobacter pylori-susceptible ethnic Malays. World Journal of Gastroenterology 19(23): 3615-3622.

Masjedizadeh, A.R., Fathizadeh, P., Syahyesteh, A.A., Alavinejad, P., Hashemi, J. & Hajiani, E. 2013. Prevalence of H. pylori infection and precancerous gastric lesion in family relative of gastric cancer in South West of Iran. Journal of Gastroenterology and Hepatology Research 2(11): 878-882.

Nishino, Y., Inoue, M., Tsuji, I., Wakai, K., Nagata, C., Mizoue, T., Tanaka, K. & Tsugane, S. 2006. Tobacco smoking and gastric cancer risk: An evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Japanese Journal of Clinical Oncology 36: 800-807.

Nomura, A.M., Wilkens, L.R., Henderson, B.E., Epplein, M. & Kolonel, L.N. 2012. The association of cigarette smoking with gastric cancer: The multiethnic cohort study. Cancer Causes Control 23(1): 51-58.

Park, Y.H. & Kim, N. 2015. Review of atrophic gastritis and intestinal metaplasia as a premalignant lesion of gastric cancer. Journal of Cancer Prevention 20(1): 25-40.

Rahman, R., Asombang, A.W. & Ibdah, J.A. 2014. Characteristics of gastric cancer in Asia. World Journal of Gastroenterology 20(16): 4483-4490.

Rojborwonwitaya, J. & Vijitjunykul, N. 2005. Comparison of the accuracy of two commercial rapid urase tests, CLOtest® and pronto dry®, in detecting Helicobacter pylori infection. Thai Journal of Gastroenterology 6(2): 55-60.

Rokkas, T., Sechopoulos, P., Pistiolas, D., Margantinis, G. & Koukoulis, G. 2010. Helicobacter pylori infection and gastric histology in first-degree relatives of gastric cancer patients: A meta-analysis. European Journal of Gastroenterology & Hepatology 22(9): 1128-1133.

Roman, L.D., Lukyanchuk, R., Sablin, O.A., Araslanova, E.I., Eklund, C., Hendolin, P., Paloheimo, L. & Syrjanen, K. 2016. Prevalence of H. pylori infection and atrophic gastritis in a population-based screening with serum biomarker panel (GastroPanel®) in St. Petersburg. Anticancer Research 36: 4129-4138.

Shin, C.M., Kim, N., Yang, H.J., Cho, S.I., Lee, H.S., Kim, J.S., Jung, H.C. & Song, I.S. 2010. Stomach cancer risk in gastric cancer relatives: Interaction between Helicobacter pylori infection and family history of gastric cancer for the risk of stomach cancer. Journal of Clinical Gastroenterology 44(2): e34-39.

Shiota, S., Cruz, M., Abreu, J.A.J., Mitsui, T., Terao, H., Disla, M., Iwatani, S., Nagashima, H., Matsuda, M., Uchida, T., Tronilo, L., Rodriguez, E. & Yamaoka, Y. 2014. Virulence genes of Helicobacter pylori in the Dominican Republic. Journal of Medical Microbiology 63: 1189-1196.

Song, H., Ekheden, I.G., Zheng, Z., Ericsson, J., Nyren, O. & Ye, W. 2015. Incidence of gastric cancer among patients with gastric precancerous lesions: Observational cohort study in a low risk Western population. British Medical Journal 351: 1-7.

Syam, A.F., Miftahussurur, M., Makmun, D., Nusi, I.A., Zain, L.H., Zulkhairi., Akil, F., Uswan, W.B., Simanjuntak, D., Uchida, T., Adi, P., Utari, A.P., Rezkitha, Y.A., Subsomwong, P., Nasronudin, Suzuki, R. & Yamaoka, Y. 2015. Risk factors and prevalence of Helicobacter pylori in five largest islands of Indonesia: A preliminary study. PLoS ONE 10(11): e0140186.

Szoke, D. 2009. Genetic factors related to the histological and macroscopic lesions of the stomach. Budapest: Semmelweis University. pp. 7-61 (Unpublished).

Tan, P. & Yeoh, K. 2015. Genetics and molecular pathogenesis of gastric adenocarcinoma. Gastroenterology 149(5): 1153- 1162.

Trindade, L.M., Menezes, L.B., de Souza Neta, A.M., Leite Rolemberg, P.C., Souza, L.D., Barreto, I.D. & Meurer, L. 2017. Prevalence of Helicobacter pylori infection in samples of gastric biopsies. Gastroenterology Research 10(1): 33-41.

Weck, M.N. & Brenner, H. 2006. Prevalence of chronic atrophic gastritis in different parts of the world. Cancer Epidemiology, Biomarkers & Prevention 15: 1083-1094.

Wu, Y., Fan, Y., Jiang, Y., Wang, Y., Liu, H. & Wei, M. 2013. Analysis of risk factors associated with precancerous lesion of gastric cancer in patients from Eastern China: A comparative study. Journal of Cancer Research and Therapeutics 9(2): 205-209.

Yashima, K., Sasaki, S., Koda, M., Kawaguchi, K., Harada, K. & Murawaki, Y. 2010. Premalignant lesions in gastric cancer. Clinical Journal of Gastroenterology 3(1): 6-12.

Yeh, L.Y., Raj, M., Hassan, S., Aziz, S.A., Othman, N.H., Mutum, S.S. & Naik,V.R. 2009. Chronic atrophic antral gastritis and risk of metaplasia and dysplasia in an area with low prevalence of Helicobacter pylori. Indian Journal of Gastroenterology 28(2): 49-52.

Zali, H., Rezaei-Tavirani, M. & Azodi, M. 2011. Gastric cancer: Prevention, risk factors, and treatment. Gastroenterology and Hepatology from Bed to Bench 4(4): 175-185.

Zhang, X.Y., Zhang, P.Y. & Aboul-Soud, M.A.M. 2017. From inflammation to gastric cancer: Role of Helicobacter pylori. Oncology Letters 13: 543-548.

Zhou, J., Teng, R., Xu, C., Wang, Q., Guo, J., Xu, C., Li, Z., Xie, S., Shen, J. & Wang, L. 2013. Overexpression of ERalpha inhibits proliferation and invasion of MKN28 gastric cancer cells by suppressing beta-catenin. Oncology Reports 30: 1622-1630.

Zullo, A., Hassan, C., Romiti, A., Giusto, M., Guerriero, C., Lorenzetti, R., Campo, M.A. & Tomao, S. 2012. Follow-up intestinal metaplasia in the stomach: When, how, and why. World Journal of Gastrointestinal Oncology 4(3): 30-36.

 

*Corresponding author; email: gontarsir@gmail.com