Abstract
Introduction:Helicobacter pylori (H. pylori) eradication aimed at the prevention of gastric cancer development should ideally be administered before the establishment of significant gastric precancerous conditions (SGPCs), including advanced gastric atrophy, intestinal metaplasia, and dysplasia. We evaluated the interaction effect of H. pylori infection and positive family history of gastric cancer (FHx) on the age at which SGPCs are detected. Methods: A cross-sectional study was conducted among treatment-naïve adult patients with upper gastrointestinal symptoms. Factors associated with SGPCs were identified using multivariable logistic regression. Age cutoffs for predicting SGPCs were determined using predicted probabilities from an interaction logistic regression model accounting for various probability thresholds. Results: There were 761 patients with a median age of 42.0 years. The SGPC predictors included H. pylori infection (OR: 2.269, 95% CI: 1.626–3.165), positive FHx (OR = 1.754, 95% CI: 1.144–2.689), and age (OR = 1.072, 95% CI: 1.054–1.091). Neither positive FHx nor H. pylori infection alone markedly altered the SGPC probabilities under the age of 30 years, but H. pylori infection increased the SGPC probabilities after the age of 30 years. The earliest SGPC onset occurred in patients with both positive FHx and H. pylori infection. At the probability threshold of 0.20, the age cutoffs for detecting SGPCs were 41, 35, 33, and 19 years for patients without positive FHx and H. pylori infection, with positive FHx only, with H. pylori infection only, and with both positive FHx and H. pylori infection, respectively. Conclusions: A positive FHx has a synergistic effect with H. pylori on the development of SGPCs and should be considered when determining the appropriate age for H. pylori eradication.
Plain Language Summary
Gastric cancer (GC) is a major health concern worldwide, and it often develops from early changes in the stomach mucosa called significant gastric precancerous conditions (SGPCs). These changes include gastric atrophy, intestinal metaplasia, and dysplasia, which increase the risk of developing GC. Helicobacter pylori is a common stomach infection that can lead to these precancerous changes. Additionally, people with a positive family history of gastric cancer (FHx) may be at higher risk. This study examined how H. pylori infection and positive FHx interact to influence the age at which SGPCs are detected. The research included 761 adults who had stomach-related symptoms and had not received previous treatment for H. pylori. The results showed that both H. pylori infection and positive FHx independently increased the likelihood of developing SGPCs. However, people who had both risk factors together developed these lesions at an even younger age. Based on the findings, the average age at which SGPCs were detected varied depending on risk factors. Those without H. pylori infection or a positive FHx were diagnosed around age 41 years, while those with either risk factor were diagnosed between ages 33 and 35 years. However, individuals with both H. pylori and a positive FHx developed SGPCs as early as 19 years old. These findings suggest that screening and treatment for H. pylori infection should be considered at an earlier age, particularly for people with a positive FHx. Identifying and treating H. pylori infection before significant stomach damage occurs could help reduce the risk of GC.
