H. pylori infection is a key risk factor for proximal gastric cancer

Background: Despite evidence for the association of distal gastric cancer (GC) with the H. pylori infection, relevance of the infection for proximal GC is uncertain. Aims: We analysed the prevalence of H.pylori in proximal and distal GC and its association with premalignant mucosal alterations in different gastric locations. Methods: We performed a retrospective analysis on 152 patients with GC, stratified according to the location of the main tumor mass into proximal (n = 73) and distal (n = 79) GC. H.pylori prevalence and CagA-status were determined by serology. Intestinal metaplasia (IM), glandular atrophy and mucosal inflammation were diagnosed from histological specimens and graded according to the updated Sydney-classification. Results: H.pylori prevalence (78.1 vs. 82.3%) and CagA-status (77.2 vs. 84.6%) were similar in proximal and distal GC as well as in intestinal and diffuse GC. IM (79.8 vs. 60.3%; P = 0.012) and atrophy (50.0 vs. 19.1%; P < 0.001) were more frequent in the mucosa surrounding intestinal tumors. There was a higher degree of surrounding IM in case of distally located compared to proximal tumors (P = 0.001). Overall, IM was more severe in the antrum than the corpus. In contrast, there was more severe active inflammation in the corpus than the antrum (P = 0.017). Conclusion: The prevalence of H.pylori is similar in proximal and distal GC if precise allocation of the primary tumor has been performed, especially at the esophagogastric junction. Distal tumors of the intestinal type are more often associated with local IM than proximal and diffuse type carcinomas. This suggests a distinct pathophysiological relevance of these mucosal alterations.