Global strategy for prevention of gastric cancer

Global prevention of gastric cancer needs to increase its level of effectiveness.The prevention strategy should include all stages of primary and secondary prevention.The necessary steps to prevent gastric cancer are the following:Maintaining a healthy lifestyle and diet,avoiding smoking and alcohol;serological screening of Helicobacter pylori infections and eradication;serological screening of atrophic gastritis in the population over 45 years of age and identification of severe atrophic gastritis with a high risk of developing gastric cancer;verification of atrophic gastritis and precancerous changes in the gastric mucosa using modern endoscopic(confocal laser endomicroscopy,narrow-spectrum imaging,and magnifying endoscopy)and morphological methods among patients with severe atrophic gastritis who were identified using serological screening;treatment of patients with atrophic gastritis during diagnosis verification;annual endoscopic and morphological monitoring of patients with atrophic gastritis during permanent treatment;annual serological monitoring of patients with atrophic gastritis who refused endoscopic and morphological monitoring;and radical treatment of patients with verified early gastric cancer.Ways to implement the algorithm for the global strategy for the prevention of gastric cancer(protocol of practical recommendations)are:State,government,and municipal programs;departmental programs of health departments;family doctors for patients who have a contract at the initiative of the doctor;family doctors for patients with a contract at the patient’s initiative;and within private healthcare system where both doctors and patients can initiate the implementation of algorithm.

Distribution of H.pylori antigens in gastric mucosa and its significance

Objective: To investigate the distribution of H.pylori antigens in the gastric mucosa in patients with H.pylori infection, and the relationship between the distribution and gastric cancer. Methods: Of 112 patients confirmed by patho-logical study to have chronic superficial gastritis, precancerous changes (chronic atrophic gastritis, intestinal metaplasia or atypical hyperplasia) and gastric cancer, 28 were H.pylori negative and 84 were H.pylori positive. H.pylori antigens in the gastric mucosa were detected by immunohistochemistry. Results: The H.pylori positive group, comprised 12 of 22 (50.0%) in the chronic superficial gastritis group, 22 of 25 (88.0%) in the precancerous changes group and 13 of 35 (37.1%) in the gastric cancer group. The positive rates of H.pylori antigens in the cytoplasm progressively increased, respectively at 0.0% (0/12), 63.6% (14/22) and 84.6% (11/13) for the same groups (c2=19.76, P=0.000); H.pylori antigens were located in the mucus layer and above the neck of the mucosal gland in 9 of 12 (75.0%) cases with chronic superficial gastritis, at the neck of the mucosal gland and the isthmus in 12 of 22 (54.5%) cases with precancerous changes, below the isthmus in 9 of 13 (69.2%) cases with gastric cancer (c2=25.30, P=0.000). In the H.pylori negative group, no H.pylori antigen was observed. Conclusion: With the progression of chronic superficial gastritisprecancerous changesgastric cancer, H.pylori antigens progressively migrated from the outer part to the inner part of the cell, and from the superficial to the deep gastric mucosa.