Age-related twin-peak prevalence profiles of H. pylori infection, gastritis, GIN and gastric cancer: Analyses of 70,534 patients with gastroscopic biopsies

OBJECTIVES: H. pylori (Hp) infection has been indicated in the pathogenesis of gastric diseases including gastric cancer (GC). This study aimed at exploring the relationships between Hp infection and gastric diseases including GC in a large dataset of routine patients undergoing gastroscopy. METHODS: From November 2007 to December 2017, 70,534 first-time visiting patients aged 18–94 years with gastroscopic biopsies were histologically diagnosed and analyzed. Patients’ data were entered twice in an Excel spreadsheet database and analyzed using the SPSS (version 22.0) software package and statistical significance was defined as P<0.05 for all analyses. RESULTS: The first interesting observation was age-related twin-peak prevalence profiles (TPPs) for Hp infection, gastritis, and advanced diseases with different time spans (TS) between the first and second occurring peaks. Hp infection and gastritis had TPPs occurring at earlier ages than TPPs of gastric introepithelial neoplasia (GIN) and GC. More patients were clustered at the second occurring TPPs. The time spans (TS) from the first occurring peak of Hp infection to the first occurring peaks of other gastric diseases varied dramatically with 0–5 years for gastritis; 5–15 years for GINs, and 5–20 years for GC, respectively. The number of males with Hp infection and gastric diseases, excluding non-atrophic gastritis (NAG), was more than that of females (P<0.001). CONCLUSIONS: We have first observed age-related twin-peak prevalence profiles for Hp infection, gastritis, GIN, and GC, respectively, among a large population of patients undergoing gastroscopy. The second prevalence peak of GC is at ages of 70–74 years indicating that many GC patients would be missed during screening because the cut-off age for screening is 69 years old in China.