Case Control Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2016; 22(22): 5228-5236
Published online Jun 14, 2016. doi: 10.3748/wjg.v22.i22.5228
Factors affecting occurrence of gastric varioliform lesions: A case-control study
Tian-Hui Zou, Ru-Hua Zheng, Qin-Yan Gao, Xuan Kong, Xiao-Yu Chen, Zhi-Zheng Ge, Ying-Xuan Chen, Xiao-Ping Zou, Jing-Yuan Fang
Tian-Hui Zou, Qin-Yan Gao, Xuan Kong, Xiao-Yu Chen, Zhi-Zheng Ge, Ying-Xuan Chen, Jing-Yuan Fang, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai 200001, China
Ru-Hua Zheng, Xiao-Ping Zou, Division of Gastroenterology and Hepatology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Author contributions: Zou TH performed telephone interviews of most participants and wrote the manuscript; Zheng RH performed part of the telephone interviews; Gao QY and Kong X provided analytical tools; Chen XY offered the pathological data; Ge ZZ offered the endoscopic data; Chen YX served as scientific advisors; Fang JY designed the study and edited the manuscript; all authors approved the final version of the manuscript.
Supported by National Natural Science Foundation of China, No. 31371420 (to FJY); the National Key Technology R and D Program, No. 2014BAI09B05 (to CYX); and the National Natural Science Foundation of China, No. 81402347 (to KX).
Institutional review board statement: The study was approved by Shanghai Jiao Tong University School of Medicine.
Informed consent statement: All patients gave informed consent.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: Statistical code and dataset available from the corresponding author at jingyuanfang@sjtu.edu.cn.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jing-Yuan Fang, PhD, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, No. 145 Shandong Zhonglu, Shanghai 200001, China. jingyuanfang@sjtu.edu.cn
Telephone: +86-21-63200874 Fax: +86-21-63266027
Received: January 18, 2016
Peer-review started: January 19, 2016
First decision: March 7, 2016
Revised: March 16, 2016
Accepted: March 30, 2016
Article in press: March 30, 2016
Published online: June 14, 2016
Processing time: 135 Days and 21.1 Hours
Abstract

AIM: To investigate the factors influencing the occurrence of gastric varioliform lesions (GVLs) and their possible link with gastric cancer.

METHODS: A 1:1 matched case-control study was performed to retrospectively analyze data from 1638 chronic gastritis patients who had undergone gastroscopy at one of two Chinese hospitals between 2009 and 2014. Patients with GVLs (cases) were compared to those without such lesions (controls). Endoscopic and pathological findings were recorded, along with interview information on Helicobacter pylori (H. pylori) infection, medical, drug and family histories, lifestyle and eating habits. The association between each factor and the occurrence of GVLs was estimated, and then multivariate conditional logistic regression was used to evaluate the independent factors.

RESULTS: The frequency and severity of glandular atrophy, intestinal metaplasia (IM) and low-grade intraepithelial neoplasia were significantly increased in the GVL group (P < 0.01). Overall analysis showed that H. pylori infection [3.051 (2.157, 4.317), P <0.001], allergic respiratory diseases [3.636 (2.183, 6.055), P < 0.001], work-related stress [2.019 (1.568, 2.600), P < 0.001], irregular meals [2.300 (1.462, 3.619), P < 0.001], high intake of spicy food [1.754 (1.227, 2.507), P = 0.002] and high intake of fresh fruit [0.231 (0.101, 0.529), P = 0.001] were significantly correlated with the occurrence of GVLs (positively, except for the latter). Stratified analyses indicated that pickled food consumption in patients over 50 years old [7.224 (2.360, 22.115), P = 0.001] and excessive smoking in men [2.013 (1.282, 3.163), P = 0.002] were also positively correlated, and that, for antral GVLs, vegetable consumption [0.491 (0.311, 0.776), P = 0.002] was negatively correlated.

CONCLUSION: Seven risk factors and two protective factors are determined for GVLs, which were found to be associated with premalignant abnormalities.

Keywords: Gastric cancer; Gastric varioliform lesions; Precancerous lesion; Risk factor; Varioliform gastritis

Core tip: To our knowledge, this is the first case-control study investigating the factors influencing the formation of gastric varioliform lesions, which were supposed to be associated with gastric neoplasia in previous reports. Our results indicate a potentially increased cancer risk for the affected patients, and that Helicobacter pylori infection, allergic respiratory diseases, high work-related stress, irregular meals, high intake of spicy food, pickled food consumption in elder people, excessive smoking in men, consumption of vegetables and high intake of fresh fruit are found to be correlated with the occurrence of gastric varioliform lesions.