Published online Jun 14, 2016. doi: 10.3748/wjg.v22.i22.5228
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
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.
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.