Helicobacter pylori infection, garlic intake and precancerous lesions in a Chinese population at low risk of gastric cancer

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Abstract
Cangshan County of Shandong Province has one of the lowest rates of gastric cancer (GC) in China. While intestinal metaplasia (IM) and dysplasia (DYS) are less conimon in Cangshan than in areas of Shandong at high risk of GC, these precursor lesions nevertheless affect about 20% of adults age ≥55. In order to evaluate determinants of IM and DYS in Cangshan County, a low risk area of GC a survey was conducted among 214 adults who participated in a gastroscopic saeening survey in Cangshan County in 1994. A dietary interview and measurement of serum Helicobacter pylori antibodies were performed. The prevalence of H. pylori was lowest (19%) among those with normal gastric mucosa, rising steadily to 35% for superficial gastritis (SG), 56% for chronic atrophic gastritis (CAG), 80% for TM, and 100% for DYS. The prevalence odds of precancerous lesions were compared with the odds of normal histology or SG. The odds ratio (OR) or CAG associated with H. pylori positivity was 4.2 (95% confidence interval [CI] : 1.7–10.0), while the OR of IM/DYS associated with H. pylori positivity was 31.5 (95% CI: 5.2–187). After adjusting for H. pylori infection, drinking alcohol was a risk factor for CAG (OR = 3.2, 95% CT: 1.1–9.2) and IM/DYS (OR = 7.8, 95% CI: 1.3–47.7). On the other hand, consumption of garlic showed non-significant protective effects and an inverse association with H. pylori infection. The findings of this study suggest that infection with H. pylori is a risk factor and garlic may be protective, in the development and progression of advanced precancerous gastric lesions in an area of China at relatively low risk of GC.