Helicobacter pylori infection and gastric cancer. A nested case-control study in a rural area of Japan

Dig Dis Sci. 1997 Jul;42(7):1383-7. doi: 10.1023/a:1018833819860.


We conducted a seroepidemiological nested case-control study to determine the association of gastric cancer with Helicobacter pylori infection and atrophic gastritis. A cohort of 2858 participants in an annual multiphasic health check-up were followed for eight years. Data for 45 gastric cancer cases and 225 sex-, age-, and address-matched control subjects were analyzed. Helicobacter pylori infection was determined by IgG antibodies, and atrophic gastritis was diagnosed by both serum pepsinogen I level (< or = 70 ng/ml) and the pepsinogen I/II ratio (< or = 3.0). Univariate analysis showed that Helicobacter pylori and atrophic gastritis were significantly associated with gastric cancer. In a multivariate analysis, atrophic gastritis was associated with significantly increased risk of cancer (odds ratio, 3.38; 95% confidence interval, 1.54-7.42); however, Helicobacter pylori was not associated with cancer (odds ratio, 1.84; 95% confidence interval, 0.59-5.72). These results suggest that Helicobacter pylori infection alone is not directly associated with gastric carcinogenesis but has an indirect relation to gastric cancer through the development of atrophic gastritis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Gastritis, Atrophic / epidemiology
  • Gastritis, Atrophic / microbiology*
  • Helicobacter Infections / epidemiology*
  • Helicobacter pylori*
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pepsinogens / blood
  • Registries
  • Risk Factors
  • Rural Population
  • Seroepidemiologic Studies
  • Sex Distribution
  • Stomach Neoplasms / epidemiology
  • Stomach Neoplasms / microbiology*


  • Pepsinogens