ArticleGastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association2026
Gastric cancer secondary prevention in dyspeptic patients.
Article in Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn dyspeptic patients without alarm symptoms, the “Test-and-Treat” (TT) strategy aims to alleviate symptoms and prevent adverse outcomes. An alternative workup expands the TT-strategy by incorporating esophagogastroduodenoscopy (Test-Treat-and-Scope [TT-S]).
objectiveThis prospective cross-sectional study provides evidence-based insights into the clinical workup of dyspepsia by applying the TT and TT-S options.
designIn a consecutive cohort of 2171 dyspeptic patients without alarm symptoms, H. pylori (Hp) status was assessed by 13C-Urea Breath Test, Rapid urease test, and histology. Histology profiling was based on six biopsies and included atrophy staging (OLGA-system).
resultsAmong Hp-positive and Hp-negative patients, the prevalence of mucosal atrophy was 22.2% and 1.3% (p < 0.001), respectively. In the study population, 92.5% did not exhibit atrophic disease (OLGA stage 0). Among Hp-positive patients, mucosal atrophy occurred in 142/640 subjects. Nine in 640 (1.4%) Hp-positive patients presented advanced atrophy (OLGA-stages III-IV), considered at high-risk for gastric cancer. The overall prevalence of high-risk OLGA stages (III-IV) was below 1.5% (all Hp-positive). The mean age of patients with OLGA stages III-IV was 15 years older than that of non-atrophic patients (p < 0.0001). In all atrophic OLGA-stages, Hp-positive subjects dominated over the Hp-negative (test-for-trend; p < 0.0001). None of the Hp-negative subjects showed extensive atrophy (OLGA-stages III-IV).
conclusionIn the considered epidemiological context, advanced gastric atrophy (OLGA-stages III-IV), consistently recognized as at risk of cancer development, only occurred in Hp-positive patients over 55 years. These results support the priority of the TT-S-strategy in Hp-positive patients older than 55, even in the absence of alarm symptoms.
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