In the frame of an in-depth study on the epidemiology of gastric cancer (GC) in the Trieste Province (in North-East Italy, at the border with Slovenia), we reconsidered the relationship between Helicobacter pylori infection and GC outbreak. Our sample confirmed that, although much progress in the knowledge of GC pathogenesis has been achieved in the last few years, an effective early diagnosis of the disease is still remote. We took into consideration 258 cases, with fully available clinical data, out of 300 cases of GC diagnosed for the first time by biopsy (65.5%) or at autopsy (34.5%) in the years 1986/88, when H.pylori infection was not treated. If we consider that in the Province about 70% of all deaths undergo autopsy and that all biopsies are centralized in the same Institute, the sample has to be considered highly representative of GC epidemiology in the geographic area. In all cases the gastric biopsies performed before the diagnosis of GC were obtained from the Pathology Department files; if they were negative for malignancy they were reconsidered with special regard to the presence of H.pylori and other lesions such as inflammation, atrophy, ulcer, intestinal metaplasia, and dysplasia. Surprisingly, although the Gastroenterology Department is very active in our Province, especially as regards prevention, out of 258 patients only 27 had undergone a gastric biopsy before the positive one for GC; H. pylori was present in 12 cases, inflammation in 16 cases, atrophy in 7 cases, ulcer in 13 cases, intestinal metaplasia in 9 cases, and dysplasia in 10 cases. On the basis of our data, which relate to an European area with an effective Health System, we may state that in the Trieste Province only 10.5% of all the patients who developed GC in the years 1986/88, had previously undergone endoscopy with biopsy in the presumably long period when they were candidate to, but not affected by, GC. In our opinion, this is explained by the absence of early symptoms in most patients. In conclusion, in our Province, but also in Europe, where an effective prevention of GC is still more a speculative matter than a real strategy, an effort is needed to identify at least suitable criteria for an earlier diagnosis of this very aggressive disease.
|Publication status||Published - 1997|
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