Different Pathophysiology of Gastritis in East and West? A Western Perspective

Background: Gastritis results from multifactorial gastric mucosal injury. Helicobacter pylori (Hp) is the main cause, and associated diseases have typical underlying patterns of gastritis. Gastric ulcer and gastric cancer (GC) develop from chronic atrophic corpus gastritis (CAG) which therefore represents the most important pattern. GC incidences in East Asia are substantially higher than elsewhere, and this should be also reflected by higher prevalences of CAG and characteristic differences in pathophysiology compared to the West. Summary: The few available comparative studies of gastritis in Eastern and Western patients are summarized. The main pathogenic factors of gastritis are discussed together with their limitations to explain local differences in disease outcome. Emphasis was put to also include less wellestablished pathogenic host and environmental factors of possible impact. Conclusions: CAG is more prevalent in East Asian areas with high GC incidences than the West. Geographic heterogeneity of associated diseases is due to differences in Hp prevalence and virulence as well as modulating host and environmental factors. The following may contribute to the higher burden of CAG in the East: ABD type of CagA with vacA s1 and babA2 alleles of Hp , host Lewis(b) expression in sej/sej nonsecretors, H. heilmannii , low parietal cell mass, high sodium and nitrate intake, preferences in Received: February 10, 2016 Accepted: April 13, 2016 Published online: May 14, 2016 PD Dr. med. Hans-Peter Wirth GastroZentrumKreuzlingen Bahnhofstrasse 33 b CH–8280 Kreuzlingen (Switzerland) E-Mail hp.wirth @ hin.ch © 2016 S. Karger AG, Basel 2296–9403/16/0013–0113$39.50/0 www.karger.com/iid For an Asian perspective on gastritis, see Suzuki and Mori [Inflamm Intest Dis DOI: 10.1159/000446301]. D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /2 0/ 20 17 1 2: 35 :2 5 P M