Helicobacter pylori and Gastric Mucosal Atrophy in Two Ethnic Populations in Nepal

The sequence of events in the gastric mucosa that precede the manifestation of gastric cancer has been shown to begin decades earlier. Typically, it begins with chronic non-atrophic gastritis that progresses to chronic atrophic gastritis, which may eventually lead to intestinal metaplasia, dysplasia, and finally adenocarcinoma (Kuipers, 1999). Helicobacter pylori infection is accepted as the primary cause of chronic gastritis (Suerbaum and Michetti, 2002). Moreover, severe atrophic gastritis, accompanying intestinal metaplasia caused by persistent H. pylori infection, is closely related to the development of gastric cancer (Correa, 1992). Histological evaluation of gastric biopsy specimens is a standard method to identify atrophy. On the other hand recent reports showed that serum pepsinogens (PGs) are valuable in the serological screening of gastric diseases, including gastric atrophy and gastric cancer (Bornschein et al., 2012; Daugule et al., 2011; Leja et al., 2012; Lomba-Viana et al., 2012; Miki, 2006), particularly in Japan (Leung et al., 2008).