The Risk of Gastric Cancer in Patients with Duodenal and Gastric Ulcer: Research Progresses and Clinical Implications
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The Risk of Gastric Cancer in Patients with Duodenal and Gastric Ulcer: Research Progresses and Clinical Implications Zunwu Zhang
Published online: 28 May 2008 # Humana Press Inc. 2008
Abstract Introduction Although controversial, clinicians generally consider patients who present with gastric ulcer to have an increased risk of gastric cancer, while the risk for patients with duodenal ulcer is reduced in comparison with that of the general population. Infection with Helicobacter pylori and the use of non-steroidal anti-inflammatory drugs (NSAIDs) are the major causes for peptic ulcers, but their roles in relation to the risk of gastric cancer in patients with peptic ulcer may be different. Methods and Results This article reviewed existing literature to assess our understanding of the risk of gastric cancer in patients with gastric and duodenal ulcers more than 25 years after the discovery of H. pylori and also examined whether gastric ulcers induced by NSAID carry a lower risk of gastric cancer as compared to those induced by H. pylori infection or other causes. Keywords gastric cancer . gastric ulcer . duodenal ulcer . complications . NSAIDs . H. pylori
Introduction The discovery of Helicobacter pylori in the early 1980s has significantly changed the understanding and management of upper gastrointestinal disease [1–2]. The bacteria has been classified as a Class I pathogen for gastric cancer by
Z. Zhang (*) Norfolk and Norwich University Hospital, University of East Anglia, Colney Lane, Norwich NR4 7UY, UK e-mail: [email protected]
the World Health Organization and is known to be the causal factor of gastric and duodenal ulcer [3, 4]. Although controversial, clinicians generally consider patients who present with gastric ulcer to have an increased risk of gastric cancer, while the risk for patients with duodenal ulcer is reduced or at least not increased in comparison with that of the general population [5–12]. However, the knowledge that H. pylori induces both peptic ulcer and gastric cancer has strongly challenged this concept. The finding that use of non-steroidal anti-inflammatory drugs (NSAIDs), the most common cause of peptic ulcer other than the infection of H. pylori, may be protective against the development of gastric cancer has added further confusion [13, 14]. Recent studies on bacterial factors of H. pylori contribute little to our understanding on the development of clinical outcomes of bacterial infection. This article will examine the current data on the risk of gastric cancer in patients with gastric and duodenal ulcers and assess recent progresses on research and clinical implications.
The Risk of Gastric Cancer in Patients with Peptic Ulcer Gastric Ulcer Available data seem to support the theory that gastric ulcer is associated with an increased risk of gastric cancer. The strongest evidence for this theory came from a Swedish cohort study by Hansson et al. [7] in which the risk of stomach cancer was examined in a large cohort of hospitalized patients with peptic ulcers. Among 29,287
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