Inflammation, atrophy, and gastric cancer
James G. Fox, Timothy C. Wang
James G. Fox, Timothy C. Wang
Published January 2, 2007
Citation Information: J Clin Invest. 2007;117(1):60-69. https://doi.org/10.1172/JCI30111.
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Review Series

Inflammation, atrophy, and gastric cancer

Abstract

The association between chronic inflammation and cancer is now well established. This association has recently received renewed interest with the recognition that microbial pathogens can be responsible for the chronic inflammation observed in many cancers, particularly those originating in the gastrointestinal system. A prime example is Helicobacter pylori, which infects 50% of the world’s population and is now known to be responsible for inducing chronic gastric inflammation that progresses to atrophy, metaplasia, dysplasia, and gastric cancer. This Review provides an overview of recent progress in elucidating the bacterial properties responsible for colonization of the stomach, persistence in the stomach, and triggering of inflammation, as well as the host factors that have a role in determining whether gastritis progresses to gastric cancer. We also discuss how the increased understanding of the relationship between inflammation and gastric cancer still leaves many questions unanswered regarding recommendations for prevention and treatment.

Authors

James G. Fox, Timothy C. Wang

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Figure 2

Proposed Correa pathway of pathological events in gastric adenocarcinoma.

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Proposed Correa pathway of pathological events in gastric adenocarcinoma...
In well-differentiated, intestinal-type gastric cancer, histopathological studies indicated that chronic H. pylori infection progresses over decades through stages of chronic gastritis, atrophy, intestinal metaplasia, dysplasia, and cancer (123). The development of cancer has been attributed to alterations in DNA caused by chronic inflammation, recruitment and engraftment of bone marrow–derived cells, an imbalance between epithelial cell proliferation and apoptosis, and, in a milieu of atrophy and achlorhydria, gastric colonization by enteric bacteria with nitrate reductase activity, which facilitates the formation of carcinogenic nitrosamines. Corpus-predominant atrophy, or the loss of specialized glandular cell types such as parietal and chief cells, appears to be the critical initiating step in the progression toward cancer. Adapted with permission from the New England Journal of Medicine (14).