Aim. The aim of this literature review is to generalize existing approaches to the pathogenetic treatment of gastritis as a basis for the prevention of gastric cancer, as well as to submit a resolution of a scientific symposium that brought together gastroenterologists from a number of CIS countries.Background. H. pylori infection is widespread in CIS countries. The proportion of infected adults in the population ranges from 60 % to over 90 %. This causes a high incidence of chronic gastritis and other diseases associated with H. pylori. In 2012, gastric cancer was recognized as the 3rd leading malignant disease in the Kyrgyz Republic and the Republic of Uzbekistan, 5th — in Belarus and Kazakhstan, 6th — in Armenia and the Russian Federation. According to the standardized cancer mortality rate, gastric cancer takes the 1st place in Kyrgyzstan and Uzbekistan, 2nd — in Belarus, 3rd — in Kazakhstan, and 4th — in Armenia and Russia. In every case of H. pylori detection, it is important to make a decision about the expediency of eradication therapy. This is particularly significant, since H. pylori eradication has been recognized as an effective method of gastric cancer prevention. In addition, H. pylori eradication therapy in patients suffering from chronic gastritis with dyspepsia symptoms serves as the firstchoice therapy that allows patients with dyspepsia resulting from H. pylori infection to be excluded. The choice of the H. pylori eradication therapy scheme is determined by the protocols (standards) of patient management accepted in the respective CIS country. A high efficacy of H. pylori infection eradication is shown to be provided by bismuthcontaining schemes.Conclusion. Opportunistic screening of H. pylori is carried out by general practitioners, district physicians, gastroenterologists and other specialists. The most effective method of gastric cancer prevention is the eradication therapy of H. pylori infection in chronic gastritis. The maximal positive potential of such a therapy is realized when it is performed before the atrophic changes of the gastric mucosa have appeared.
The condition of gastric mucosa was assessed in relatives of patients with gastric cancer (RPGC). The study included 108 RPGC (main group) and 102 patients with no family history of gastric cancer who were screened for dyspepsia. All study participants were subjected to clinical examination, questioning and esophagogastroduodenoscopy (EGDS) with a biopsy, in which the gastric mucosa state was assessed according to the modified Sydney system, the OLGA and OLGIM systems, and the definition of Helicobacter pylori (H. pylori) infection. It was established that the prevalence of H. pylori infection in the main group was 58.3 % (95 % CI 48.8–67.7), in the control group – 56.0 % (95 % CI 46.1–65.6). At RPGC, atrophy of any localization (46.3 % (95 % CI 39.4–53.2) versus 26.5 % (95 % CI 20.4–32.6), respectively, was found more often than in the control group, respectively, p = 0.002), antral atrophic gastritis (41.6 % (95 % CI 34.8–48.4) versus 26.5 % (95 % CI 20.4–32.6), respectively, p = 0.020), and isolated atrophy in the stomach body (4.6 % (95 % CI 1.7–7.4) versus 0 % ( p = 0.03). In RPGC, atrophy developed at a younger age (48.0 years (95 % CI 44.0–52.0) versus 53.0 years in the control group (95 % CI 48.3–57.8) p = 0.000). There were no significant differences between the groups in the incidence of metaplasia and dysplasia. The following risk factors for development of atrophy were identified in the factor analysis: age over 6f0 years (odd ratio (OR) 53.0; 95 % CI 12.2–390.1; p < 0.001), age over 40 years (OR 4.0; 95 % CI 2.0–8.2; p < 0.001), heredity burdened by gastric cancer (OR 2.7; 95 % CI 1.4–5.7; p = 0.006) and the use of strong alcoholic beverages (OR 5.5; 95 % CI 1.6–21.6; p = 0.009). The frequency of the atrophy development of the gastric mucosa is increased in RPGC, and atrophic gastritis develops at a younger age in comparison with individuals without a burdened hereditary history. In addition to the hereditary factor, the risk of atrophy is associated with age and alcohol use.
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