A Case-control Study On The Risk And Protective Factors Of Endoscopic Varioliform Changes In Gastric Mucosa

Aim: To investigate the impact factors for formation and progression of endoscopic varioliform changes in gastric mucosa.Methods: A 1:1 matched case-control study was performed to analyse retrospectively data of 1638 patients who had undergone a gastroscopy at Renji Hospital, School of Medicine, Shanghai Jiao Tong University or Gulou Hospital, School of Medicine, Nanjing University during January 2009 to June 2013, including the cases of gastric varioliform lesions and the controls of chronic gastritis without such lesions. Endoscopic and pathological findings were recorded, and telephone interviews were made for the information of Helicobacter pylori(H. pylori) infection history, past medical history, drug history, familly history, life style and eating habits. Univariate analysis was firstly used to estimate the association between each impact factor and occurrence of gastric varioliform lesions, and then multivariate conditional Logistic regression analysis was applied to evaluate further independent risk and protective factors for formation of endoscopic varioliform changes in gastric mucosa.Results: Compared with the controls, the pathological features, such as glandular atrophy, intestinal metaplasia(IM) and intraepithelial neoplasia in the cases had a significantly higher incidence rate. Furthermore, the severity levels of inflammation, glandular atrophy and atrophic gastritis with IM were increased significantly, and the differences between two groups were statistically significant. Overall analysis for the pathogenic factors showed that H. pylori infection(OR=3.051), allergic respiratory diseases(OR=3.636), higher working pressure(OR=2.019), irregular meals(OR=2.300), high intake of spicy foods(OR=1.754) or high intake of fresh fruits(OR=0.231) were associated significantly with occurrence of gastric varioliform lesions, and the difference compared with the control group was statistically significant(P<0.01). Moreover, subgroup analyses showed that pickled food comsumption in patients over 50 years old(OR=7.224) and excessive smoking in men(OR=2.013) were correlated with the gastric varioliform lesions, and vegetable side meals(OR=0.491) were associated with occurrence of varioliform lesions in the antrum, and all these differences between two groups were statistically significant(P<0.01).Conclusion: Endoscopic varioliform changes in gastric mucosa had a potential cancerous risk. Analyses suggested that H. pylori infection, allergic respiratory diseases, higher working pressure, irregular meals, high intake of spicy food, pickled food comsumption in elder people, and excessive smoking in men were independent risk factors and high intake of fresh fruits was an independent protective factor for occurrence of varioliform lesions. In addition, higher intake of vegetables was potential protective factor for the varioliform lesions in the antrum.