Helicobacter pylori infection and gastritis: The Systematic Investigation of gastrointestinaL diseases in China (SILC)


  • Duowu Zou, Jia He and Xiuqiang Ma contributed equally to this study.

  • This study was presented as a poster at Asian Pacific Digestive Week 2009, 27–30 September 2009, Taipei, Taiwan (Zou D et al. J Gastroenterol Hepatol 2009;24(s1):A9), and as an oral presentation at Digestive Disease Week 2010, 1–6 May 2010, New Orleans, USA (Zou D et al. Gastroenterology 2010;138(5 Suppl 1):S-23).

Professor Zhaoshen Li, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 800 Xiangyin Road, Shanghai 200433, China. Email: zhaoshenli@hotmail.com


Background and Aim: Helicobacter pylori infection remains common in East Asia, though its prevalence is decreasing in Western countries. H. pylori-related atrophic gastritis (AG) may reduce the likelihood of gastroesophageal reflux disease (GERD). We investigated the prevalence of H. pylori infection and AG and their association with endoscopic findings and symptom-defined GERD in Shanghai.

Methods:  A representative random sample of 3600 Shanghai residents aged 18–80 years was invited to complete a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire, to provide blood samples for H. pylori serology and pepsinogen (PG) I/II assay (to detect AG, defined as PGI < 70 µg/L and/or PGI/PGII < 7), and to undergo endoscopy. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multivariate logistic regression.

Results:  A total of 1022 Shanghai residents underwent endoscopy and were valid for inclusion in the study. Of these, 71.7% tested positive for H. pylori, 63.8% had AG and 30.5% had moderate/severe AG (PGI < 50 µg/L and/or PGI/PGII < 5). Helicobacter pylori infection was equally common in all age groups. Severity of AG increased with age in women. Reflux esophagitis was inversely associated with AG (OR, 0.23 [CI, 0.09–0.55] for moderate/severe AG compared with no H. pylori or gastritis). However, symptom-defined GERD showed no clear association with AG.

Conclusions: Helicobacter pylori infection and AG are very common in Shanghai, and the infection is acquired early in life. Atrophic gastritis is inversely associated with reflux esophagitis but is not significantly associated with symptom-defined GERD.