Gastric cancer at the Kenyatta National Hospital Blood Group Distribution, helicobacter pylori status and dietary patterns in patients with gastric carcinoma: A comparative study

Abstract

Gastric carcinoma is the 9th commonest malignancy in Kenya and a major cause of morbidity and mortality. Various risk factors have been associated with it. Blood group A is associated with increased incidence of diffuse type Ca stomach. It is possible that this observation is related to differences in the mucous secretion (Sulfomucins, a marker of pre-neoplastic transformation) of the various ABO blood groups and Lewis and Secretor phenotypes, which modulate the interaction between H.pyrori and the gastric surface epithelium. H.pylori is thought to play an important role in the pathogenic pathway of Ca stomach by depletion of gastric acid ascorbic acid. The risk of development of Ca stomach is six times higher in presence of H.pylori. Environmental exposure, probably beginning early in life is related to development of gastric carcinoma later in life, with dietary carcinogens considered the most likely factor(s) Food items may be, carcinogenic, vehicles for carcinogens, converted to carcinogens in food preparation process, may contain promoters of carcinogens or may lack inhibitors of carcinogens to. starchy foods are the most frequently implicated. The main effects are thought to be excessive salt, carbohydrates and Nitrates/Nitrites to Very few local studies have examined the contribution of these risk factors.

To determine Blood group, H.pylori status and dietary patterns in patients with carcinoma of the Stomach at the Kenyatta National Hospital and compare these with controls.

Case control study:

Kenyatta National Hospital, Nairobi, Kenya

Subjects were patients 13 years and above with a diagnosis of Gastric cancer made by histology at endoscopy or laparatomy. The controls were age (to the nearest 5 years), sex and region matched without gastrointestinal symptoms admitted to the medical and surgical wards.

Blood group, H.pylori status and pre-morbid dietary habits.

50 cases and 50 controls were recruited and analyzed. The mean age was 59.65years with a range of20 to 91years and a Male: Female ratio of 1:1 Majority of the Gastric cancer cases, (44%) were of blood group 0, with similar findings in the controls, (38% blood group 0). 90% tested positive for the H.pylori antigen, in both the cases and the controls. Dietary variables of primary interest were frequency of consumption of cereals/grains, starchy roots, meat, vegetables and fruits. There was no ·obvious risk of consumption of cereals/grains, starchy roots and meat, neither was there obvious benefit of consumption of vegetables and fruits. There was no obvious risk of grilling, frying or roasting foods, neither was there obvious benefit of consumption of raw or cooked vegetables. Majority consumed different maize meal products prepared differently and there was no statistical difference in the food habits of the gastric cancer cases and the controls. Among the non-dietary variables considered, no statistically significant difference was observed between, alcohol use, level of education, previous radiation therapy or family history of gastric cancer and smoking habits of the cases and controls.

Blood group distribution was similar in both groups. There was a higher prevalence gastric cancer in Blood group 0 patients; however, this did not achieve statistical significance. There was a high prevalence of H.pylori in both the cases and the controls; hence the risk was not discriminatory for gastric cancer. The pattern of consumption of conventional "Gastric cancer risk foods" like starches and "protective foods" like vegetables and fruits was not different in the gastric cancer cases and the controls.