BACKGROUND Although H. pylori is the most important risk factor for gastric cancer, the role of anti-H. pylori antibody titers in gastric carcinogenesis has not been investigated outside Asia. We aimed to analyze the relationship between H. pylori antibody titers and the risk of gastric precancerous lesions in a Caucasian population.

METHODS We analyzed the GISTAR pilot study data on participants from Latvia with available anti-H. pylori IgG antibody serology and histopathological information. Participants were classified into four groups according to antibody titer: low-negative (LN), high-negative (HN), low-positive (LP), and high-positive (HP). Odds ratios (ORs) for atrophic gastritis among the 4 groups were compared using logistic regression.

RESULTS Among a total of 1725 individuals, 970 with available histopathological information were included. A total of 738 individuals (76.1%) had histologically diagnosed atrophic gastritis. Risk of histological atrophic gastritis for each group compared to LN was as follows: HN (OR, 1.52; 95% confidence interval (CI) 0.85-2.72), LP (OR 2.04; 95% CI 1.25-3.32), and HP (OR, 2.47; 95% CI 1.50-4.07). Antibody titer as a continuous variable showed a positive relationship with histological atrophic gastritis (OR 1.09 per 10 EIU; 95% CI 1.04-1.14). The positive relationship was clearer among those aged ≥ 50 years.

CONCLUSIONS Anti-H. pylori antibody titer was positively related to the risk of atrophic gastritis in a middle-aged Caucasian population, suggesting its potential complementary role in gastric cancer risk stratification in a European setting where upper endoscopic examination is less routinely available.