Is helicobacter pylori-induced enlarged fold gastritis a high-risk factor for gastric carcinoma?

It is now a generally accepted fact that Helicobacter pylori is an important cause of gastric carcinoma. The International Agency for Research on Cancer classified H. pylori as a group 1 carcinogen. We previously reported that H. pylori‐ positive subjects had enlarged folds (fold width = 5 mm); that is, ‘enlarged fold gastritis’. Helicobacter pylori ‐induced enlarged fold gastritis is accompanied by a massive infiltration of inflammatory cells, profound production of interleukin‐1β (IL‐1β) and hepatocyte growth factor (HGF), which decrease gastric acid secretion and increase the proliferation rate of the gastric epithelial cells. In addition, there is increased mutagenicity of gastric juice, and mucosal 8‐hydroxydeoxyguanosine (8‐OhdG) levels. Fold width improves and these factors recover to within a normal range with the eradication of H. pylori. The odds ratio for gastric carcinoma and the prevalence of diffuse‐type early gastric carcinoma in the body region increased with an increase in fold width. Therefore, enlarged fold gastritis may be a major risk factor for gastric carcinoma among H. pylori ‐infected people. We propose that H. pylori ‐infected persons with enlarged fold gastritis are a potential population for the prevention of gastric carcinoma via the use of antibiotics.